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Infection > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

1
Q

What is heat exhaustion?

A

Inability to maintain CO with normal CNS function (core body temp not above 40C)

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2
Q

What is heat stroke??

A

Life-threatening condition in which body temp exceeds 41.1C because of in imbalance in heat generation and dissipation

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3
Q

What are climate/environment associated health problems travellers may be exposed to?

A 
Sunburn
Heat stroke/exhaustion 
Fungal infections
Bacterial skin infections
Cold injury 
Altitude sickness
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4
Q

What causes altitude sickness?

A

Hypoxaemia from low O2 levels

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5
Q

What are the symptoms of altitude sickness?

A

Headache, NV, fatigue, weakness, pitting oedema, epistaxis, dyspnoea

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6
Q

What diseases are controllable by improved sanitation?

A

Traveller’s diarrhoea, typhoid, hep A and E, giardiasis, amoebiasis, helminth infections, viral gastroenteritis, food poisoning, shigella dysentery, cholera, cryptosporidosis

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7
Q

What diseases are preventable by immunisation?

A

Polio, diphtheria

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8
Q

What diseases are preventable by education?

A

HIV/STIs

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9
Q

What water related infections are assoc. with travel?

A 
Schistosomiasis
Leptospirosis
Liver flukes
Strongyloidiasis
Hookworms
Guinea worms
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10
Q

What is schistosomiasis?

A

Parasitic disease caused by schistosomes (trematode)

Infection occurs when skin comes into contact with parasite infected water

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11
Q

What is leptospirosis?

A

Infection with leptospira bacteria
Direct transmission to humans when broken skin/mucous membranes come into contact with infected animal urine, e.g. rodents
Usually self-limiting, may progress to Weil’s disease

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12
Q

What are the three things assoc. with Weils disease?

A

AKI, jaundice, bleeding

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13
Q

What are liver flukes?

A

Parasitic trematode which are principally parasites of the liver

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14
Q

What is strongyloidiasis?

A

Nematode

Usually only seen in those returning from wet tropical areas

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15
Q

What are hook worms?

A

Intestinal roundworm parasites

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16
Q

What are guinea worms?

A

Worms residing in s/c tissue

Eventually emerges from the feet in most cases

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17
Q

What are the arthropod-borne infections?

A 
Malaria
Dengue fever
Rickettsial infection 
Leishmaniasis
Trypanosomiasis
Filarisis 
Onchocericiasis
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18
Q

What is malaria and dengue fever spread by?

A

Mosquitos

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19
Q

What is rickettsial infection spread by?

A

Ticks

Causes typhus

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20
Q

What transmits leishmaniasis?

A

Sand fly bite

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21
Q

What is the presentation of leishmaniasis?

A

Cutaneous/visceral manifestation

Most important visceral manifestation is kala-azar (weight loss, hepatosplenomegaly, immunosuppression)

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22
Q

What is typanosomiasis transmitted by?

A

Tsetse fly

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23
Q

What does trypanosomiasis cause?

A

Sleeping sickness (somnolence, coma, lymphadenopathy, recurrent fever)

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24
Q

What is filariasis spread by?

A

Mosquitos

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25
Q

What does filariasis cause?

A

Elephantiasis (enlargement and swelling of the lower limbs)

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26
Q

What is onchoceriasis spread by?

A

Black flies

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27
Q

What does onchoceriasis cause?

A

River blindness

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28
Q

What are the emerging infectious diseases assoc. with travel?

A 
Zika virus (Latin America, carribbean)
Ebola (w. Africa) 
MERS-CoV (middle east) 
Swine flu (H1N1) 
Avian flu (H5N1) 
SARS (far east) 
West nile virus (USA)
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29
Q

What causes malaria?

A

Plasmodium species

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30
Q

What is required for a country to be able to be at risk of malaria?

A

Mosquitos bread in stagnant water - so req. high rainfall, high humidity and temperature

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31
Q

What is the vector for malaria?

A

Female anopheles mosquito
Male feeds on nectar
Females req. nutrition from blood for development of their eggs

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32
Q

How do mosquitos know how to get to blood?

A

Follow CO2 and bodily smells

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33
Q

What is the lifecycle of malaria?

