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Y2 infection > travel related infection > Flashcards

travel related infection Flashcards

1
Q

unfamiliar features of imported diseases

A 
presenting features
isolation requirements
diagnostic methods
treatment/management 
unexpected complications
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2
Q

vulnerability of travelers to infection

A

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

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3
Q

common worldwide infections

A

influenza
community acquired pneumonia
meningococcal disease
STD

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4
Q

climate or environment related health problems

A 
sunburn 
heat exhaustion/heat stroke 
fungal infections 
bacterial skin infections 
cold injury
altitude sickness
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5
Q

how are infections controllable by public health measures

A

sanitation
immunisation
education

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6
Q

infections controllable by sanitation

A 
traveller's diarrhoea
typhoid 
hep A/E
giardiasis 
amoebiasis 
helminth infections 
viral gastroenteritis 
food poisoning 
shigella dysentery 
cholera
cryptosporidiosis
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7
Q

infections controllable by immunisation

A

poliomyelitis

diphtheria

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8
Q

infections controllable by education

A

HIV

STDs

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9
Q

water related infections

A

bathing in infected water

schistosomiasis 
leptospirosis 
liver flukes 
strongyloidiasis 
hookworks 
guinea worms
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10
Q

arthropod borne infections

A

mosquitos - malaria, dengue fever
mosquitoes - elephantiasis, filariasis
ticks - rickettsial infections, typhus
sand flies - leishmaniasis
tsetse fly - trypanosomiasis, sleeping sickness
black flies - river blindness, onchocerciasis

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11
Q

emerging infectious diseases

A 
COVID 19 - global pandemic 
zika - latin america, caribbean 
ebola - west africa 
MERS-CoV - middle east 
swine flu - worldwide
avian flu - china 
SARS: far east, worldwide
west nile virus - US
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12
Q

important tropical diseases

A 
malaria 
typhoid 
dengue fever 
schistosomiasis 
rickettsiosis 
viral haemorrhagic fevers
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13
Q

malaria epidemiology

A

most important imported disease
UK - 1400 cases p/a, 6 deaths p/a
worldwide - 207mln cases p/a, 627 000 deaths p/a

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14
Q

what cells does malaria effect

A

RBC

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15
Q

what areas of the world does malaria affect

A

tropics

subsaharan africa, northern parts of south africa, northern parts of south america, asia (indian subcontinent, SE Asia)

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16
Q

what is the vector for malaria

A

female anopheles mosquito

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17
Q

what are the 5 species of malaria

A

potentially severe: plasmodium falciparum

“benign”: P. vivax, P. ovale, P. malariae, P. knowlesi

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18
Q

symptoms of malaria

A 
fever 
rigors
aching bones
abdo pain 
headache 
dysuria 
frequency 
sore throat 
cough
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19
Q

signs of malaria

A

majority show none at the beginning
splenomegaly
hepatomegaly
mild jaundice

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20
Q

complications of malaria

A 
cerebral malaria (encephalopathy)
blackwater fever 
pulmonary oedema 
jaundice 
severe anaemia 
algid malaria
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21
Q

cerebral malaria

A

non-immune visitors
children in endemic areas

hypoglycaemia
convulsions
hypoxia

potentially fatal

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22
Q

blackwater fever

A 
severe intravascular haemolysis 
high parasitaemia 
profound anaemia 
hemoglobinuria 
acute renal failure
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23
Q

what is algid malaria

A

development of gram -ve septicaemia in those w/ malaria

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24
Q

malaria diagnosis

A

thick and thin blood films - giemsa, field’s stain

quantitative buffy coat (QBC) - centrifugation, UV microscopy

rapid antigen tests - optiMal, ParaSight-F

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25
Q

severity assessment

A

complicated malaria = one or more of:

impaired consciousness or seizures 
hypoglycaemia 
parasite count ≥2%
haemoglobin ≤8mg/dL 
spontaneous bleeding/DIC
haemoglobulinuria 
renal impairment or pH <7.3
pulmonary oedema or ARDS
shock (algid malaria) - ? gram -ve bacteraemia
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26
Q

2 main drugs for malaria treatment

A

quinine

artemisinins

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27
Q

treatment options for uncomplicated P. falciparum malaria

A

riamet - 3 days
eurartesim - 3 days
malarone - 3 days
quinine - 7 days plus oral doxycycline (or clindamycin)

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28
Q

side effects of quinine

A 
nausea
tinnitus 
deafness (cinchonism)
rash 
hypoglycaemia
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29
Q

treatment options for complicated or severe P. falciparum malaria

A

IV artesunate
IV quinine plus oral doxycycline (or clindamycin)

switch to oral treatments when pt is stable and able to swallow

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30
Q

side effects of IV quinine

A

cardiac depression
cerebral irritation
N+V

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31
Q

treatment of P. vivax, P. ovale, P. malariae, P. knowlesi

A

chlorquine - 3 days
riamet - 3 days

add primaquine (14 days) in vivax and ovale to eradicate liver hypnozonites

32
Q

malaria control programmes

A

mosquito breeding sites - drainage of standing water
larvacides into the water - paris green, temphos, biological
mosquito killing sprays - DDT, malathion, dieldrin
human behaviour - bed nets, mesh windows

33
Q

typhoid fever causative organisms

A

salmonella typhi

salmonella paratyphi

34
Q

epidemiology of typhoid fever

A

global - 27mln infections p/a
>200 000 deaths p/a
UK - 500 cases p/a

35
Q

how is typhoid fever spread

A

poor sanitation

unclean drinking water

36
Q

clinical features of typhoid fever - week 1

A 
fever 
headache 
abdo discomfort
constipation 
dry cough 
relative bradycardia 
neutrophilia 
confusion
37
Q

timeline for typhoid fever

A

incubation period - 7days-4wks

disease becomes apparent over next 4 wks

38
Q

clinical features of typhoid fever - week 2

A 
fever peaks at 7-10 days 
rose spots
diarrhoea
tachycardia 
neutropenia
39
Q

clinical features of typhoid fever - week 3 (complications)

