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Infection > Travel related infection > Flashcards

Travel related infection Flashcards

1
Q

What are some unfamiliar features of imported diseases?

A
  • Presenting features
  • Isolation requirements
  • Diagnostic methods
  • Treatment/Management
  • Unexpected complications
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2
Q

Why are travelers vulnerable to infection?

A
  • Temptation to take risks away from home
    • food, water, animals, sex
  • Different epidemiology of some diseases
    • HIV, TB, polio, diphtheria
  • Incomplete understanding of health hazards
  • Stress of travel
  • Refugees: deprivation, malnutrition, disease, injury
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3
Q

Which infections are common worldwide?

A
  • influenza
  • community-acquired pneumonia
  • meningococcal disease
  • sexually transmitted diseases
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4
Q

What are some climate/environmental related health problems?

A
  • Sunburn
  • Heat exhaustion and heatstroke
  • Fungal infections
  • Bacterial skin infections
  • Cold injury
  • Altitude sickness
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5
Q

Which diseases can be prevented by sanitation?

A
  • Travelers’ diarrhoea
  • Typhoid
  • Hepatitis A or E
  • Giardiasis
  • Amoebiasis
  • Helminth infections
  • Viral gastroenteritis
  • Food poisoning
  • Shigella dysentery
  • Cholera
  • Cryptosporidiosis
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6
Q

Which can be prevented by immunisation?

A
  • Poliomyelitis
  • Diphtheria
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7
Q

Which infections can be prevented by education?

A
  • HIV
  • STD’s
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8
Q

What are some water related infections?

A
  • Schistosomiasis
  • Leptospirosis
  • Liver flukes
  • Strongyloidiasis
  • Hookworms
  • Guinea worms
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9
Q

Name some common arthropod-borne infections?

A
  • Malaria (mosquitos)
  • Dengue fever (mosquitos)
  • Rickettsial infections (ticks: typhus)
  • Leishmaniasis (sand flies: Kala-azar)
  • Trypanosomiasis (tsetse fly: sleeping sickness)
  • Filariasis (mosquitoes: elephantiasis)
  • Onchocerciasis (black flies: River Blindness)
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10
Q

Please give examples of emerging infectious disease:

A
  • Zika: Latin America, Caribbean
  • Ebola virus disease: West Africa
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11
Q

Righty: what are the important tropical diseases?

A
  • Malaria
  • Typhoid
  • Dengue Fever
  • Schistosomiasis
  • Rickettsiosis
  • Viral haemorrhagic fevers
  • Zika fever
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12
Q

Give some brief epidemiology of malaria:

A
  • Most important imported disease
  • United Kingdom (HPA, 2015)
    • 1400 cases/year
    • 6 deaths/year
  • Worldwide (WHO, 2012)
    • 207 million cases/year
    • 627,000 deaths/year
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13
Q

Which regions contain malaria?

A
  • South america
  • Central Africa
  • India
  • South East Asia
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14
Q

What is the malaria vector?

A

female Anopheles mosquito

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15
Q

Which is the most severe malaria species?

A

Plasmodium falciparum

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16
Q

What are some benign species of malaria?

A

Plasmodium vivax

Plasmodium ovale

Plasmodium malariae

Plasmodium knowlesi (like P malariae; Far East, 2004)

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17
Q

Symptoms of malaria?

A
  • fever
  • rigors
  • aching bones
  • abdo pain
  • headache
  • dysuria
  • frequency
  • sore throat
  • cough
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18
Q

What are the signs of malaria?

A
  • none
  • splenomegaly
  • hepatomegaly
  • mild jaundice
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19
Q

What are the severe complications of malaria?

A
  1. Cerebral malaria (encephalopathy)
    • non- immune visitors, children in endemic areas hypoglycaemia, convulsions, hypoxia
  2. Blackwater fever
    • severe intravascular haemolysis, high parasitaemia, profound anaemia, haemoglobinuria, acute renal failure
  3. Pulmonary oedema
  4. Jaundice
  5. Severe anaemia
  6. Algid malaria
    • Gram-negative septicaemia
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20
Q

How do we make a diagnosis of malaria?

