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Infection > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

1
Q

Factors that can make travellers vulnerable to infection

A 
Temptation to take risks away from home
- food
- water
- animals
- sex
Different epidemiology of some diseases 
- HIV, TB, Polio, diptheria 
Incomplete understanding of health hazards
Stress of travel 
Refugees 
- deprevation 
- malnutrition 
- disease
- injury
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2
Q

Climate or environment related health problems

A 
Sunburn 
Heat exhaustion/Heat stroke
Fungal infections
Bacterial skin infections
Cold injury 
Altitude sickness
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3
Q

Infections that are controllable by sanitation

A 
Traveller's diarrhoea
Hep A or E 
Typhoid 
Food poisoning
Cholera
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4
Q

Water related infections include

A

Schistosomiasis
Leptospirosis
Liver flukes

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5
Q

What is malaria’s vector?

A

Female anopheles mosquito

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6
Q

What is dengue fever vector?

A

Mosquitos

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7
Q

What is leishmaniasis’s vector?

A

Sand flies

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8
Q

Definition of malaria

A

Parasitic infection of red blood cells

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9
Q

Malaria life cycle

A
  1. mosquito bite
  2. sporozoites injected into bloodstream which rapidly migrate to liver cells
  3. multiple in liver cells to merozoites
  4. these go to red cells and replicate and make them burst
  5. A cycle of replication is made
  6. Male and female gameotocytes replicate inside the mosquitos gut
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10
Q

5 species of malaria

A 
plasmodium falciparum (serious)
plasmodium vivax
plasmodium ovale
plasmodium malariae
plasmodium knowlesi
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11
Q

Presentation of malaria

A 
Fever and rigors
Aching bones
Abdominal pain 
Headache
Dysuria 
Frequency 
Sore throat
Cough 
Majority no signs until established disease 
- splenomegaly 
- hepatomegaly
- jaundice
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12
Q

Complications of malaria

A 
Cerebral malaria (encephalopathy)
Blackwater fever 
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria
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13
Q

Definition of algid malaria

A

Gram -ve septicaemia

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14
Q

Investigations of malaria

A

Thick and thin blood films
Quantative buffy coat (QBC)
Rapid antigen tests

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15
Q

Complicated malaria means one or more of…..

A

Impaired consciousness/seizures
Hypoglycaemia
Parasite count >_2%
haemoglobin

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16
Q

Treatment of uncomplicated P. Falciparum malaria

A

Rimamet, euratesim and malarone for 3 days OR

Quinine 7 days plus oral doxycycline/clindamycin

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17
Q

Treatment of complicated or severe P. falciparum malaria

A

IV quinine plus oral doxycycline/clindamycin

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18
Q

Treatment of benign species of malaria

A

Cholorqine 3 days
Riamet 3 days
Add primaquine (14 days) in vivax + ovale to eradicate liver hypnozoites

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19
Q

Malaria control measures

A 
Mosquito breeding sites
- drainage of standing water
Larvacides
Mosquitos killing sprays (DDT)
Human behaviour 
- DDT
- bed nets
- mesh windows
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20
Q

Causative organisms of typhoid (enteric) fever

A

Salmonella typhi

Salmonella paratyphi

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21
Q

Causes of typhoid fever

A

Poor sanitation

Unclean drinking water

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22
Q

How is typhoid fever transmitted?

A

Faecal-oral route

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23
Q

Incubation time for typhoid fever

A

7 days - 4 weeks

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24
Q

Presentation of typhoid fever

A 
1st week 
- fever
- headache
- abdominal discomfort 
- constipation 
- dry cough 
- relative bradycardia
- neutrophilia
- confusion 
2nd week 
- fever peaks 7-10 days
- rose spots
- diarrhoea begins
- tachycardia
- neutropenia 
3rd week (complications)
- intestinal bleeding
- perforation 
- peritonism 
- metastatic infections 
4th week (recovery)
- 10-15% relapse
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25
Q

Investigations for typhoid fever

A

Blood culture
urine culture
stool culture
Bone marrow culture

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26
Q

Treatment of typhoid fever

A

uncomplicated, Asian acquired
- oral azithromycin
Complicated/concerning
- IV ceftriaxone

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27
Q

What is the commonest human arbovirus infection?

A

Dengue fever

28
Q

Where is dengue fever found?

A

South of the equator - tropical conditions

29
Q

Presentation of dengue fever

A 
Sudden fever
Severe headache, retro-orbital pain 
Severe myalgia and arthralgia 
Macular/maculopapular rash 
haemorrhagic 
- petechiae, purpura
30
Q

Investigations for dengue fever

A 
Clinical 
- thrombocytopenia
- leucopenia
- elevated transaminases
- positive tourniquet test
PCR
Serology
31
Q

Treatment for dengue fever

A

No treatment

32
Q

Complications of dengue fever

A

Dengue haemorrhagic fever (DHF)

Dengue shock syndrome (DSS)

33
Q

Treatment of complications of dengue fever

A

IV fluids
Fresh frozen plasma
Platelets

34
Q

Prevention of dengue fever

A 
Avoid bites
New vaccine (degvaxia)
35
Q

Where is schistosomiasis found?