A

intestinal bleeding
perforation
peritonism
metastatic infections

40
Q

what % of typhoid fever pts relapse

A

10-15%

41
Q

diagnosis of typhoid fever

A

not easy
based on evolution of clinical features

laborator: culture blood, urine and stool, sometimes culture bone marrow

42
Q

treatment of typhoid fever

A

oral azithromycin - drug of choice for asian-acquired, uncomplicated enteric fever
IV ceftriaxone - if complicated or concerned re absorption

43
Q

dengue

A

viral infection
commonest human arbovirus infection

100mln cases p/a
25 000 deaths p/a

disease of the tropics

44
Q

transmission of dengue

A

aedes aegypti mosquito

45
Q

clinical presentation of dengue fever

A 
sudden fever 
severe headache, retro-orbital pain 
severe myalgia and arthralgia 
macular/maculopapular rash 
haemorrhagic signs: petechiae, purpura, +ve tourniquet test
46
Q

dengue diagnosis

A

clinical: thrombocytopenia, leucopenia, elevated transaminases, +ve tourniquet test
lab: PCR, serology

47
Q

dengue management

A

no specific therapeutic agents

48
Q

complications of dengue

A

dengue haemorrhagic fever (DHF)
dengue shock syndrome (DSS)
rx: IV fluids, fresh frozen plasma, platelets

49
Q

prevention of dengue

A

avoid bits

new vaccine - limited use

50
Q

schistosomiasis transmission

A

fresh water
freshwater snails

parasitic infection

51
Q

schistosomiasis causative organisms

A

S. haematobium
S. mansoni
S. japonicum

52
Q

schistosomiasis clinical features

A 
swimmers itch (1st few hrs, clears in 24-28hrs)
invasive stage (after 24hrs)
katayama fever (15-20 days)
acute disease (6-8wks)
chronic disease
53
Q

schistosomiasis invasive stage

A

cough
abo discomfort
splenomegaly
eosinophilia

54
Q

schistosomiasis katayama fever

A 
prostate 
fever 
urticaria 
lymphadenopathy 
splenomegaly 
diarrhoea 
eosinophilia
55
Q

schistosomiasis acute disease

A

eggs deposited in bowel - dysentery

eggs deposited in bladder - haematuria

56
Q

diagnosis of schistosomiasis

A

clinical diagnosis
antibody tests
ova in stools and urine
rectal snip

57
Q

treatment of schistosomiasis

A

praziquantel 20mg/kg
2 doses 6 hrs apart

prednisolone if severe

58
Q

rickettsiosis

A

tick typhus (R. conorii, R. africae)

rocky mountain spotted fever (R. rickettsii)
epidemic typhus (R. prowazekii)
murine or endemic typhus (R. mooseri)
scrub typhus (R. tsutsugamushi) 
others
59
Q

commonest form of rickettsiosis imported to the UK

A

tick typhus

from southern africa, mediterranean, arabian gulf

60
Q

clinical features of rickettsiosis

A 
abrupt onset swinging fever 
headache 
confusion 
endovasculitis 
rash - macular, petechial
bleeding
61
Q

diagnosis of rickettsiosis

A

clinical features

serology

62
Q

management of rickettsiosis

A

tetracycline

63
Q

viral haemorrhagic fevers examples

A

ebola
congo-crimea haemorrhagic fever
lassa fever
marburg disease

serious infections but rare in UK

64
Q

management of viral haemorrhagic fevers

A

maximum incubation period 3 wks
rule out common severe infections
isolation - high security infection unit
supportive treatment

65
Q

Zika

A

flavirus
related to dengue, yellow fever, Jap B encephalitis, west nile viruses

pacific outbreak 2013-14 latin america pandemic - 2015-16

66
Q

how is zika virus transmitted

A

daytime biting Aedes mosquitoes
sexual contact
blood transfusion

67
Q

clinical features of Zika

A 
no or mild symptoms 
headache 
rash 
fever 
malaise
conjunctivitis 
joint pains

like dengue

68
Q

what can Zika infection in pregnancy result in

A

microcephaly

other neurological problems

69
Q

what syndrome can Zika lead to

A

Guillain-Barre

70
Q

management of Zika

A

no antiviral therapy
mosquito control measures
vaccines in development

71
Q

most common cause of fever in a returning traveller

A

malaria

72
Q

history for fever in a returning traveller

A 
is it tropical 
travel hx 
precautions taken 
risks 
symptoms 
incubation periods
73
Q

signs to look for in examination in fever in a returning traveller

A

rash - typhoid, typhus, dengue
jaundice - hepatitis, malaria, yellow fever
lymph nodes - leishmania, trypanosomiasis
liver - malaria, typhoid, amoebic abscess
spleen - visceral leishmaniasis, typhoid, malaria

74
Q

investigations for fever in a returning traveller

A 
FBC 
malaria films 
LFTs
stool microscopy and culture 
urine analysis and culture 
blood cultures
CXR 
specific tests as indicated
75
Q

treatment for fever in a returning traveller

A

isolation (? PPE)
supportive measures (resuscitation)
empirical treatment if patient unwell (antimicrobial therapy based on likely diagnosis, aim to treat life threatening conditions e.g typhoid, septicaemia)
specific treatment once diagnosis established

Y2 infection (15 decks)

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