Travel Related Infection Flashcards
what is malaria transmitted by?
the female anopheles mosquito
what organisms causes potentially severe forms of malaria?
plasmodium falciparum
name some signs of malaria
> none
splenomegaly
mild jaundice
hepatomegaly
name some symptoms of malaria
> fever > rigors > aching bones > abdominal pain > headache > dysuria > frequency > sore throat
what complications can arise from malaria?
> blackwater fever > pulmonary oedema > severe anaemia > algid malaria (gram negative septicaemia) > encephalopathy
how is malaria diagnosed?
> thick and thin blood films
rapid antigen tests
quantative buffy coats
when assessing the severity of malaria what presentation indicates it is complicated?
> hypoglycaemia > impaired consciousness > haemoglobinuria > renal impairment > pulmonary oedema > shock > spontaneous bleeding > ?haem <8mg? > parasite count 2% or more
how do you treat uncomplicated p. falciparum malaria?
> riamet 3 days
euratesim 3 days
malarone 3 days
quinine 7 days + oral doxycycline
how would you manage complicated severe p. falciparum?
> IV quinine + oral doxycycline
> IV artesunate
how would you manage vivax/ovale/malariae/Knowles malaria?
> chloroquine 3 days
> riamet 3 days (+ primaquine in ovale/vivax)
what methods of control exist to tackle malaria?
> draining standing water
larvicides
mosquito killing spray
behaviour (nets and mesh windows)
what is responsible for causing typhoid fever?
> salmonella typhi and paratyphi
what is the incubation period for typhoid fever?
7 days to 4 weeks
how does typhoid fever present in the 1st week?
> fever > confusion > abdominal discomfort > headache > constipation > dry cough > relative bradycardia > neutrophilia
how does typhoid fever present in the 2nd week?
> fever peaks at 7-10 days > rose spots > diarrhoea begins > tachycardia > neutropenia
what complications can occur in the 3rd week of typhoid fever?
> intestinal bleeding
perforation
peritonism
metastatic infections
what percentage of patients relapse in typhoid fever?
10-15%
how is typhoid fever diagnosed?
> clinically by evaluating features
> culture of urine, blood, stool and bone marrow
how is typhoid fever managed?
> oral azithromycin in Asian uncomplicated TF
> IV ceftriaxone in complicated TF
what transmits dengue fever?
aedes aegypti
how does dengue fever present?
> sudden fever > severe headache (retro orbital pain) > myalgia > arthralgia > macular popular rash > haemorrhagic signs (petechiae, purpura)
how is dengue fever diagnosed?
> clinically: leukopenia thrombocytopenia elevated transaminase positive tourniquet test
> lab:
serology
PCR
what are some complications of dengue fever?
> dengue haemorrhagic fever
> dengue shock syndrome
how is complicated dengue fever treated?
> IV fluids
plasma
platelets
how can dengue fever be prevented?
> avoiding bites
> vaccine (limited)
how is schistosomiasis transmitted?
via fresh water snail, the parasite then penetrates the skin and travels to the portal vein
name the parasites that cause schistosomiasis
> s. haematobium
s. mansoni
s. japonicum
what are the symptoms of schistosomiasis in the first few hours?
swimmers itch that clears in 48 hours
how does the invasive stage of schistosomiasis present?
> abdominal discomfort
cough
splenomegaly
eosonophillia
describe the katayama fever stage in schistosomiasis
> 15-20 days > fever > urticaria > diarrhoea > lymphadenopathy > eosinophilia
how does acute schistosomiasis disease present?
> 6-8 weeks
dysentery (with eggs in bowel)
haematuria
how is schistosomiasis diagnosed?
> clinically
ova in stools
rectal strip
antibody test
how is schistosomiasis treated?
> praziquantel
> prednisolone
what information would you want from a returning traveller who has a fever?
> other symptoms
where they went to
precautions they took
a returning traveller with a fever also presents with a rash.
give 3 differential diagnoses
> typhoid fever
typhus
dengue
a returning traveller with a fever also presents with jaundice.
give 3 differential diagnoses
> yellow fever
malaria
hepatitis
a returning traveller with a fever also presents with enlarged lymph nodes.
give 2 differential diagnoses
> leishmania
> trypanosomiasis
a returning traveller with a fever also presents with liver signs.
give 3 differential diagnoses
> malaria
typhoid
amoebic abscess
a returning traveller with a fever also presents with splenic signs.
give 3 differential diagnoses
> typhoid
malaria
visceral leishmiasis
what investigations would you want to carry out in a returning traveller with a fever?
> FBC > LFT's > malaria films > urinalysis and culture > stool microscopy and culture
what are the clinical features of rickediosis (tick typhus)?
> abrupt onset swinging fever > headache > bleeding > confusion > endovasculitis > rash (petechial and macular)
how is rickediosis treated?
tetracycline
what infections can cause viral haemorrhagic fever?
> Ebola
lassa-fever
Marburg disease
congo-crimea haemorrhagic fever
what is the max incubation time for viral haemorrhagic fever?
3 weeks
how does zika present?
> fever > rash > headache > malaise > conjunctivitis > joint pain > microcephaly > gaulliane barre syndrome