A

Blood meal from non-infected human by infected mosquito - sporozite enters human’s blood stream
Via bloodstream, sporozite travels to liver, where they reproduce in hepatic cells and mature into merozoites (host parenchymal cells die)
Merozites released in blood (invade RBCs & reproduce to produce lots of merozites –> bursting of RBCs) (this is the erythrocytic phase)
Merozites either re-enter erythrocytic phase or divide and give rise to gametes

Gametes can then be sucked up by uninfected female anopheles mosquito
Gametes fuse in mosquitos gut –> zygote
Zygote develops and eventually releases lots of sporozites which make their way to the salivary gland –> repeat whole process

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34
Q

What are the species of plasmodium?

A

Plasmodium falciparum (potentially severe)
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi (bottom 4 cause benign malaria)

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35
Q

What are the clinical features of malaria?

A 
Short bursts of fever
Headache
NV
Rigors
Aching bones/muscles
Abdominal pain 
Dysuria
Frequency
Sore throat
Dry cough 
Splenomegaly
Hepatomegaly
Mild jaundice

Most plasmodium infections have a mild course of symptoms and are considered uncomplicated malarial infections

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36
Q

What are the two types of complicated malaria?

A

Cerebral malaria

Blackwater fever

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37
Q

What occurs in cerebral malaria?

A

Brain is affected (haemolytic anaemia –> brain not getting enough oxygen)
Infarcts in brain tissue may result as parasited RBCs block off BVs –> ischaemia

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38
Q

What is the presentation of cerebral malaria?

A

Altered mental status, convulsions, seizures, coma

May also see gross arching of the back which is a sign of severe meningism

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39
Q

In which group of people is cerebral malaria most common?

A

Non-immune visitors and children

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40
Q

What does blackwater fever result from?

A

Severe intravascular haemolysis due to high parasitaemia leads to profound anaemia and Hb is released directly into BVs and urine
Often leads to AKI

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41
Q

What are the clinical features of blackwater fever?

A

Pulmonary oedema, jaundice, severe anaemia, algid anaemia (gram -ve septicaemia with malaria)

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42
Q

How do you manage malaria?

A

Mild - chloroquine

More serious - ITU and artesunate

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43
Q

How do you diagnose malaria?

A

Thick and thin blood films (+/- giemsa, field stain)
Quantitative buffy coat
Rapid antigen tests

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44
Q

What will you see on the thick and thin blood films for malaria?

A

RBCs with signet rings inside them

Multiple parasites in RBCs

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45
Q

What does quantitative buffy coat involve in malaria diagnosis?

A

Centrifugation to bring RBCs to the bottom and plasma to the top
UV microscopy under fluorescent light will allow for visualiation of parasites

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46
Q

What are the rapid antigen tests you can do for malaria?

A

OptiMal
ParaSight-F

Drop blood at one end of device - chemical reaction will tell you whether it is falciparum or not

47
Q

Complicated malaria = ?

A 
1+ of:
Impaired consciousness/seizures
Hypoglycaemia
Parasite count 2%+
Hb 8 or less
Spontaneous bleeding/DIC
Haemoglobulinuria 
Renal impairment or pH <7.3
Pulmonary oedema or ARDS
Shock (algid malaria)
48
Q

How do you treat uncomplicated falciparum infection?

A

Riamet (artemether-lumefantrine) 3 days
Eurartesim (dihydroartemisin-piperaquine) 3 days
Malarone (atovaquone-proguanil) 3 days
Quinine 7 days + oral doxycycline or clindaymycin

49
Q

How do you treat complicated falciparum?

A

IV artesunate
IV quinine & doxycycline/clindamycin
Parasite count >10% then exchange transfusion should be considered

50
Q

How do you treat P. vivax/ovale/malariae/knowlesi?

A

Chloroquine 3 days
Riamet 3 days
Add primaquine (14d) if vivax & ovale to get rid of liver hypnozites

51
Q

When prescribing riamet/eurartesim/malarone what must you check?

A

G6PD deficiency as can lead to anaemia in these patients

52
Q

What are the side effects of quinine?

A

Nausea, tinnitus, deafness, rash, hypoglycaemia, cardiac depression, cerebral irritation??

53
Q

What are the malaria control programmes?

