Travel related infection Flashcards
What are the unfamiliar features of imported diseases?
○ Presenting features ○ Isolation requirements ○ Diagnostic methods ○ Treatment/ Management ○ Unexpected complications
Why are travelers valnerable to infection?
○ Temptation to take risks away from home
- food, water, animals, sex
○ Different epidemiology of some diseases
- HIV, TB, polio, diphtheria
○ Incomplete understanding of health hazards
○ Stress of travel
○ Refugees: deprivation, malnutrition, disease, injury
Give examples of water related infections
○ Schistosomiasis ○ Leptospirosis ○ Liver flukes ○ Strongyloidiasis ○ Hookworms ○ Guinea worms
Give examples of arthropod-borne infections
○ 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)
What is the epidemiology
of malaria?
- Most important imported disease
- United Kingdom (HPA, 2015)
□ 1400 cases/year
□ 6 deaths/year - Worldwide (WHO, 2012)
□ 207 million cases/year
□ 627,000 deaths/year
What are the symptoms of malaria?
□ fever □ rigors □ aching bones □ abdominal pain □ headache □ dysuria □ frequency □ sore throat □ cough
What are the signs of malaria?
□ None
□ Splenomegaly
□ Hepatomegaly
□ Mild jaundice
What are the complications of malaria?
- 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 □ Gram-negative septicaemia
How is malaria diagnosed?
- Thick & thin blood films □ Giemsa, Field’s stain - Quantitative buffy coat (QBC) □ centrifugation, UV microscopy - Rapid antigen tests □ OptiMal □ ParaSight-F
How is the severity of malaria assessed?
- Complicated malaria= 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) ® Gram negative bacteraemia
What are the treatment options for uncomplicated falciparum malaria?
- Riamet ® (artemether-lumefantrine) 3 days
- Eurartesim ® (dihydroartemisinin-piperaquine) 3 days
- Malarone ® (atovaquone-proguanil) 3 days
- Quinine 7 days
□ S/E nausea, tinnitus, deafness (cinchonism), rash, hypoglycaemia
□ plus oral doxycycline (or clindamycin)
What is the treatment for complicated or severe P. falciparum
- IV artesunate (unlicensed in UK)
- IV quinine
□ (S/E cardiac depression, cerebral irritation, N&V)
□ plus oral doxycycline (or clindamycin) - When patient is stable & able to swallow, switch to oral treatments
What is the treatment of P. vivax, P. ovale, P. malariae and P. knowlesi?
- chloroquine 3 days
- Riamet ® (artemether-lumefantrine) 3 days
□ add primaquine* (14 days) in vivax and ovale, to eradicate liver hypnozoites (*check for G6PD deficiency)
Give examples of malaria control programs
- Mosquito breeding sites □ Drainage of standing water - Larvacides □ (Paris green), temphos, biological - Mosquito killing sprays □ DDT, malathion, (dieldrin) - Human behaviour □ Bed nets □ Mesh windows
What organisms cause typhoid?
- Salmonella typhi
- Salmonella paratyphi
What is the epidemiology of typhoid
- Global cases: 27 million infections/year
- Global deaths: over 200,000/year
- UK cases: 500/year
- Widespread
□ poor sanitation, unclean drinking water