A
  • Thick & thin blood films
    • Giemsa, Field’s stain
  • Quantitative buffy coat (QBC)
    • centrifugation, UV microscopy
  • Rapid antigen tests
    • OptiMal
    • ParaSight-F
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21
Q

What is the criteria for complicated malaria?

A

One or more of:

  • Impaired consciousness or seizures
  • Hypoglycaemia
  • Parasite count ³2%
  • Haemoglobin £ 8mg/dL
  • Spontaneous bleeding / DIC
  • Haemoglobinuria
  • Renal impairment or pH <7.3
  • Pulmonary oedema or ARDS
  • Shock (algid malaria)
  • ?Gram negative bacteraemia
22
Q

Tx for uncomplicated P. falciparum malaria?

A
  • Riamet ® (artemether-lumefantrine) 3 days
  • Eurartesim ® (dihydroartemisinin-piperaquine) 3 days
  • Malarone ® (atovaquone-proguanil) 3 days
  • Quinine 7 days
    • S/E nausea, tinnitus, deafness (cinchonism), rash, hypoglycaemia
    • plus oral doxycycline (or clindamycin)
23
Q

Tx for complicated or severe P. falciparum malaria?

A
  • IV artesunate (unlicensed in UK)
  • IV quinine
    • (S/E cardiac depression, cerebral irritation, N&V)
    • plus oral doxycycline (or clindamycin)
  • When patient is stable & able to swallow, switch to oral treatments
24
Q

Tx for P. vivax, P. ovale, P. malariae, P. knowlesi malaria?

A
  • chloroquine 3 days
  • Riamet ® (artemether-lumefantrine) 3 days
  • add primaquine* (14 days) in vivax and ovale, to eradicate liver hypnozoites
  • *check for G6PD deficiency
25
Q

What are some malaria control programmes?

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 causes Typhoid (enteric) fever?

A
  • Salmonella typhi
  • Salmonella paratyphi
  • Poor sanitation, unclean drinking water
27
Q

What are the clinical features of Typhoid? Including a description for each week diseased

A
  • Incubation period: 7 days - 4 week
  • 1st week:
    • fever, headache, abdo. discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion
  • 2nd week:
    • fever peaks at 7-10 days, Rose spots, diarrhoea begins, tachycardia, neutropenia
  • 3rd week (Complications):
    • intestinal bleeding, perforation, peritonism, metastatic infections
  • week 4 (Recovery):
    • 10 - 15% relapse
28
Q

How is the diagnosis of typhoid made?

A
  • Clinical
    • not easy
    • evolution of features
  • Laboratory (Salmonella typhi, S. paratyphi)
    • Culture blood, urine & stool
    • Culture bone marrow
29
Q

Tx for typhoid?

A
  • Oral Azithromycin
    • now drug of choice for Asian-acquired, uncomplicated enteric fever
  • IV Ceftriaxone
    • if complicated, or concerned regarding absorption
30
Q

What is Dengue?

A

Viral infection spread by mosquitoes. It’s widespread in many parts of the world.

  • Commonest human arbovirus infection
  • Dengue infection: 100 million cases/year
31
Q

Which countries are at risk of Dengue trasmission?

A
32
Q

What causes transmission of dengue?

A

Aedes aegypti

33
Q

What are the classical features of dengue fever?

A
  • Sudden fever
  • Severe headache, retro-orbital pain
  • Severe myalgia and arthralgia
  • Macular/ maculopapular rash
  • Haemorrhagic signs: petechiae, purpura, positive tourniquet test
34
Q

How can we make a clinical diagnosis of Dengue?

A
  • Clinical
    • Thrombocytopenia
    • Leucopenia
    • Elevated transaminases
    • Positive tourniquet test
  • Laboratory: PCR, serology
35
Q

What is the management of Dengue? Mx of complications? Prevention?

