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Infection Medicine > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

1
Q

Describe the life cycle of malaria

A
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2
Q

What are the main malaria species?

A
  • P. falciparum
  • P. vivax
  • P. malariae
  • P. ovale
  • P. knowelsi
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3
Q

Where is P. falciparum most commonly found?

A
  • Africa
  • India
  • South east asia
  • Indonesia
  • Oceania
  • Central america
  • Middle east
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4
Q

What is the average incubation of P. falciparum?

A

12 days (6 days-6 months)

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5
Q

What mosquito is implicated in the spread of malarie?

A

Female Anopheles

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6
Q

What are features of malaria?

A

Non-specific fever symptoms

  • Fever
  • headache
  • Malaise
  • Myalgia
  • Diarrhoea
  • Cough
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7
Q

How often do fevers spike in malaria falciparum?

A

Alternate days

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8
Q

What signs might you find on examination in malaria?

A
  • Pyrexia
  • Jaundice - suggestive of falciparum
  • Hepatosplenomegaly
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9
Q

What features on presentation are suggestive of falciparum infection in malaria?

A

Signs of severe disease

  • Seizures
  • Jaundice
  • Altered consciousness
  • Hypotension
  • Oliguria/anuria
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10
Q

What investigations would you consider doing in someone with suspected malaria?

A
  • Bedside - urinalysis
  • Bloods - FBC, U+E’s, LFT’s, Glucose, Consider ABG, Blood film (Thick and Thin)
    *
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11
Q

Why might you do FBC in someone with malaria?

A

Look for features of anaemia and thrombocytopenia

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12
Q

Why might you do U+E’s in someone with Malaria?

A

Look for AKI

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13
Q

Why might you look at clotting in someone with malaria?

A

Features of DIC

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14
Q

Why might you look at glucose in someone with malaria?

A

Look for hypoglycaemia

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15
Q

Why might you do ABG in someone with malaria?

A

Look for Acidosis

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16
Q

Why might you do urinalysis in someone with malaria?

A

Look for haemoglobinuria

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17
Q

Is malaria a notifiable disease?

A

Yes

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18
Q

What are the diagnostic tests for malaria?

A
  • Giemsa thick and thin blood film - looking for trophozite
  • Quantative buffy coat
  • Rapid antigen test
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19
Q

What should you consider as part of you differential for malaria if investigation was negative for malaria?

A
  • Dengue
  • typhoid
  • Hepatitis
  • Meningitis/encephalitis
  • HIV
  • Viral haemorrhagic fever
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20
Q

How would you treat uncomplicated falciparum malaria?

A

One of:

  • Riamet (artemether-lumefantrine) - 3 days
  • Eurartesim (dihydroartemisinin-piperaquine) - 3 days
  • Malarone (atovaquone-proguanil) - 3 days
  • Quinine - 7 days plus oral doxycycline (or clindamycin)
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21
Q

How would you treat complicated falciparum malaria?

A

Options include

  • IV artesunate (unlicensed in UK)
  • IV quinine plus oral doxycycline (or clindamycin)
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22
Q

How would you mange somoene with infection by P. vivax, ovale, knowelsi, or malariae?

A

One of

  • Chloroquine 3 days
  • Riamet ® (artemether-lumefantrine) 3 days

**add primaquine* (14 days) in vivax and ovale, to eradicate liver hypnozoites

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23
Q

What would you add to treatment regimen in p. vivax or ovale, if already treating them with one of riamet or chloroquine?

A

Primaquine - eradicates liver hypnozoites

24
Q

What do you need to check for before adding primaquine to malria therapy?

A

G6PD deficiency

25
Q

What are examples of methods to control malaria?

A
  • Mosquito breeding sites - Drainage of standing water
  • Larvacides - (Paris green), temphos, biological
  • Mosquito killing sprays - DDT, malathion, (dieldrin)
  • Human behaviour - Bed nets, Mesh windows
26
Q

What are complications of malaria infection?

A
  • Cerebral malaria (encephalopathy)
  • Blackwater fever
  • Pulmonary oedema
  • Jaundice + Severe anaemia
  • DIC
  • Algid malaria - Gram-negative septicaemia
27
Q

What are features of blackwater fever?

A
  • High Fever
  • Severe intravascular haemolysis - Profound anaemia
  • Jaundice
  • Haemoglobinuria - dark urine
  • Acute renal failure
28
Q

What organism causes typhoid fever?

A
  • Slamonella typhi
  • Salmonella Paratyphi
29
Q

If someone was travelling to an area with malaria of no drug resistance, how would you manage them?

