Travel related infection

Question 1

Public health measures to decrease infections

Answer 1

Sanitation - diarrhoea, typhoid
Immunisation- polio, diphtheria
Education- HIV, STDs

Question 2

Water-related infections

Answer 2

1. Schistosomiasis
2. Leptospirosis
3. Liver flukes
4. Strongyloidiais
5. Hookworms
6. Guinea worms

Question 3

Malaria vector

Answer 3

female anopheles mosquito

Question 4

Malaria species (5)

Answer 4

plasmodium: falciparum, vivex, ovale, malariae, knowlesi

Question 5

Malaria symptoms and signs

Answer 5

Fever, rigors, aching bones, abdo pain, headache, dysuria, frequency, sore throat, cough

hepatomegaly, splenomegaly, jaundice. can be no signs

Question 6

Complications of malaria (6)

Answer 6

1. cerebral malaria
2. blackwater fever
3. pulmonary oedema
4. Jaundice
5. severe anaemia
6. algid malaria (gram negative septicaemia)

Question 7

Diagnostic procedures

Answer 7

Thick and thin blood films
Quantitative buffy coat
Rapid antigen tests

Question 8

Complicated malaria

Answer 8

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

Question 9

Treatment of uncomplicated p. falciparum malaria

Answer 9

Riamet 3 days
Eurartesim 3 days
Malarone 3 days
Quinine 7 days

Question 10

Treatment of complicated/severe p.falciparum malaria

Answer 10

IV quinine (S/E cardia depression, cerebral irritation)

Question 11

Treatment of P.vivax, P.ovale, P.malariae, P.knowlesi

Answer 11

Choloroquine 3 days

Riamet 3 days

Question 12

Typhoid (why and pathogen)

Answer 12

Occurs due to poor sanitation, unclean drinking water

Pathogen: salmonella typhi, salmonella paratyphi

Question 13

Clinical features of typhoid

Answer 13

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

Question 14

Treatment of typhoid

Answer 14

Oral azithromycin

IV ceftriaxone - if complicated or absorption issues

Question 15

Dengue

Answer 15

Mosquito borne viral infection

Question 16

Presentation of dengue

Answer 16

sudden fever, severe headache - retro-orbital pain, severe muscle and joint pain. macular rash.

Positive tourniquet test

Question 17

Clinical features of dengue

Answer 17

Thrombocytopenia
Leucopenia
LFTs - elevated transaminases
Positive tourniquet test
Lab PCR, serology

Question 18

Treatment of Dengue

Answer 18

IV fluids
Fresh frozen plasma
Platelets

Question 19

Schistosomiasis

Answer 19

Fresh water snails.

Question 20

Presentation of Schistosomiasis

Answer 20

Swimmers itch > invasive stage > Katayama fever > acute disease (eggs deposited in bowel)

Question 21

Treatment of Schistosomiasis

Answer 21

Praziquantel

Prednisolone if severe

Question 22

Viral Haemorrhagic Fevers

Answer 22

Ebola, Lassa fever

maximum incubation period 3 weeks
supportive treatment

Question 23

The returning traveller - examination signs

Answer 23

rash - typhoid, typhus, dengue
jaundice - hepatitis, malaria, yellow fever
lymph nodes - leishmania
liver - malaria, typhoid, amoebic abscess
spleen - leishmaniasis, typhoid, malaria

Question 24

Investigations for returning traveller

Answer 24

Bloods: FBC, LFT, malaria films, blood cultures
Imaging: CXR
Other: stool microscopy and culture, urine analysis and culture