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Year 3: Block 1: Infection > Travel related infection > Flashcards

Travel related infection Flashcards

1
Q

Unfamiliar features of imported diseases (5)

A 
Presenting features
Isolation requirements 
Diagnostic methods
Treatment/Management
Unexpected complications
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2
Q

Give examples of how vulnerability with travellers increases away from home? (5)

A
  • Temptation to take risks away from home - food, sex
  • Different epidemiology of some diseases - HIV, aids, polio
  • Incomplete understanding of health hazards
  • Stress of travel
  • Refugees: deprivation, malnutrition, disease, injury
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3
Q

Name 4 infections that are common worldwide

A
  • influenza
  • community-acquired pneumonia
  • meningococcal disease
  • sexually transmitted diseases
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4
Q

Climate or environment related health problems

A 
Sunburn
Heat exhaustion and heatstroke
Fungal infections
Bacterial skin infections 
Cold injury
Altitude sickness
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5
Q

Give some examples of water related infections

A 
Schistosomiasis
Leptospirosis
Liver flukes
Strongyloidiasis
Hookworms
Guinea worms
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6
Q

Examples of Arthropod-borne infections

A

Malaria (mosquitos)
Dengue fever (mosquitos)
Rickettsial infections (ticks: typhus)
Leishmaniasis (sand flies: Kala-azar)

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7
Q

Important Tropical Diseases include (7)

A 
Malaria
Typhoid
Dengue Fever
Schistosomiasis
Rickettsiosis
Viral haemorrhagic fevers
Zika fever
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8
Q

What is the vector for malaria

A

female Anopheles mosquito

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9
Q

Malaria: 5 species - what one can be severe?

A 
Plasmodium falciparum 
Plasmodium vivax 
Plasmodium ovale 
Plasmodium malariae
Plasmodium knowlesi
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10
Q

Malaria - Clinical features - symptoms and signs

A 
- fever
rigors
aching bones
abdo pain
headache
dysuria
frequency
sore throat
cough

signs - splenomegaly
hepatomegaly
mild jaundice

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11
Q

Complications of Malaria (6)

A
  1. Cerebral malaria (encephalopathy)
  2. Blackwater fever
  3. Pulmonary oedema
  4. Jaundice
  5. Severe anaemia
  6. Algid malaria
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12
Q

Cerebral malaria (encephalopathy) often affects

A

non- immune visitors, children in endemic areas hypoglycaemia, convulsions, hypoxia

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13
Q

Blackwater fever causes

A

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

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14
Q

Malaria - diagnosis

A

Thick & thin blood films
Giemsa, Field’s stain

Quantitative buffy coat (QBC)
centrifugation, UV microscopy

Rapid antigen tests
OptiMal
ParaSight-F

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15
Q

Severity assessment - Complicated malaria = one or more of???

A 
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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16
Q

Treatment options for uncomplicated P. falciparum malaria (4)

A

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)

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17
Q

Treatment options for complicated or severe P. falciparum malaria?

A
  • IV artesunate (unlicensed in UK)
  • IV quinine

PLUS plus oral doxycycline (or clindamycin)

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18
Q

Treatment of P. vivax, P. ovale, P. malariae, P. knowlesi?

what can you afford to eradicate liver hypnozoites

A

chloroquine 3 days
Riamet - 3 days
primaquine

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19
Q

Typhoid (Enteric) Fever -organism names

A

Salmonella typhi

Salmonella paratyphi

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20
Q

Typhoid Fever: Clinical features - week 1-4

A

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

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21
Q

Typhoid fever incubation period

A

Incubation period: 7 days - 4 week

22
Q

Typhoid Fever: Diagnosis - clinical vs lab

A

Clinical - not easy, evolution of features

Laboratory (Salmonella typhi, S. paratyphi)
Culture blood, urine & stool
Culture bone marrow

23
Q

Typhoid Fever: Treatment

A

Oral Azithromycin

IV Ceftriaxone - (complicated)

