Travel Related Infection Flashcards
1
Q
Why are travellers at greater risk of infection?
A
Temptation to take risks away from home Different epidemiology of some diseases Incomplete understanding of health hazards Stress of travel Refugees
2
Q
Name 4 common worldwide infections
A
Influenza
Community-acquired pneumonia
Meningococcal disease
Sexually transmitted diseases
3
Q
What are the common environment-related health problems?
A
Sunburn Heat exhaustion and heatstroke Fungal infections Bacterial skin infections Cold injury Altitude sickness
4
Q
What factors an help manage controllable public health measures?
A
Sanitation
Immunisation
Education
5
Q
Education can help control which infections?
A
HIV
STDs
6
Q
Immunisation can help control which infections?
A
Polio
Diphtheria
7
Q
Why are Refugees at greater risk of infection?
A
Deprivation
Injury
Stress
Malnutrition
8
Q
What are the more common water-related infections?
A
Schistosomiasis Leptospirosis Liver flukes Strongyloidiasis Hookworms Guinea worms
9
Q
What are the common arthropod-borne infections?
A
Malaria Dengue fever Ricksettial infections (typhus) Leishmaniasis Trypanosomiasis Filariasis Onchocerciasis
10
Q
Which arthropod-borne infections are spread by mosquitos?
A
Malaria
Dengue fever
Filariasis
11
Q
What are the UK important Tropical Diseases?
A
Malaria Typhoid Dengue Fever Schistosomiasis Rickettsiosis Viral haemorrhagic fevers Zika fever
12
Q
Malaria is what?
A
Parasitic infection of RBC
13
Q
What is the most significant imported disease?
A
Malaria
14
Q
What is the distribution of malaria?
A
Tropics/subtropics
Subsaharan africa
Central america
India/SEA/islands
15
Q
What is the vector of malaria?
A
female Anopheles mosquito
Sporazoites into the blood which travel to the liver
16
Q
What are the most important species of malaria?
A
Plasmodium falciparum
17
Q
What are the benign species of malaria?
A
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi
18
Q
Symptoms of malaria
A
NON-SPECIFIC fever/rigors aching bones abdo pain headache dysuria frequency sore throat cough
19
Q
Signs of malaria
A
In ESTABLISHED malaria
Splenomegaly
Hepatomegaly
Mild jaundice
20
Q
Complications of malaria
A
Cerebral malaria Blackwater fever Pulmonary oedema Jaundice Severe anaemia Algid malaria
21
Q
Who are at risk of cerebral malaria?
A
non- immune visitors
children in endemic areas
22
Q
What is the presentation of cerebral malaria?
A
hypoglycaemia
convulsions
hypoxia
(meningitis symptoms)
23
Q
What is algid malaria?
A
Complication of severe malaria
Gram -ve septicaemia
24
Q
What is the presentation of blackwater fever?
A
Severe intravascular haemolysis High parasitaemia Profound anaemia Haemoglobinuria Acute renal failure
25
How is Malaria diagnosed?
Thick and Thin blood films (Giemsa, Field's stain)
Quantitative Buffy Coat (QBC)
Rapid Antigen Tests
26
How is complicated malaria assessed?
```
One or more of:
Impaired consciousness or seizures
Hypoglycaemia
Parasite count >2%
Haemoglobin <8mg/dL
Spontaneous bleeding / DIC
Haemoglobinuria
Renal impairment or pH <7.3
Pulmonary oedema or ARDS
Shock (algid malaria)
```
27
Treatments for uncomplicated P. falciparum?
Riamet 3 days
Eurartesim 3 days
Malarone 3 days
Quinine 7 days (plus oral Doxycycline/Clindamycin)
28
Typhoid fever is caused by what?
Salmonella typhi
29
How common is Typhoid globally?
27 million infections
30
How is Typhoid spread?
Poor sanitation
| Unclean drinking water
31
What is the incubation period of Typhoid fever?
7d - 4wk
32
What is the most common arbovirus infection?
Dengue
33
How many dengue deaths occur a year?
25,000
34
How many dengue infections occur a year?
100 million/year
35
What is the vector for dengue fever?
Water Mosquitoes - Aedes aegypti
36
How does Dengue fever present?
```
Sudden fever
Headache
Myalgia/arthralgia
Macular/maculopapular rash
Petechiae
Purpura
+ve Tourniquet test
```
37
How is Dengue Diagnosed?
```
Clinical presentation
Tourniquet test
Transaminases
Elevated platelets/WCC
PCR
Serology
```
38
How is Schistosomiasis spread?
Fresh water - freshwater snails
39
What organisms cause schistosomiassis?
S. haematobium
S. mansoni
S. japonicum
40
What are the generalised malaria drugs?
Quinine
| Artemisinins
41
What are the treatment options for complicated/severe P. falciparum malaria?