A

Chloroquine or Proguanil - 1 week before, during trip, and 4 weeks after travel

30
Q

If someone was travelling to areas with malaria with little chloroquine resistance, how would you manage them?

A

Chloroquine plus proguanil - 1 week before, during and 4 weeks after trip

31
Q

What drugs would you consider giving someone who is travelling to an area where chloroquine resistanct malaria is endemic?

A
  • Mefloquine
  • Doxycycline
  • Atovaquone-progunial combination
32
Q

How is typhoid fever spread?

A

Unclean drinking water, poor sanitation

33
Q

What is the incubation period of typhoid fever?

A

7 days - 4 weeks

34
Q

What features present within the first week of typhoid fever?

A
  • Fever
  • Headache
  • Abdo. discomfort
  • Constipation
  • Dry cough
  • Relative bradycardia
  • Neutrophilia
  • Confusion
35
Q

What features occur in the 2nd week of typhoid fever infection?

A

Fever peaks at 7-10 days,

  • Rose spots
  • Diarrhoea begins
  • Tachycardia
  • Neutropenia
36
Q

What features occur in the 3rd week of typhoid infection?

A

Can present with complications

  • Intestinal bleeding
  • Perforation
  • Peritonism
  • Meastatic infections
37
Q

How would you investigate somoene with suspected typhoid fever?

A
  • Bloods - FBC, Blood culture
  • Orifices - Stool culture, ​Urine culture
  • Specific - bone marrow culture
38
Q

How would you treat typhoid fever?

A
  • Oral azithromycin
  • IV ceftriaxone - if complicated
39
Q

What vector is implicated in the transmission of dengue fever?

A

Aedes aegypti mosquite

40
Q

What are features of dengue fever?

A

Break bone fever

  • Sudden fever
  • Severe headache, retro-orbital pain
  • Severe myalgia and arthralgia
  • Macular/ maculopapular rash
  • Haemorrhagic signs: petechiae, purpura, positive tourniquet test
41
Q

What are qarning signs seen in dengue fever?

A
  • Abdo pain
  • Persistent vomiting
  • Fluid accumulation
  • Mucosal bleeding
  • Hepatomegaly
  • Shock
  • Severe bleeding
  • Respiratory distress
42
Q

What investigations would you consider doing in someone with suspected dengue feveR?

A
  • Bloods - FBC, LFTs, albumin, Serology and PCR
  • Specific - tourniquet test
43
Q

What bedside test would you consider doing in someone with dengue fever?

A

Tourniquet test

44
Q

What are complicaitons of dengue fever?

A
  • Dengue haemorrhagic fever (DHF)
  • Dengue shock syndrome (DSS)
45
Q

How would you manage someone with dengue fever?

A

Supportive

  • IV fluids
  • Consider FFP and platelets
46
Q

What is the cause of schistosomiasis?

A
  • S. haematobium
  • S. mansoni
  • S. japonicum
47
Q

Describe the life cycle of schistosomiasis

A
48
Q

How is schistosomiasis spread?

A

Contact with contaminated water

49
Q

What are initial features of schistosomiasis infeciton?

A

Swimmer’s itch - first few hours

50
Q

What are features that occur following the initial phase of schistosomiasis infection?

A

Following clinical syndromes

  • Invasive stage (after 24hrs) - cough, abdo discomfort, splenomegaly, eosinophilia
  • Katayama Fever (after 15-20 days) - prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
  • Acute disease (6-8 weeks) - eggs deposited in bowel (dysentery) or bladder (haematuria)
  • Chronic disease
51
Q

How would you investigate someone with suspected schistosomiasis?

A
  • Bedside - urinalysis
  • Bloods - FBC, Blood culture, thick and thin blood flim
  • Orifices - stool culture, urine culture
52
Q

What might you find on stool culture in schistosomiasis?

A

Ova in stools

53
Q

How would you treat schistosomiasis?

A
  • Praziquantel - 20mg/kg, two doses 6hrs apart
  • Prednisolone if severe/katayama fever
54
Q

What are features of rickettsiosis?

A
  • Abrupt onset swinging fever
  • Headache
  • Confusion
  • Endovasculitis
  • Rash (macular, petechial)
  • Bleeding
55
Q

How would you manage rickettsiosis?

A

Tetracycline

56
Q

What are side effects of quinine?

A
  • Cinchonism - Tinnitus, headache, nausea, dizziness, flushing, visual
  • Hypoglycaemia
  • Severe hypotension
  • QT prolongation
  • Haematological abnormalities
57
Q

What should you monitor in someone who is on quinine?

A
  • Blood glucose
  • U+E’s

Infection Medicine (12 decks)

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