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Infection > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

1
Q

International travel health advice

A

Risk assessment
Requirements change
Up-to-date information
Individual advice regarding general measures, immunisation and drug prophylaxis

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2
Q

Risk assessment of the traveller

A 
Health of the traveller 
Areas to be visited 
Duration of visit 
Accommodation 
Activities 
Remote areas
Previous immunisation and prophylaxis
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3
Q

Sources of information on travel advice

A

British national formulary
Immunisation against infectious diseases
Health information for overseas travel
Institutions e.g. schools of tropical medicine
Internet

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4
Q

Common immunisations for travellers

A 
Tetanus 
Polio 
Typhoid 
Hepatitis A 
Yellow fever
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5
Q

Immunisation for travellers in special circumstances

A 
Meningococcus 
Rabies 
Diptheria 
Hepatitis B 
Japanese B encephalitis 
Tick borne encephalitis 
Pneumococcus 
Influenza
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6
Q

Who should be given malaria chemoprophylaxis and how long should the course of treatment be?

A

Essential for all travellers to endemic areas, including children and pregnant women

Commence 1-3 weeks before travel and continue for up to 4 weeks after leaving

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7
Q

Examples of viral haemorrhagic fevers that travellers may be at risk of

A 
Yellow fever
Dengue haemorrhagic fever
Hentavirus infections 
Lessa fever
Marburg fever
Ebola fever
Congo-Crimea haemorrhagic fever
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8
Q

Examples of zoonoses that travellers may be at risk of

A

Brucellosis
Rabies
Tularaemia
Anthrax

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9
Q

Unfamiliar features of imported disease

A 
Presenting features 
Isolation requirements
Diagnostic methods
Management requirements
Unexpected complications
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10
Q

Factors increasing the vulnerability of travellers to infection

A

Temptation to take risks away from home
Different epidemiology of some diseases
Incomplete understanding of health hazards
Stress of travel
Refugees - deprivation, malnutrition, disease or injury

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11
Q

Infections common worldwide

A

Influenza
Community-acquired pneumonia
Meningococcal disease
STDs

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12
Q

Conditions caused/exacerbated climate/environment

A 
Sunburn 
Heat exhaustion 
Heat stroke 
Fungal infections 
Bacterial skin infections 
Cold injury 
Altitude sickness
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13
Q

Infections controllable by sanitation

A 
Traveller's diarrhoea 
Typhoid
Hepatitis A or E 
Giardiasis 
Amoebiasis 
Helminth infections 
Viral gastroenteritis 
Food poisoning 
Shigella dysentery 
Cholera 
Cryptosporidiosis
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14
Q

Infections controllable by immunisation

A

Poliomyelitis

Diphtheria

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15
Q

Infections controllable by education

A

HIV

STDs

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16
Q

Infections transmitted in water and mud

A 
Schistosomiasis 
Leptospirosis 
Liver flukes 
Strongyloidiasis 
Hookworms 
Guinea worms
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17
Q

Infections transmitted by arthropod vectors

A 
Malaria 
Dengue fever
Rickettsial infections
Leishmaniasis 
Trypanosomiasis 
Filariasis 
Onchocerciasis
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18
Q

Emerging infectious diseases

A 
Zika 
Ebola 
MERS-CoV
Swine flu 
Avian flu 
SARS
West Nile virus
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19
Q

Important tropical diseases

A 
Malaria 
Typhoid 
Dengue fever
Schistosomiasis 
Rickettsiosis 
Viral haemorrhagic fevers
Zika fever
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20
Q

Epidemiology of malaria

A

Tropical
Most important imported disease
Vector is the female anopheles mosquito

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21
Q

Cases of malaria per year according to WHO 2012

A

207 million cases/year

781,000 deaths/year

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22
Q

Species of malaria

A 
Plasmodium falciparum (potentially severe) 
Plasmodium vivax
Plasmodium ovale 
Plasmodium malariae
Plasmodium knowlesi
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23
Q

