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Infection > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

1
Q

What are major travel related infections to worry about

What is travel infection / fever

A

Malaria
VHF
Typhoid

Fever >38
Person returning from abroad
Generally within 1 months but can be up to a year

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2
Q

What is important in the history

A

Where

  • Exact location
  • Season in country e.g. monsoon season increase mosquito

When

  • Exact dates of travel
  • When did they come home
  • When did they become unwell
  • Time of onset of symptoms and duration

Why - Reason for travel as different risks

  • Tourist vs aid vs immigrant
  • Visiting family = increased risk as decreased immune and don’t take prophylaxis

What - specific exposure

  • Contact
  • Food
  • Water - bottle or tap
  • Exposure risk
  • IVDU
  • Sexual

Which

  • Vaccination
  • Prophylaxis
  • Compliance
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3
Q

What do you do if foreign travel + fever

A

Admit
Triage
- Identify life threatening
- qSOFA

Infection control

  • Resp Isolation vs full PPE if VHF
  • Family and staff contact

VHF risk assessment / MERS if within 3 weeks

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4
Q

What causes Schistosomiasis

A

S.Haematobium

Fluke

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5
Q

How do you get Schistosomiasis

A 
Fresh water exposure 
Fresh water snails release eggs into fresh water
Pentrate skin and go to circulation
Mature in liver
Lay eggs in rectum
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6
Q

What are initial symptoms of Schistosomiasis

A

Fever + eosinophilia think schistosomiasis

Swimmers itch after a few hours
Cough 
Abdo pain 
Frank haematuria
Increased freuqnecy
Dysuria
Fever
Diarrhoea
Splenomegaly
Eosinophilia
- Also +Ve in worms / allergy / asthma
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7
Q

What causes splenomegaly

A

Portal vein congestion

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8
Q

What causes chronic

A

High worm burden

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9
Q

What are symptoms of chronic

A 
Obstructive uropathy / hydronephrosis due to scarring
Renal failure
Increased risk of bladder SCC
Anaemia
Malnutrition
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10
Q

How do you Dx

A

Serology
Ab test
Microscopic detection of eggs in stools / urine
Rectal snip

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11
Q

How do you Rx

A

Praziquantel

Prednisolone

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12
Q

What is consequence of Schistosomiasis and how does it present

A 
Katayama Fever 
15-20 days after
Fever
Asthmatic cough
Lymphadenopathy
Splenomegaly
Diarrhoea
Eosinophilia
Bronchospasm
Urticarial rash
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13
Q

What causes Strongyloides

A

Helminth worms
Most worms e.g. tapeworm can’t reproduce but Strongyloides can
Get through skin
Present in soil

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14
Q

What are the symptoms

A 
Hyperinfection
Very unwell as larvae transport
Diarrhoea
Abdo pain
Papulovesicular lesions where worms enter
Pulmonary Sx
Fever
Eosinophilia
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15
Q

What puts you at risk

A

Immunosuppressed

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16
Q

How do you `Dx

A

Serology

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17
Q

`What are Ddx

A

Churg Strauss

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18
Q

What is malaria

Most common cause of Fever in returning traveller

A 
Parasitic infection of RBC
Mature in liver of infected person 
Causes red cells to clump together and haemolyse
- Ischaemia
- Stickier blood 
- Haemolytic anaemia 
- Can cause multi-organ failure
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19
Q

What causes malaria

A

Plasmodium falciparum = parasite
Female anopheles mosquito = vector (night biter)
Increased risk in Monsoon season

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20
Q

What are benign causes

A

Vivax
Ovale
Malariae
Knowlesi

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21
Q

How does malaria present

A 
ALWAYS THINK IF FORIEGN TRAVEL + FEVER
Flu 
Headache
Malaise
Fever 
Rigors / chills / sweating
Abdo pain
Myalgia
Diarrhoea 
Dysuria
Sore throat
Dry cough
N+V
Confusion
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22
Q

What are signs

A 
Jaundice 
Pallor of anaemia 
HSM 
Thrombocytopenia - reduction of RBC
NO LEUCOCYTOSIS
Abnormal LFT
No rash or LN
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23
Q

What are important differential

A 
SEPSIS 
Typhoid
Hepatitis
Dengue
Avian
SARS
HIV
Meningits
VHF
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24
Q

Who is at risk of severe infection

A

Pregnancy

Babies

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25
Q

What is protective of malaria

A

Sickle cell
G6PD
Absence of Duffy Ab

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26
Q

When do you consider malaria

A

Any illness within 1 year but particularly 3 months

Even if had prophyaxis

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27
Q

How do you Dx

A

Thick and thin blood film
Will shows species and % parasite
>10% = very severe disease