IV artesunate
| IV quinine + oral doxycycline/clindamycin
42
What are the treatment options for non-P. falciparum malaria?
Chloroquine 3 days
Riamet 3 days
Primaquine (P. vivax, ovale)
43
How is Primaquine used in Malaria?
P. vivax and P. ovale for liver hypnozoites
| Be aware of G6PD deficiency
44
What are the available Malaria control programs?
Mosquito breeding site removal - standing water
Larvacides
Mosquito killing sprays
Human behaviour
45
What can humans do to reduce the spread of malaria?
Bed nets
| Mesh windows
46
What are the clinical features of Typhoid fever?
```
7d-4wk incubation
1st week:
Fever, headache, abdominal pain, constipation, bradycardia, confusion
2nd week:
Fever peaks 7-10 days
Rose spots
Tachycardia
Diarrhoea
3rd week (complications):
Intestinal bleeding
Perforation
Peritonitis
4th week (recovery):
10-15% relapse
```
47
How is Typhoid fever diagnosed?
Evolution of features
Stool culture, urine and stool
Bone marrow culture
48
How is Typhoid feature treated?
Oral Azithromycin - uncomplicated
| IV Ceftriaxone - complicated
49
How is Dengue fever managed?
No treatment
Manage complications
Prevent
50
How is Dengue fever prevented?
Avoid bites
| Vaccine
51
What are the complications of Dengue fever?
Dengue haemorrhagic fever
| Dengue Shock syndrome
52
How are the complications of Dengue fever managed?
IV fluids
Fresh frozen plasma
Platelets
53
What is the life cycle of Schistosomiasis?
Schistosomiasis release eggs into water
These live in snails as sporocysts
Mature and penetrate the skin
Live in bowel/rectum
54
What is the clinical presentation of schistosomiasis?
```
Swimmer's itch
Invasive stage
Katamaya Fever
Acute Disease
Chronic disease
```
55
How does the invasive stage of schistosomiasis present?
```
After 24hrs
Cough
Abdo discomfort
Splenomegaly
Eosinophilia
```
56
How does the Katayama fever stage of schistosomiasis present?
```
After 15-20 days
Prostrate
Fever, urticaria
Lymphadenopathy
Splenomegaly
Diarrhoea
Eosinophilia
```
57
How long does the acute phase of schistosomiasis last?
6-8 weeks
58
How is schistosomiasis diagnosed?
Clinical
Antibody Tests
Ova in stools and urine
Rectal snip
59
How is schistosomiasis treated?
Praziquantel 20mg/kg, 2 doses, 6hrs apart
| Prednisolone if severe
60
How does Tick Typhus present?
```
Tick-bite Eschar
Maculopapular rash
Abrupt swinging fever
Headache
Confusion
Bleeding
```
61
What species cause Tick Typhus?
Rickettsiosis conorii, R. africae
62
Where is Tick Typhus endemic?
Southern africa
Mediterranean
Arabian Gulf
63
How is Tick Typhus diagnosed?
Clinical features
| Serology
64
How is Tick Typhus treated?
Tetracycline
65
What are the most common viral Haemorrhagic fevers?
Ebola
Congo-Crimea haemorrhagic fever
Lassa fever
Marburg disease
66
How are viral haemorrhagic fevers managed?
3 week incubation
Rule out common infections
High Security Infection Unit
Supportive management
67
What type of virus is Zika?
Flavivirus
68
How is Zika transmitted?
Daytime-biting Aedes mosquitoes
Sexual contact
Blood transfusion
69
Where is Zika Endemic?
Mexico to brazil (central america)
70
How does Zika present?
Mild symptoms - headache, rash, fever, malaise, conjunctivitis, joint pain
Teratogenic
Guillain-Barre
71
What is the impact of Zika on Pregnancy?
Microcephaly
| Neurological issues
72
How is Zika managed?
Vaccines
| Mosquito control measures
73
What are the most common causes in returned traveller fever?
```
Malaria 30-40%
Hepatitis
URTI
UTI
Undiagnosed (25%)
```
74
Which travel-related infectious diseases commonly cause rash?
Typhoid
Typhus
Dengue
75
Which travel-related infectious diseases commonly cause jaundice?
Hepatitis
Malaria
Yellow fever
76
Which travel-related infectious diseases commonly cause lymphadenopathy?
Leishmeniasis
| Trypanosomiasis
77
Which travel-related infectious diseases commonly cause liver issues?
Malaria
Typhoid
Amoebic abscess
78
Which travel-related infectious diseases commonly cause spleen issues?
Visceral Leishmaniasis
Typhoid
Malaria
79
What investigations are used in travel-related infectious diseases?
```
FBC
Malaria films
LFTs
Stool microscopy & culture
Urine analysis & culture
Blood culture
CXR
Specific tests for pathogens
```
80
Generally, how are travel-related infectious diseases treated?
Isolation
PPE
Supportive measures