Symptoms of malaria

A 
Fever 
Rigors
Aching bones 
Abdominal pain 
Headache 
Dysuria 
Frequency 
Sore throat 
Cough
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24
Q

Signs of malaria

A

May be none
Splenomegaly
Hepatomegaly
Mild jaundice

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25
Q

Complications of malaria

A 
Cerebral malaria (encephalopathy) 
Blackwater fever
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria
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26
Q

Features of cerebral malaria (encephalopathy)

A

Hypoglycaemia
Convulsions
Hypoxia

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27
Q

Features of blackwater fever

A 
Severe intravascular haemolysis 
High parasitaemia 
Profound anaemia 
Haemoglobinuria 
Acute renal failure
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28
Q

Diagnosis of malaria

A

Thick and thin blood films
Quantitative buddy coat
Rapid antigen tests

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29
Q

When assessing malaria severity, one or more of what features are indicative of complicated malaria?

A 
Impaired consciousness or seizures 
Hypoglycaemia 
Parasite count 2% or more 
Haemoglobin 8mg/dL or less
Spontaneous bleeding 
Haemoglobinuria 
Renal impairment or pH < 7.3
Pulmonary oedema or ARDS
Shock
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30
Q

Traditional malaria drugs

A

Quinine

Artemisinins

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31
Q

Management of uncomplicated P. falciparum malaria

A

Quinine 7 days plus oral doxycycline or clindamycin
Malarone 3 days
Riamet 3 days

32
Q

Side effects of quinine

A

Nausea
Tinnitus
Deafness
Rash

33
Q

Management of complicated or severe P. falciparum malaria

A

IV quinine plus oral doxycycline or clindamicin

Switch to oral therapy when patient is stable and able to swallow

34
Q

Side effects of IV quinine

A

Cardiac depression
Cerebral irritation
Nausea
Vomiting

35
Q

Management of P. vivax, ovale, knowlesi and malariae

A

Chloroquine 3 days
Riamet 3 days
Plus primaquine 14 days in vivax and ovale to eradicate liver hypnozoites

36
Q

Malaria control programmes

A

Drainage of standing water at mosquito breeding sites
Temphos/biological management of larvicides
Mosquito killing sprays
Human behaviour e.g. bed nets, mesh windows

37
Q

Adjuvant measures for malaria infection

A 
O2 or ventilation if pulmonary oedema
Maintain blood glucose 
Correct anaemia 
Dialysis if acute renal failure 
Exchange transfusion if high parasitaemia
38
Q

Examples of prophylaxis for malaria

A

Malarone
Mefloquiine
Doxycycline

39
Q

Causative organisms of typhoid fever

A

Salmonella typhi

Salmonella paratyphi

40
Q

How many global cases of typhoid fever are there?

A

27 million infections per year
Over 200,000 global deaths per year
200 UK cases per year

41
Q

Incubation period of typhoid fever

A

7 days - 4 weeks

42
Q

Features of first week of typhoid fever

A 
Fever
Headache
Abdominal discomfort 
Constipation 
Dry cough 
Relative bradycardia 
Neutrophilia 
Confusion
43
Q

Features of second week of typhoid fever

A 
Fever peaks at 7-10 days 
Rose spots
Diarrhoea 
Tachycardia 
Neutropenia
44
Q

Features of third week of typhoid fever

A 
Complications 
Intestinal bleeding 
Perforation 
Peritonism 
Metastatic infections
45
Q

Diagnosis of typhoid fever

A

Not an easy clinical diagnosis, based on evolution of features
Laboratory - blood, urine, stool and bone marrow culture

46
Q

Treatment of typhoid fever

A

Azithromycin - drug of choice for Asian acquired uncomplicated typhoid fever
Ceftriaxone - if complicated or concerned regarding absorption

47
Q

Cases of dengue fever each year

A

100 million infections per year

25,000 deaths per year

48
Q

Features of classical dengue fever

A 
Sudden fever 
Sever headache, retro-orbital pain 
Severe myalgia and arthralgia 
Macular/maculopapular rash 
Haemorrhagic signs e.g. petechiae, purpura, positive tourniquet test
49
Q

Diagnosis of dengue fever

A

Clinical - thrombocytopenia, leucopenia, elevated transaminases, positive tourniquet test

Laboratory - PCR, serology

50
Q

Management of dengue fever

A

Conservative - no specific therapeutic agents

IV fluids
fresh frozen plasma
platelets

51
Q

Species causing schistosomiasis

A

S. haematobium
S. mansoni
S. japonicum

52
Q

How is schistosomiasis contracted?