A

Fresh water and fresh water snails

36
Q

Types of Schistosomiasis

A

S. Haematobium
S. mansoni
S. japonicum

37
Q

Life cycle of schistosomiasis

A
  1. Eggs in faeces and urine
  2. Eggs hatch releasing miracidia
  3. Miracidia penetrate snail tissue
  4. Sporocysts in snail (successive generation)
  5. Cercarial released by snail into water and free swimming
  6. Penetrate skin
  7. Cercarial lose tails during penetration and become schistosomulae
  8. circulation
  9. Migrate to portal circulation in liver and mature into adults
  10. Paired adult worms migrate to
    - mesenteric venules of bowels/rectum (layering eggs that circulate to the liver and shred in stools)
    - venous plexus of the bladder
  11. excreted out in faeces/urine (eggs)
38
Q

Presentation of schistosomiasis

A 
Swimmers itch in first few hours - clears after 24-48 hours
Invasive stage (after 24 hours)
- cough 
- abdominal discomfort
- splenomegaly
- eosinophilia 
Katayama fever (After 15-20 days)
- prostate
- fever
- urticaria
- lymphadenopathy 
- splenomegaly
- diarrhoea
- eosinophilia 
Acute disease (6-8 weeks)
- eggs deposited in bowel (dysentery) or bladder (haematuria)
39
Q

Investigations for schistosomiasis

A

Clinical
Antibody tests
Ova in stools and urine
Rectal snip

40
Q

Treatment for schistosomiasis

A

Praziquantel 2 doses 6 hours apart

Prednisolone if severe

41
Q

Presentation of Rickettsiosis/tick typhus

A 
Tick bite eschar
Maculopapular rash 
Abrupt onset swinging fever
Headache
Confusion 
Endovasculitis
Rash (macular, petechial)
bleeding
42
Q

Diagnosis of ricketsiosis/tick typhus

A

Clinical features

Serology

43
Q

Treatment of tick typhus/rickettsiosis

A

Tetracycline

44
Q

Maximum incubation period of viral haemorrhagic fevers

A

3 weeks

45
Q

Examples of viral haemorrhagic fever infections

A

Ebola
Lassa fever
Marburg disease

46
Q

Treatment of viral haemorrhagic fevers

A

Supportive

47
Q

Transmission of zika virus

A

daytime-biting aedes mosquito
sexual contact
blood transfusion

48
Q

What is the Zika virus related to?

A

Dengue
Yellow fever
Jap B encephalitis
West nile virus

49
Q

Presentation of zika virus

A 
No or mild symptoms
- headache
- rash 
- fever
- malaise
- conjunctivitis 
- joint pains (like dengue)
In pregnancy 
- microencephaly and other neurological problems
Guillian barre syndrome
50
Q

Treatment of the zika virus

A

No treatment

51
Q

Investigations of a returning traveller with a fever

A 
FBC
Malaria films
LFTs
Stool microscopy/culture
Urinalysis + culture 
Blood cultures
CXR
Specific tests for specific diseases as indicated
52
Q

If a rash and fever on examination, what can this indicated in a returning traveller?

A

Typhoid
Typhus
Dengue

53
Q

What can jaundice and fever on examination of a returning traveller indicate?

A

Leishmania

Trypanosomiasis

54
Q

What can liver signs and fever suggest in a returning traveler?

A

Malaria
Typhoid
Ameobic abscess

55
Q

What can spleen signs and fever suggest in a returning traveler?

A

Visceral leishmaniasis
Typhoid
Malaria

56
Q

Treatment of non falciparum acute malaria

A

Chloroquine

57
Q

Most common non falciparum malaria

A

Plasmodium vivax

58
Q

What is yellow fever spread by?

A

Aedes mosquito

59
Q

Incubation of yellow fever

A

2 - 14 days

60
Q

Presentation of yellow fever

A

Mild flu like illness lasting < 1 week
Sudden onset high fever, rigours, N + V, bradycardia
Brief remission
Then jaundice, haematemesis, oliguria

61
Q

What may be seen in hepatocytes in yellow fever?

A

Councilman bodies (inclusion bodies)

62
Q

Transmission of typhoid

A

Faecal oral (and contaminated food and water)

63
Q

Presentation of typhoid

A 
Headache 
Fever
Arthrlagia 
Relative bradycardia
Abdominal pain and distension 
Rose spots (trunk in 40%) - more common in parathyroid
64
Q

Complications of typhoid

A 
Osteomyelitis 
GI bleed / perforation 
Meningitis 
Cholecystitis 
Chronic carriage (1% - more likely if adult females)
65
Q

Treatment of amoebiasis

A

Metronidazole

Infection (16 decks)

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