Rapid antien test -urine dip

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28
Q

What do you need to exclude Dx

A

3 -ve over 24 hours

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29
Q

What else can be done

A 
FBC
Blood glucose
Urinanalysis - blood 
Stool MC+S if diarrhoea
CXR - exclude pneumonia 
Blood culture - typhoid
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30
Q

What will bloods show show

A

Anaemia
Thrombocytopenia
Abnormal LFT
Abnormal U+E

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31
Q

What do you do if falciparum confirmed

A

All patients with Falciparum need admitted as can deteriorate rapidly for IV artesunate
ABG
12 lead ECG
Clotting screen

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32
Q

What are complications / severe

A 
Sepsis if develop superimposed bacterial 
ARDS / hypoxia 
Lactic acidosis
AKI 
DIC - bleeding
Severe haemolytic anaemia
Hypoglycaemia due to massive stress response and impaired liver gluconeogensis  
Shock 
High parasitaemia >2%
Haemoglobinuria 
Cerebral Malaria  
Blackwater fever
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33
Q

What can cause shock

A

Algid malaria

Gram -ve bactaeraemia

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34
Q

What is cerebral malaria

A

Impaired consciousness
Convulsions
Seizure

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35
Q

What is Blackwater fever

A 
Severe intravascular haemolysis
High parasite % 
Anaemia
Haemoglobinuria
Renal failure 2 tubular necrosis
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36
Q

How do you treat uncomplicated malaria

A 
Oral Artesunate combination therapy (ACT) 
Riamet 3 days
Malarone 
Quinine
Doxycycline
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37
Q

How do you treat complicated / severe

A

IV artesunate
IV quinine
Oral doxycycline

38
Q

What are SE of Malarone

A

Pain
Nausea
Headache

39
Q

What are SE of Quinine

A 
Nausea
Tinnitus
Deaf
Rash
Neuropsychiatric so CI if history
40
Q

What can quinine + doxycycline cause

A

Cardiac depression
N+V
Cerebral

41
Q

What other measures do you do

A 
Senior 
HDU
O2
Flud balance 
May need blood transfusion 
Dialysis 
Exchange transfusion 
Consider CVP monitor 
Blood glucose regular
ECG
4 hourly obs
Repeat bloods daily
42
Q

How do you treat benign (vivax and ovale)

A

CHloroquine

Primaquine to eradicate liver hyponosites which can remain dormant causing relapsing remitting

43
Q

What should you do before giving primaquine

A

Check G6PD deficiency as cause haemolytic

44
Q

What do you give as prophylaxis

A

Malarone
Doxycycline
Mosquito spray and nets

45
Q

When do you do exchange transfusion

A

> 10%

46
Q

What causes typhoid / enteric fever

A

Salmonella typhi

Gram -ve

47
Q

How is it spread

A

Faecla oral
Poor sanitation
Unclean water

48
Q

What are acute symptoms of salmonella typhoid

A 
Headache
Fever + relative Brady = think typhoid 
Arthralgia
Cough
Abdo pain 
Constipation 
Bradycardia + neutropenia
49
Q

What are subacute symptoms

A 
Fever peaks 7-10 days
Rose spots
Diarrhoea
HSM
Tachycardia
50
Q

How long to recovery

A

4 week

51
Q

What are complications

A 
Septicaemia 
GI bleed
Bowel perforation
Peritonism 
OM
Cholecystitis
Meningitis
52
Q

How do you Dx

A

Blood culture

53
Q

What else can you do

A

Culture urine, stool, bone

54
Q

How do you treat

A

IV ceftriazone

Vaccine

55
Q

What is more common than Malaria and typhoid

A

Dengue fever

56
Q

How is Dengue transmitted

A

Arbovirus / flavivirus
Aedes mosquito
- Day biter
4 serotypes

57
Q

What are the symptoms of Dengue (Chingyuwa = similar)

A 
FEVER / ARTHRALGIA / RASH 
Fever <2 weeks
Headache
Arthralgia 
Maculopapular rash
Facial flush 
Pleuritic pain 
D+V
Pleural effusion and oedema can occur

First infection usually self-limiting
DevelopAb
Further infection though can cause haemorrhagic fever due to Ab depending enhancement

58
Q

What are signs

A 
Thrombocytopenia causing mouth / nose bleed / PV
Peripheral oedema 
Elevated LFT
HSM
Jaundice
59
Q

What is critical phase

A 
Hypotension
Brady 
Pleural effusion and oedema 
Ascites 
GI bleed 
Seizure
Altered GCS
60
Q

How do you Dx

A 
PCR
\+ve tourniquet test if poor country
- Put BP cuff and pump up between D+S 
- Leave a few minutes
- See if petechiae forms
61
Q

