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Ethics and Law > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

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1
Q

What factors can make the individual more vulnerable to infections?

A

Temptation to take risks away from home
Different epidemiology (HIV and TB)
Incomplete understanding of health hazards
Stress of travel
Refugees or workers that move (bring infections)

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2
Q

What are the three main areas that can be controlled by public health measures?

A

Sanitation, immunisation and education

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3
Q

What are some examples of water-related infections?

A 
Schistosomiasis
Leptospirosis
Liver flukes
Strongyloidiasis
Hookworms
Guinea worms
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4
Q

What are some examples of arthropod-borne infections?

A

Malaria (mosquitos)
Dengue fever (mosquitos)
Rickettsial infections (ticks: typhus)
Leishmaniasis (sand flies: Kala-azar)
Trypanosomiasis (tsetse fly: sleeping sickness)
Filariasis (mosquitoes: elephantiasis)
Onchocerciasis (black flies: River Blindness)

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5
Q

What is the vector for malaria?

A

Female Anopheles mosquito

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6
Q

What are the 5 species of malaria?

A 
Plasmodium falciparum 


Plasmodium vivax 
Plasmodium ovale 
Plasmodium malariae
Plasmodium knowlesi
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7
Q

What is the most serve species for malaria?

A

Plasmodium falciparum

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8
Q

What are the signs and symptoms of malaria?

A 
SYMPTOMS
fever
rigors
aching bones
abdo pain
headache
dysuria
frequency
sore throat
cough
SIGNS
none
splenomegaly (chronic)
hepatomegaly (chronic)
mild jaundice
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9
Q

What are the complications of malaria?

A 
Cerebral malaria (encephalopathy)
non- immune visitors, children in endemic areas hypoglycaemia, convulsions, hypoxia

Blackwater fever
severe intravascular haemolysis, high parasitaemia, profound anaemia, haemoglobinuria, acute renal failure

Pulmonary oedema

Jaundice

Severe anaemia

Algid malaria

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10
Q

How is malaria diagnosed?

A 
Thick & thin blood films (Thick = presence, Thin= species)
- Giemsa, Field’s stain
Quantitative buffy coat (QBC) 
- centrifugation, UV microscopy 
Rapid antigen tests
- OptiMal
- ParaSight-F
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11
Q

What are the ancient malaria drugs?

A

Quinine (from chinchona) and Artemisinins (from Quinghaosu)

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12
Q

What are the treatment options for uncomplicated P.falciparum?

A

Riamet ® (artemether-lumefantrine) 3 days
Eurartesim ® (dihydroartemisinin-piperaquine) 3 days 

Malarone ® (atovaquone-proguanil) 3 days 

Quinine 7 days


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13
Q

What are the side effects of quinine?

A

S/E nausea, tinnitus, deafness (cinchonism), rash, hypoglycaemia 
 plus oral doxycycline (or clindamycin)

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14
Q

What are the treatment options for complicated or severe P.falciparum?

A 
IV artesunate (unlicensed in UK) 
IV quinine 
plus oral doxycycline (or clindamycin)

When patient is stable & able to swallow, switch to oral treatments

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15
Q

What is the treatment of P. viva, P.ovale, P.malariae and P.knowlesi?

A

chloroquine 3 days

Riamet ® (artemether-lumefantrine) 3 days 

add primaquine* (14 days) in vivax and ovale, to eradicate liver hypnozoites

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16
Q

What are the species involved in Typhoid Fever?

A

Salmonella typhi

Salmonella paratyphi

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17
Q

What are the species involved in Typhoid Fever?

A

Salmonella typhi

Salmonella paratyphi

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18
Q

How is it transmitted?

A

Contaminated food and water

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19
Q

What are the clinical features of Typhoid fever?

A

Incubation period: 7 days - 4 week
1st week: 
fever, headache, abdo. discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion
2nd week: 
fever peaks at 7-10 days, Rose spots, diarrhoea begins, tachycardia, neutropenia
3rd week (Complications): 
intestinal bleeding, perforation, peritonism, metastatic infections
week 4 (Recovery): 
10 - 15% relapse

20
Q

What is the treatment for uncomplicated typhoid fever?

A

Oral Azithromycin

21
Q

What is the treatment for complicated typhoid fever?

A

IV Ceftriaxone

22
Q

How is Dengue transmitted?

A

Aedes aegypti mosquito

23
Q

What is the classical clinical presentation of dengue fever?

A 
Sudden fever
Severe headache, retro-orbital pain
Severe myalgia and arthralgia
Macular/ maculopapular rash
Haemorrhagic signs: petechiae, purpura, positive tourniquet test
24
Q

What laboratory results would you expect in a pt with Dengue?

A

Thrombocytopenia
Leucopenia
Elevated transaminases

25
Q

How is Dengue diagnosed?

A

PCR and Serology

26
Q

What are the complications of Dengue?

A

Dengue haemorrhagic fever (DHF)

Dengue shock syndrome (DSS)

27
Q

How can you prevent Dengue?

A

Vaccine; Dengvaxia (limited use)

28
Q

Where is Schistosomiasis found in the environment?

A

Freshwater (snails)

29
Q

What are the different types of Schostosomiasis?

A

S. haematobium
S. mansoni
S. japonicum

30
Q

What are the clinical features of Schistosomiasis?

A 
Swimmers itch (hrs)
Invasive stage (>24hrs)
Katayama Fever (15-20 days)
Acute Disease (6-8 weeks)
Chronic Disease
31
Q

What are the symptoms of Katayama Fever?

A

Prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia

32
Q

How can you diagnose Schistosomiasis?

A

Clinical diagnosis
Antibody tests
Ova in stools and urine
Rectal snip


33
Q

What is the treatment for Schistosomiasis?

A

PRAZIQUANTEL 20mg/kg, two doses 6hrs apart

Prednisolone if severe

34
Q

What are the different types of Rickettsiosis?

A

Tick typhus: R.conorii and R.africae

35
Q

What are the clinical features of tick typhus?

A

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

36
Q

What is the management of Rickettsiosis/tick typhus?

A

Tetracycline

37
Q

What is the management of Rickettsiosis/tick typhus?

A

Tetracycline

38
Q

What are the serious viral haemorrhage fevers?

A

Ebola
Congo-crimea haemorrhagic fever
Lassa fever
Marburg Disease

39
Q

What is the management of viral haemorrhage fevers?

A

Isolation in a high security infection unit

and supportive treatment

40
Q

What is the organism that causes Zika?

A

Flavivirus

41
Q

How is Zika transmitted?

A

Day-time bitting Aedea mosquitos, sexual contact and blood transfusion

42
Q

What are the clinical features of Zika?

A

No or mild symptoms - headache, rash, fever, malaise, conjunctivitis, joint pains

43
Q

What are the complications of Zika in pregnant women?

A

Microcephaly and other neurological problems

44
Q

What complications can arise with Zika?

A

Guillain-Barre Syndrome

45
Q

What are the most common infections that occur in travellers?

A

Malaria, Hepatitis and undiagnosed

46
Q

What are the possible examination signs that can be seen and what are they associated with?

A

rash - typhoid, typhus, dengue


jaundice - hepatitis, malaria, Yellow fever


lymph nodes - leishmania, trypanosomiasis


liver - malaria, typhoid, amoebic abscess 


spleen – visceral leishmaniasis, typhoid, malaria

47
Q

What are the general investigation that need to be carried out?

A 
FBC
malaria films
liver function tests
stool microscopy & culture
urine analysis & culture
blood culture(s)
CXR

Ethics and Law (3 decks)

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