A

Mosquito breeding sites drainage
Larvicides - biological, temphos
Mosquito killing sprays (DDT)
Human behaviour - bed nets, mesh windows

54
Q

What causes typhoid (enteric fever)?

A

Infectious disease caused by faecal-oral transmission of salmonella

55
Q

What are the two species of salmonella that cause typhoid fever?

A

Salmonella typhi and salmonella paratyphi

56
Q

What is the incubation period of typhoid fever?

A

7 days - 4 weeks

57
Q

What is the presentation of typhoid fever/

A

wk1 - headache, fever, discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion

wk2 - fever peaks, rose spots (chest, abdo), diarrhoea, begins, tachycardia, neutropenia

wk3 - clinical features of wk 2 + complications (e.g. intestinal bleeding, perforation, peritonism, metastatic infections)

wk4 - recovery for most

58
Q

What tests can help you diagnose typhoid fever?

A

Culture blood, urine and stool

Diagnosis made on blood culture!

59
Q

How do you treat typhoid fever?

A 
Oral azithromycin (uncomplicated) 
IV ceftriaxone (complicated)
60
Q

What is dengue fever?

A

Infection with dengue virus

Can progress to viral haemorrhagic fever

61
Q

What is the presentation of dengue fever in most people?

A

Mild and passes without lasting problems in about a week

62
Q

What species of mosquito carries the dengue virus?

A

Aedes aegypti species

63
Q

When do the Aedes aegypti species of mosquito tend to bite?

A

During the day or early evening before dusk

64
Q

Where are Aedes aegypti mosquitos often found?

A

Living around sources of stagnant water, e.g. wells/water tanks

65
Q

What is the classical presentation of dengue fever?

A 
Sudden fever
severe headache, retro-orbital pain 
Severe myalgia/arthalgia
Maculopapular rash 
Facial flushing
Pleuritic pain
66
Q

What is potentially life-threatening dengue fever called? What are its clinical manifestations?

A 
Dengue haemorrhagic fever (form of DIC)
Severe abdominal pain 
Abdominal swelling
Persistent vomiting (of blood) 
Difficulty breathing
Cold, clammy skin 
Purpura, petechiae
Positive tourniquet test
67
Q

What does a tourniquet test determine?

A

Capillary fragility & hence haemorrhagic potential

68
Q

How do you diagnose dengue fever?

A

Clinically - thrombocytopenia, leucopenia, elevated transaminases, positive tourniquet test
PCR and serology in the lab ca help

69
Q

How do you manage dengue fever?

A

Fluids and paracetamol

Complications: DHF & dengue shock syndrome (circulatory failure & DHF) - fluids, FFP, platelets

70
Q

How do you prevent dengue fever?

A

Avoid bites

New vaccine - limited use

71
Q

What is schistosomiasis?

A

Infection with schistosomes (flatworms)

72
Q

When should you think schistosomiasis?

A

Traveller returning with haematuria or dysentry

73
Q

Where is schistosomiasis most common?

A

Rural areas with freshwater sources and poor sanitation

74
Q

What are the species of schistosomes?

A

S. haematobium
S. mansoni
S. japonicum

75
Q

What is the life cycle of the schistosomes?

A

Infected human excretes schistosome eggs in urine/faeces
Eggs hatch in water and release miracidia
Miracidia infect fresh water snails (intermediate hosts) where they develop into cercaria and are released back into the water
When humans come into contact with contaminated water - cercaria can penetrate and enter circulation
Migration into portal blood and liver where they mature into adults
Paired adult worms migrate into mesenteric venules of bowel/rectum (laying eggs that circulate to liver and shed n the stools) or venous plexus of bladder depending on species

76
Q

What are the clinical features of schistosomiasis?

A 
Swimmer's itch (first few h) - clears after 24-48h
Invasive stage (after 24h) - cough, abdo discomfort, splenomegaly, eosinophilia
Katayama fever (after 15-20 days) - prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
Acute disease (6-8wks) - eggs deposited in bowel (dysentery) or bladder (haematuria)

Chronic disease (tends not to occur in travellers, but can lead to neurological problems)

77
Q

How do you diagnose schistosomiasis?

A

Clinical diagnosis
Antibody tests
Ova in stools/urine
Rectal snip

78
Q

How do you treat schistosomiasis?