24
Q

Commonest human arbovirus infection

A

Dengue

25
Q

Transmission of Dengue

A

Aedes aegypti

26
Q

Classical Dengue Fever (5)

A
  • Sudden fever
  • Severe headache, retro-orbital pain
  • Severe myalgia and arthralgia
  • Macular/ maculopapular rash
  • Haemorrhagic signs: petechiae, purpura, positive tourniquet test
27
Q

the rashes of Dengue fever

A

Macular rash

Petichial rash

28
Q

Dengue Diagnosis - clinical (4)

laboratory

A 
Clinical 
Thrombocytopenia
Leucopenia
Elevated transaminases
Positive tourniquet test

PCR, serology

29
Q

Dengue Management

prevention?

A

No specific therapeutic agents

avoid bites
new vaccine (Dengvaxia), 2016; limited use
30
Q

Dengue Management - complications (2) - how to treat?

A
  • Dengue haemorrhagic fever (DHF)
  • Dengue shock syndrome (DSS)

Rx: IV fluids, fresh frozen plasma, platelets

31
Q

Schistosomiasis is found in

A

fresh water and freshwater snails

32
Q

Schistosomiasis types (3)

A

S. haematobium
S. mansoni
S. japonicum

33
Q

Schistosomiasis - Clinical features

A
  • Swimmers Itch - 1st few hours
  • Invasive stage - 24 hrs
  • Katayama Fever
  • Acute disease (6-8 weeks)
  • Chronic disease
34
Q

Schistosomiasis - Clinical diagnosis

A

Antibody tests
Ova in stools and urine
Rectal snip

35
Q

Schistosomiasis - treatment (2)

A

PRAZIQUANTEL 20mg/kg, two doses 6hrs apart

Prednisolone if severe

36
Q

Tick typhus - what will show on the skin

A

Tick-bite eschar

Maculopapular rash

37
Q

Rickettsiosis - types

most common in UK and give a few more examples

A

Tick typhus (R. conorii, R. africae)

  • Rocky Mountain Spotted Fever (R. rickettsii)
  • Epidemic typhus (R. prowazekii)
38
Q

Rickettsiosis - CLINICAL features, diagnosis/management?

A

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

  • serology
    tetracycline
39
Q

Viral Haemorrhagic Fevers- ones rare to the UK but serious include? (4)

A

Ebola
Congo-Crimea haemorrhagic fever
Lassa fever
Marburg disease

40
Q

Some features of the Zika virus

A

flavivirus

  • daytime-biting Aedes mosquitos
  • sexual contact, blood transfusions
41
Q

Zika - clinical features (6)

A

no or mild symptoms - headache, rash, fever, malaise, conjunctivitis, joint pains (like dengue)

42
Q

Zika - in pregnancy

A

microcephaly and other neurological problems

43
Q

Zika infections can cause what condition?

A

Guillain-Barre syndrome

44
Q

Zika has no antiviral therapy so what must you do instead?

A

Mosquito control measures

Vaccines in development

45
Q

Examination signs - rash often caused by

A

typhoid, typhus, dengue

46
Q

Examination signs - jaundice - what condition

A
  • hepatitis, malaria, Yellow fever
47
Q

Examination signs - lymph nodes

A
  • leishmania, trypanosomiasis
48
Q

Examination signs - liver - condition?

A
  • malaria, typhoid, amoebic abscess
49
Q

Examination signs - spleen - condition ?

A

visceral leishmaniasis, typhoid, malaria

50
Q

Investigations for a returning traveller

A 
FBC
malaria films
liver function tests
stool microscopy &amp; culture
urine analysis &amp; culture
blood culture(s)
CXR
51
Q

Treatments for a returning traveller?

A

Isolation: ?personal protective equipment
Supportive measures (resuscitation)
Empirical treatment if patient unwell
Antimicrobial therapy based on likely diagnosis
aim to treat life-threatening conditions e.g. typhoid, septicaemia

Year 3: Block 1: Infection (14 decks)

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