A

Swimming in contaminated water

53
Q

Clinical features of first 24-48 hours of schistosomiasis

A

Swimmers itch

54
Q

Features of invasive stage of schistosomiasis

A 
After 24 hours 
Cough 
Abdominal discomfort 
Splenomegaly 
Eosinophilia
55
Q

Features of schistosomiasis after 15-20 days

A 
Katayama fevere 
Prostrate 
Fever
Urticarial 
Lymphadenopathy 
Splenomegaly 
Diarrhoea 
Eosinophilia
56
Q

Features of acute schistosomiasis disease

A

After 6-8 weeks

Eggs deposited in bowel causing dysentery or in bladder causing haematuria

57
Q

Diagnosis of schistosomiasis

A

Clinical
Antibody test
Ova in stools and urine
Rectal snip

58
Q

Treatment of schistosomiasis

A

Praziquantel 40mg/kg single dose

Prednisolone if severe

59
Q

Features of tick typhus

A

Tick bite eschar

Maculopapular rash

60
Q

Organisms causing rickettsiosis

A 
R. conorii
R. africae
R. rickettsii 
R. prowazekii
R. moosen
R. tsutsugamushi
61
Q

Clinical features of rickettsiosis

A 
Abrupt onset swinging fever
Headache 
Confusion 
Endovasculitis 
Rash 
Bleeding
62
Q

Diagnosis of rickettsiosis

A

Clinical features

Serology

63
Q

Management of rickettsiosis

A

Tetracycline

64
Q

Management of viral haemorrhagic fevers

A 
Rule out common severe infections 
Isolation in high security infection unit 
No specific treatment 
Supportive treatment 
May be fatal
65
Q

How is zika virus transmitted?

A

By daytime biting aedes mosquito

66
Q

Features of zika virus

A 
No or mild symptoms 
Headache
Rash 
Fever
Malaise 
Conjunctivitis 
Joint pains 
Microcephaly and other neurological problems in unborn babies
67
Q

Features of amoebic liver abscess

A

Fever

Right upper quadrant pain

68
Q

Treatment of amoebic liver abscess

A

Drainage and metronidazole then diloxanide

69
Q

Important features of history of a traveller returning with a febrile illness

A 
Is it tropical 
Travel history 
Precautions taken 
Risks taken 
Symptoms 
Incubation periods
70
Q

What travel-related infection might a rash be a sign of?

A

Typhoid
Typhus
Dengue

71
Q

What travel-related infection might jaundice be a sign of?

A

Hepatitis
Malaria
Yellow fever

72
Q

What travel-related infection might enlarged lymph nodes be a sign of?

A

Leishmania

Trypanosomiasis

73
Q

What travel-related infection might a palpable liver be a sign of?

A

Malaria
Typhoid
Amoebic abscess

74
Q

What travel-related infection might a palpable spleen be a sign of?

A

Kala-Azar
Typhoid
Malaria

75
Q

Common investigations into travellers returning with an illness

A 
FBC 
Malaria films 
LFTs
Stool microscopy and culture 
Urinalysis and culture 
Blood cultures
CXR
76
Q

Specific serology tests for travellers returning with an illness

A 
Dengue 
Respiratory viral/atypical 
Hepatitis A, B, C
Tick typhus
Schistosomiasis 
Amoebic 
Leptospirosis/hantavirus
Brucellosis
Viral haemorrhagic fevers
77
Q

General treatment measures for travel related infections

A

Isolation
Supportive measures
Empirical treatment
Specific treatment

Infection (14 decks)

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