How do you prevent / treat

A

Avoid bites
Vaccine

Supportive 
Careful fluid 
Manage acidosis 
Transfusion / blood products 
Self-limting
62
Q

What are complications of Dengue

A

Dengue Haemorrhagic Fever
Dengue shock syndrome
Cause DIC

63
Q

How do you treat

A

Fluid
FFP
Platelets

64
Q

What causes Rickettsiosis

A

Tick typhus bite

65
Q

What are the Sx

A 
Maculopapular rash
Swinging fever
Headache
COnfusion
Bleeding 
Neck pain
Reactive arthritis 
Vasculitis
66
Q

How do you Dx

A

Serology

67
Q

How do you Rx

A

Doxycycline if severe

68
Q

What causes Zika virus

A

Aedes moquito
Sexual
Blood

69
Q

How does Zika present

A 
Usually asymptomatic 
Headache
Rash 
Fever
Malaise
Conjunctivitis 
Joint pain 
GBS
70
Q

How do you prevent

A

Mosquito control

Vaccine

71
Q

Whatdoes it cause in pregnancy

A

Microcephaly

72
Q

What are viral haemorrhagic fever

A

Ebola
Yellow fever
Dengue

73
Q

When do you consider

A

Fever within 21 days to endemic country

74
Q

What are symptoms

A

FEVER
BLEEDING
Conjunctivitis common as spread through mucosal bleeding
If fever + conjunctivitis <21 days = VHF

75
Q

What is shown in bloods

A

Low platelet
Low WCC
Raised LFT
Raised PT

76
Q

How does Ebola present

A 
Fever
Fatigue
Muscle pain
Headache / sore throat
D+V
Rash
Kidney and liver failure
Internal and external bleeding
77
Q

How do you investigate

A

Urgent malaria test
FBC, U+E, LFT, CRP, Glucose
Clotting
Culture / PCR

78
Q

If confirmed

A 
DO NOT COME TO SURGERY 
Public health for support 
High level isolation 
Supportive care 
No RX
79
Q

Take home

A

Rule out life threatening
Test malaria same day
HIV test where appropriate

80
Q

What is biggest killer in travellers

A

Sepsis

81
Q

What Sx do you want to ask in fever Hx

A

Nature

  • Swinging
  • Constant
  • How long

Resp Sx
- Haemoptysis / chest pain

GI

  • Stool - blood ?
  • Bloating / appetite / weight loss

GU

  • Urinary Sx and discharge
  • Any ulcers or lumps
  • HAEMATURIA

Neuro
- Headache / confusion / seizure

Skin = important

  • Rash
  • Ulcers - painless think STI
  • Swelling
  • Itch

Ocular
- Conjunctivitis - VHF?

Other

  • Myalgia / arthralgia
  • Night sweats
  • Bleeding ?
82
Q

What signs do you want to look for

A 
Lymphadenopathy 
- Cervical, axillary and inguinal 
Abdo exam 
- HSM / tender
Eyes
- Jaundice
- Conjunctival haemorrhage
Derm
- Eschar - dark crusted bite
- Rash 
Neuro
83
Q

When do you get conjunctival haemorrhage

A

Leptospirosis

84
Q

What is Eschar suggestive of

A

Anthrax

Plaque

85
Q

What is important in Hx of fever

A

Incubation

86
Q

What has short incubation <10 days

A 
COVID 
Malaria
Influenza - don't miss common
Dengue
Chikungungya
Typhoid
Ricketsia
Plaque
87
Q

What has intermediate

A

VHF
Lyme’s
Brucellosis
All above can also present

88
Q

What has long incubation >21 days

A 
Malaria
- Depending on species 
Hep ABCE
HIV 
Schistomiasis - Katayama
Leishmaniasis 
AMoebeiasis
TB
89
Q

What malaria is relapsing remitting

A

Ovale

90
Q

When would you alway contact infectious disease

A 
Recent travel + fever 
Rash + systemic Sx
Malaria 
Possible TB
Known HIV +Ve + unwell
91
Q

What investigations for undifferentiated fever + travel

A 
REFER SECONDARY to exclude differential 
Bloods in everyone
- FBC, U+E, LFT, CRP, clotting and gas
- Malaria rapid diagnostic test + thick and thin blood films 
Serology depending on Hx
- Monospot for EBV
- Dengue / syphillis / hepatitis / rickettsia 
Culture as many places
- Blood
- Urine dip and MC+S
- Can send urine for legionella and pneumococcal
- Sputum if productvie
- Stool
CXR
Swab 
- Any ulcer
- CVOID +- resp for common 
DONT FORGET HIV
92
Q

What is important to know with malaria

A

If falciparum present as this can rapid deteriorate

Infection (14 decks)

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