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Infection > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

1
Q

What factors make travellers more at risk from infection?

A

Temptation to take risks when away from home (food, water, animals, sex)
Different epidemiology of some diseases
Incomplete understanding of health hazards
Stress of travel
Refugees

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2
Q

What infections are common world wide?

A

Influenza
Community-acquired pneumonia
Meningococcal disease
Sexually transmitted disease

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3
Q

What are some climate/temperature related health problems?

A 
Sunburn
Heat exhaustion and heatstroke
Fungal infections
Bacterial skin infections 
Cold injury
Altitude sickness
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4
Q

What are some common water-related travel-related infections?

A 
Schistosomiasis
Leptospirosis
Liver flukes
Strongyloidiasis
Hookworms
Guinea worms
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5
Q

What are the common tropical diseases to be aware of?

A 
Malaria
Typhoid
Dengue Fever
Schistosomiasis
Rickettsiosis
Viral haemorrhagic fevers (ie ebola)
Zika fever
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6
Q

What pathology underlies a malaria infection?

A

parasites replicating within red blood cells, causing these cells to burst and the disease to spread to other red cells

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7
Q

Where is malaria most common?

A

In the tropics and subtropics

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8
Q

What is the vector for malaria?

A

The female anopheles mosquito

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9
Q

What is the non-benign species of malaria?

A

Plasmodium falciparum

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10
Q

What are the symptoms of malaria?

A 
Fever
Rigors
Aching bones
Abdominal pain
Headache
Dysuria
Frequency
Sore throat
Cough
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11
Q

What are the signs of malaria?

A

Often none
Splenomegaly
Hepatomegaly
Mild jaundice

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12
Q

What are the complications of malaria?

A

Cerebral malaria (potentially fatal, more common in non-immune visitors and children in endemic areas, causes hypoglycaemia, convulsions and hypoxia)
Blackwater fever (causes severe intravascular haemolysis, high parasitaemia, profound anaemia, haemoglobinuria and acute renal failure. Also causes urine to be very dark due to renal system damage) Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria (gram-negative septicaemia)

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13
Q

How is malaria diagnosed?

A

Thick and thin blood films (gold standard)- Giemsa, Field’s stain (can identify species of malaria)
Quantitative buffy coat- centrifugation, UV microscopy (quicker than blood films)
Rapid antigen tests- OptiMal, ParaSight-F (used when no access to healthcare)

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14
Q

How is malaria graded?

A 
Severe or non-severe
Severe if one or more of following present:
-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
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15
Q

What are the treatment options for uncomplicated P falciparum malaria?

A

Riamet- 3 days (first line)
Eurartesim- 3 days
Malarone- 3 days
Quinine plus oral doxycycline or clindamycin- 7 days

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16
Q

What are the treatment options for complicated P falciparum malaria?

A 
IV quinine (SE- cardiac depression, cerebral irritation, N&amp;V) plus oral doxycycline or clindamycin
IV artenusate (unlicensed in UK)
When patient is stable and able to swallow, switch to oral treatments
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17
Q

What are the other malarial species other than P. falciparum?

A

Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi

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18
Q

How are the other malarial species other than P. falciparum treated?

A

Cholorquine- 3 days
Riamet- 3 days
Add primaquine for 14 days in vivax and ovale to eradicate liver hypnozoites

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19
Q

What are some malarial control programmes?

A

Drainage of standing water to reduce mosquito breeding sites
Larvacides
Mosquito killing sprays (DDT, malathion)
Human behaviour (bed nets, mesh windows)

20
Q

What is the causative organism of typhoid/enteric fever?

A

Salmonella typhi

Salmonella paratyphi

21
Q

What are the clinical features of typhoid fever?

A

Incubation period of 1-4 weeks
1st week- fever, headache, abdominal discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion
2nd week- fever peaks at 7-10 days, Rose spots, diarrhoea, tachycardia, neutropenia
3rd week- intestinal bleeding, perforation, peritonism, metastatic infections
4th week- 10-15% relapse

22
Q

How is typhoid fever diagnosed?

A

Laboratory diagnosis through culture of:

  • Blood
  • Urine
  • Stool
  • Bone marrow
23
Q

How is typhoid fever treated?

A 
Oral azithromycin (uncomplicated)
IV ceftriaxone (complicated)
24
Q

What regions have the highest incidence of Dengue fever?

A

Southeast Asia
Southern America
Parts of Central Africa

25
Q

How is Dengue fever transmitted?

A

Via the aedes aegypti mosquito (lives in water)

26
Q

What are the clinical features 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
27
Q

How can diagnosis of Dengue fever be done?

A 
Clinical:
-	Thrombocytopenia
-	Leucopenia
-	Elevated transaminases
-	Positive tourniquet test- spots appear on arm when tourniquet applied
Laboratory: 
-	PCR
-	Serology
28
Q

How is Dengue fever treated?

A

No specific therapeutic agents

IV fluids, FFP and platelets helpful in preventing complications

29
Q

What are the complications of Dengue fever?

A

Dengue haemorrhagic fever

Dengue shock syndrome

30
Q

What are the microbial causes of schistosomiasis?

A

S. haematobium
S. mansoni
S. japonicum

31
Q

Where does schistosomiasis breed?

A

In freshwater and freshwater snails

32
Q

Where is schistosomiasis most common?

A

South America
Africa
Southeast Asia

33
Q

What are the clinical features of schistosomiasis?

A

Swimmers Itch (1st few hrs)
-clears 24-48hrs
Invasive stage (after 24hrs)
-cough, abdo discomfort, splenomegaly, eosinophilia
Katayama Fever (after 15-20 days)
-prostate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
Acute disease (6-8 weeks)
-eggs deposited in bowel (dysentery) or bladder (haematuria)
-Chronic disease

34
Q

How is schistosomiasis diagnosed?

A

Clinically
Serology
Presence of ova in stool or urine
Rectal snip (if rapid diagnosis required)

35
Q

How is schistosomiasis treated?

A

Two doses of praziquantel six hours apart

Prednisolone required in severe cases

36
Q

What are the features of tick typhus?

A

Result of infection from ticks typically in southern africa
Incubation period of one week
Maculopapular rash develops
Diagnosis done clinically

37
Q

What are the causes of rickettsiosis?

A 
Tick typhus
Rocky Mountain Spotted Fever (R. rickettsii)
Epidemic typhus (R. prowazekii)
Murine or endemic typhus (R. mooseri)
Scrub typhus (R. tsutsugamushi)
38
Q

What are the clinical features of rickettsiosis?

A 
Abrupt onset swinging fever
Headache
Confusion
Endovasculitis
Rash (macular, petechial)
Bleeding
39
Q

How is rickettsiosis diagnosed?

A

Clinically

Serology

40
Q

How is rickettsiosis treated?

A

Tetracycline

41
Q

What are the most common types of viral haemorrhagic fevers?

A

Ebola
Congo-Crimea haemorrhagic fever
Lassa fever
Marburg disease

42
Q

What is the incubation period for viral haemorrhagic fevers?

A

Maximum of three weeks

43
Q

How is Zika virus transmitted?

A

Aedes mosquito
Sexual contact
Blood transfusion

44
Q

What infections can Zika virus be related to?

A

Dengue fever
Yellow fever
Jap B encephalitis
West nile viruses

45
Q

What are the clinical features of Zika virus?

A 
Often no or mild symptoms
Headache
Rash
Fever
Malaise
Conjunctivitis
Joint pains
In pregnancy- microcephaly and other neurological problems such as Guillain-Barre syndrome

Infection (13 decks)

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