A

Praziquantel 20mg/kg, 2 doses 6h apart

Prednisolone to dampen symptoms

79
Q

What is ricketsiosis/typhus?

A

Infection of 1+ ricketsial bacteria transmitted by fleas, lice, ticks, mites

80
Q

What species cause tick typhus?

A

R. conorri, R. africae

81
Q

What species cause rocky mountain spotter fever?

A

R. richettsii

82
Q

What species cause endemic typhus?

A

R. prowazekii

83
Q

What species causes murine/endemic typhus?

A

R. Mooseri

84
Q

What species causes scrub typhus?

A

R. tsutsugamushi

85
Q

What are the clinical features of tick typhus?

A

Abrupt onset swinging fever, headache, confusion, endovasculitis, rash (macular, petechial), bleeding

86
Q

How do you diagnose tick typhus?

A

Clinical, serology

87
Q

How do you manage tick typhus?

A

Tetracycline

88
Q

What are the viral haemorrhagic fever?

A

Ebola
Congo-Crimea haemorrhagic fever
Lassa fever
Marburg disease

89
Q

What is the maximum incubation period of the viral haemorrhagic fevers?

A

3 weeks

90
Q

How do you manage people with viral haemorrhagic fevers?

A

Rule out common severe infections, Rx supportive

91
Q

What kind of virus is vika virus?

A

Flavivirus

92
Q

What is zika virus transmitted by?

A

Day time biting by Aedes mosquito

Also spread by sexual contact and blood transfusion

93
Q

What are the clinical features of zika virus?

A

None/mild - headache, rash, fever, malaise, conjunctivitis, joint pains
GB syndromes

94
Q

In pregnancy what can zika virus lead to?

A

Microencephaly, other neurological problems

95
Q

How do you Rx zika virus?

A

No antivirals

Mosquito control measures

96
Q

What should you be aware of in trying to diagnose fever in a returning traveller?

A

It is most likely not tropical fever, e.g. just influenza

97
Q

What history should you take in fever in returning traveller?

A

Travel hx
Precautions taken
Risk
Symptoms

98
Q

What travel related infections will you see a rash in?

A

Typhoid
Typhus
Dengue

99
Q

What travel related infections will you see jaundice in?

A

Yellow fever
Malaria
Hepatitis

100
Q

What travel related infections will you see lymphadenopathy in?

A

Leishmaniasis, trypanosomiasis

101
Q

What travel related infections involve the liver?

A

Malaria, typhoid, amoebic abscess

102
Q

What travel related infections involve the spleen?

A

Visceral leishmaniasis, typhoid, malaria

103
Q

What things may mean people are protected from malaria?

A

Sickle cell trait
G6PD deficiency
HLA-B53
Absence of Duffy antigens

104
Q

What are different malaria prophylaxis regimens?

A

Atovaquone + proguanil (malarone)

Chloroquine

Doxycycline

Mefloquine (lariam)

Proguanil (paludrine)

Proguanil + chloroquine

105
Q

What are SEs of malarone?

A

GI upset

106
Q

What are SEs of chloroquine?

A

Headache
CI in epilepsy

NB take weekly

107
Q

What are SEs of doxycyline?

A

Oesophagitis

Photosensitivity

108
Q

What are SEs of lariam?

A

Dizziness
Neuropsychiatric disturbance
CI in epilepsy

NB also take weekly

109
Q

What advice should be given to pregnant woman re. malaria?

A

Avoid travelling to regions where it is endemic
If not -
Chloroquine can be used
Proguanil can only be taken with folate 5mg supplementation
Avoid others

110
Q

What are the criteria for severe falciparum malaria?

A 
High parasitaemia (>2%)
Hypoglycaemia
Severe anaemia
Renal failure
Pulmonary oedema
Metabolic acidosis
Abnormal bleeding
Multiple convulsions
Seizures
Shock
111
Q

What is yellow fever?

A

A type of viral haemorrhagic fever spread by the Aedes mosquito

112
Q

What are the features of yellow fever?

A

Flu like illness lasting <1 week
High fever, rigors, NV, bradycardia
Brief remission, followed by jaundice, haematemesis, oliguria

Councilman bodies may be seen in hepatocytes

113
Q

What vaccines are routinely offered to pregnant women?

A

Flu and pertussis

Infection (22 decks)

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