A
  • No specific therapeutic agents
  • Complications
    • Dengue haemorrhagic fever (DHF)
    • Dengue shock syndrome (DSS)
    • Rx: IV fluids, fresh frozen plasma, platelets
  • Prevention
    • avoid bites
    • new vaccine (Dengvaxia), 2016; limited use
36
Q

What is schistosomiasis? Where and what transmits it?

A

also known as snail fever and bilharzia, is a disease caused by parasitic flatworms called schistosomes

Freshwater

Freshwater snails

37
Q

What are the three main strains of schistosomiasis? Where is it distributed?

A
  • S. haematobium
  • S. mansoni
  • S. japonicum

Africa, Asia, Brazil

38
Q

What are the 5 stages of clinical features of schsitosomiasis?

A
  • Swimmers Itch (1st few hrs)
    • clears 24-48hrs
  • 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
39
Q

How do we make a diagnosis of schisto?

A
  • Clinical diagnosis
  • Antibody tests
  • Ova in stools and urine
  • Rectal snip
40
Q

What is the Tx for schisto?

A
  • PRAZIQUANTEL 20mg/kg, two doses 6hrs apart
  • Prednisolone if severe
41
Q

What is rickettsiosis?

A

Infection caused by an unusual type of bacteria that can live only inside the cells of another organism. Most of these infections are spread through ticks, mites, fleas, or lice.

42
Q

What is the main Rickettsiosis?

A

Tick typhus (R. conorii, R. africae)

  • From Southern Africa, Mediterranean, Arabian Gulf
43
Q

Clinical features of rickettsiosis?

A
  • Abrupt onset swinging fever, headache, confusion, endovasculitis, rash (macular, petechial), bleeding
  • Diagnosis: clinical features, serology
  • Management: tetracycline
44
Q

Name some viral haemorrhagic fevers:

A
  • Ebola
  • Congo-Crimea haemorrhagic fever
  • Lassa fever
  • Marburg disease
45
Q

What are the necessary steps when managing a viral hemorrhagic fever?

A
  • Maximum incubation period 3 weeks
  • Rule out common severe infections
  • Isolation: High Security Infection Unit
  • Treatment: supportive!
46
Q

What is flavivirus?

A

Any of a group of RNA viruses, mostly having arthropod vectors, which cause a number of serious human diseases including yellow fever, dengue, various types of encephalitis, and hepatitis C.

  • Transmitted by daytime-biting Aedes mosquitos
  • Also by sexual contact, blood transfusion
  • Related to dengue, yellow fever, Jap B encephalitis and West Nile viruses
47
Q

What are the clinical SSx of Zika virus? WHERE IS IT?

A
  • No or mild symptoms - headache, rash, fever, malaise, conjunctivitis, joint pains (like dengue)
  • In pregnancy, can cause microcephaly and other neurological problems
  • Can cause Guillain-Barre syndrome
  • No antiviral therapy
  • Mosquito control measures
  • Vaccines in development
48
Q

What do we need to gain from a history of a returning traveler who has history of fever?

A
  • Is it tropical?
  • Travel history
  • Precautions taken
  • Risks
  • Symptoms
  • Incubation periods
49
Q

What are some examination signs and their causative pathology?

A
  • Rash - typhoid, typhus, dengue
  • Jaundice - hepatitis, malaria, Yellow fever
  • Lymph nodes - leishmania, trypanosomiasis
  • Liver - malaria, typhoid, amoebic abscess
  • Spleen – visceral leishmaniasis, typhoid, malaria
50
Q

What investigations are required when investigating a returning traveler presenting with fever?

A
  • FBC
  • malaria films
  • liver function tests
  • stool microscopy & culture
  • urine analysis & culture
  • blood culture(s)
  • CXR
51
Q

Management of someone with a foreign fever?

A
  • Isolation: ?personal protective equipment
  • Supportive measures (resuscitation)
  • Empirical treatment if patient unwell
    • Antimicrobial therapy based on likely diagnosis
    • aim to treat life-threatening conditions e.g. typhoid, septicaemia
  • Specific treatment
    • once diagnosis is established

Infection (12 decks)

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