Travel related infection Flashcards
What are some climate or environment related health problems?
Sunburn Heat exhaustion and heat stroke Fungal infections Bacterial skin infections Cold injury Altitude sickness
How are infections controllable by public health measures?
Sanitation
Immunisation
Education
What are some example of infections controllable by sanitation?
Travellers’ diarrhoea
Food poisoning
Cholera
What are some water related infections?
Schistosomiasis
Leptospirosis
Liver flukes
What are some arthropod borne infections?
Malaria
Dengue fever
Leishmaniasis
What are the emerging infectious diseases?
Zika Ebola Swine flu Avian flu SARS West Nile virus MERS-CoV
What is the vector for malaria?
Female anopheles mosquito
What is the life cycle of malaria?
Malaria parasite enters body and sporozoites injected into bloodstream and travel to liver
There, they produce merozoites which replicate in RBCs and destroy them
The damaged RBCs are then drunk by a mosquito, where the parasite can form a zygote and replicate, ready to infect another patient
What are the species of malaria?
Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae Plasmodium knowlesi
What is the potentially severe form of malaria?
Plasmodium falciparum
What are he clinical features of malaria?
Fever, riggers, aches and pains Abdo pain Headache Dysuria and frequency Sore throat, cough
What signs can be present with malaria?
Splenomegaly
Hepatpmegaly
Mild jaundice
How is malaria diagnosed?
Thick and thin blood films
Quantative buffy coat
Rapid antigen tests
What is complicated malaria diagnosed by?
One or more of: Impaired conciousness/seizures Hypoglycaemia Parasite count >2% Haemoglobin <8 Spontaneous bleeding Haemoglobinuria Renal impairment or pH <7.3 Pulmonary oedema Shock
What is the management of uncomplicated p. falciparum malaria?
3 days Riamet, Eurartesm or Malarone OR
7 days Quinine with oral doxycycline
What is the management of complicated p. falciparum malaria?
IV artesunate OR IV quinine with oral doxycycline
What is the treatment of p. vivax and p. ovale malaria?
3 days chloroquine or Riamer
AND primaquine 14 days
What is the treatment of p. malariae and p. knowlesi malaria?
3 days chloroquine or Riamer
What are the possible complications of malaria?
Cerebral malaria Blackwater fever Pulmonary oedema Jaundice Sever anaemia Algid malaria
What does cerebral malaria cause?
Drowsiness, seizures, coma and death
What does blackwater fever cause?
Haemoglobulinuria and acute renal failure
What is typhoid due to?
Salmonella typhi or salmonella paratyphi
How is typed spread?
Via poor sanitation or unclean drinking water
What are the week 1 clinical features of typhoid?
Fever Headache Abdo discomfort Constipation Dry cough Bradycardia
What are th week 2 clinical features of typhoid?
Fever peaks at 7-10 days
Rose spots
Diarrhoea
Tachycardia
What are the possible week 3 complications of typhoid?
Intestinal bleeding
Perforation
Peritonism
What is the typical week 4 progression of typhoid?
Recovery
10-15% relapse rate
How is typhoid diagnosed?
Clinical
Lab- Culture blood, urine, stool and bone marrow
Rule out malaria
What is the treatment of typhoid?
Oral azithromycin or IV ceftriaxone
How is dengue transmitted?
Via aedes aegypti
What is the classical presentation of dengue?
Sudden fever Severe headache or retro-orbital pain Severe myalgia and arthralgia Macular/maculopapular rash Haemorrhagic signs
How is dengue diagnosed?
Positive tourniquet test
Thrombocytopenia, leucopenia, elevated transaminases
PCR and serology
What is the management of dengue?
No specific therapeutic management
Prevention
What are the possible complications of dengue?
Dengie haemorrhage fever
Dengue shock syndrome
How is schistosomiasis transmitted?
Fresh water snails
What are the bacteria involved in schistosomiasis?
s. haemotobium
s. mansion
s. japonicum
What is the life cycle of schistosomiasis?
Infected snails release cercariae into water
These penetrate skin of the human and become schistosomulae by losing tails
These are in circulation and migrate to portal circulation;ation where they mature
What are the immediate features of schistosomiasis?
Swimmers’ itch in few hours
What are the phases of schistosomiasis?
Invasive stage
Katayama fever
Acute disease
Chronic disease
What are the clinical features of the invasive stage of schistosomiasis?
After 24 hours
Cough, abdominal discomfort, splenomegaly, eosinophilia
What are the clinical features of the Katayama fever phase of schistosomiasis?
15-20 days
Fever, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia, urticaria
What are the 2 types f acute disease in schistosomiasis?
Eggs deposited in bowel- dysentery
Eggs deposited in bladder- haematuria
When does the acute disease in schistosomiasis happen?
6-8 weeks
How is schistosomiasis diagnosed?
CLinical
Antibody tests
Ova in stool/urine
Rectal snip
What is the treatment of schistosomiasis?
Praziquantel- 2 doses 6 hours apart
Prednisolone if severe
What is the commonest cause of rickettsiosis imported to the UK?
Tick typhus, caused by r. conorii or r. africae
What are the clinical features of rickettosis?
Abrupt onset swinging fever
Headache, confusion, endovasculitis, rash, bleeding
How is rickettosis diagnosed?
Clinical
Serology
What is the management of rickettosis?
Tetracycline
What are the viral haemorrhage fevers we are concerned about?
Ebola
Congo-Crimea haemorrhage fever
What is the incubation period of viral haemorrhage fevers?
Max 3 weeks
What is the treatment of viral haemorrhage fevers?
Isolation
Supportive
How is the zika virus transmitted?
Via aedes aegypti mosquito, sexual contact or blood transfusion
What are the clinical features of zika?
No or mild symptoms- headache, rash, fever, malaise, conjunctivitis, joint pain
Can cause Guillain Barre
What can zika during pregnancy cause?
Microcephaly and other neurological problems
