Travel related infection Flashcards
Public health measures to decrease infections
Sanitation - diarrhoea, typhoid
Immunisation- polio, diphtheria
Education- HIV, STDs
Water-related infections
- Schistosomiasis
- Leptospirosis
- Liver flukes
- Strongyloidiais
- Hookworms
- Guinea worms
Malaria vector
female anopheles mosquito
Malaria species (5)
plasmodium: falciparum, vivex, ovale, malariae, knowlesi
Malaria symptoms and signs
Fever, rigors, aching bones, abdo pain, headache, dysuria, frequency, sore throat, cough
hepatomegaly, splenomegaly, jaundice. can be no signs
Complications of malaria (6)
- cerebral malaria
- blackwater fever
- pulmonary oedema
- Jaundice
- severe anaemia
- algid malaria (gram negative septicaemia)
Diagnostic procedures
Thick and thin blood films
Quantitative buffy coat
Rapid antigen tests
Complicated malaria
Involves one or more of:
Brain: Impaired consciousness/seizures
Blood: Hypoglycaemia, parasite count high, reduced haemoglobin, spontaneous bleeding
Renal: haemoglobinuria, renal impairment or pH <7.3
Resp: pulmonary oedema or ARDS
Shock - ?algid malaria
Treatment of uncomplicated p. falciparum malaria
Riamet 3 days
Eurartesim 3 days
Malarone 3 days
Quinine 7 days
Treatment of complicated/severe p.falciparum malaria
IV quinine (S/E cardia depression, cerebral irritation)
Treatment of P.vivax, P.ovale, P.malariae, P.knowlesi
Choloroquine 3 days
Riamet 3 days
Typhoid (why and pathogen)
Occurs due to poor sanitation, unclean drinking water
Pathogen: salmonella typhi, salmonella paratyphi
Clinical features of typhoid
Clinical diagnosis difficult as it comes from the progression.
Incubation 1-4weeks
Week 1: fever headache, ando, constipation, dry cough, bradycardia, neutrophilia, confusion
Week 2: peak fever, rose spots, diarrhoea, tachy, neutropenia
Week 3: complications: intestinal bleeding, perforation, peritonism, metastatic infections.
Week 4: recovery - 10-15% relapse
Treatment of typhoid
Oral azithromycin
IV ceftriaxone - if complicated or absorption issues
Dengue
Mosquito borne viral infection
Presentation of dengue
sudden fever, severe headache - retro-orbital pain, severe muscle and joint pain. macular rash.
Positive tourniquet test
Clinical features of dengue
Thrombocytopenia Leucopenia LFTs - elevated transaminases Positive tourniquet test Lab PCR, serology
Treatment of Dengue
IV fluids
Fresh frozen plasma
Platelets
Schistosomiasis
Fresh water snails.
Presentation of Schistosomiasis
Swimmers itch > invasive stage > Katayama fever > acute disease (eggs deposited in bowel)
Treatment of Schistosomiasis
Praziquantel
Prednisolone if severe
Viral Haemorrhagic Fevers
Ebola, Lassa fever
maximum incubation period 3 weeks
supportive treatment
The returning traveller - examination signs
rash - typhoid, typhus, dengue
jaundice - hepatitis, malaria, yellow fever
lymph nodes - leishmania
liver - malaria, typhoid, amoebic abscess
spleen - leishmaniasis, typhoid, malaria
Investigations for returning traveller
Bloods: FBC, LFT, malaria films, blood cultures
Imaging: CXR
Other: stool microscopy and culture, urine analysis and culture
