Travel related infections

Question 1

What are some common/important travel related infections?

Answer 1

Malaria, Dengue, Schistosomiasis, Zika, HIV, cholera, Typhoid, Hep A or E.

Question 2

Name a few reasons why travellers are vulnerable to infection

Answer 2

Temptation to take risks away from home, such as with food, water, animals and sex
Different epidemiology of some diseases e.g. TB, polio, diphtheria, HIV
Incomplete understanding of health hazards
Stress of travel (on the immune system)
Refugees are at increased risk because of deprivation, malnutrition, disease and injury

Question 3

What infections are transmitted by arthropods?

Answer 3

Malaria-mosquitoes
Dengue fever- mosquitoes
Rickettsial infections- ticks/typus
Leishmaniasis- sand flies
Trypanosomiasis -tsetse fly
Filariasis/elephantiasis- mosquitoes
Onchocerciasis/river blindness- black flies

Question 4

How is Malaria transmitted?

Answer 4

Female anopheles mosquito

Question 5

What countries is Malaria usually found in?

Answer 5

Much of the continent of Africa, Northern parts of South America and some of central America, South and South East Asia.
The golden triangle (Thialand, Loas and Malaysia) often have the most resistant type of Malaria.

Question 6

What are the symptoms/signs of Malaria and what is the species which can be most severe?

Answer 6

Fever, rigors, aching bones, abdo pain, headache, dysuria, sore throat, cough, splenamegaly, hepatomegaly, mild jaundice.
(all causative species are Plasmodium) the potentially severe one is Plasmodium falciparum

Question 7

What are the potential complications of malaria?

Answer 7

Cerebral malaria (encephalopathy)
Blackwater fever - very dark urine due to renal failure
Pulmonary oedema
Jaundice
Severe anaemia

Question 8

How is malaria diagnosed?

Answer 8

Thick (shows presence of parasites) and thin blood films (shows more detail so species can be identified)
Quantitive buffy coat (QBC)
Rapid antigen test

Question 9

How is malaria treated?

Answer 9

Quinines (chloroquinine, primaquine ect) and Artemisinins, Riamet.

Doxycycline and clindamycin can be used as well.

Question 10

How is complicated/severe Plasmodium falciparum treated?

Answer 10

IV artesunate, IV quinine and oral doxycycline or clindamycin.

Question 11

What causes Typhoid/enteric fever?

Answer 11

Salmonella typhi or salmonella paratyphi

They thrive with poor sanitation and in unclean drinking water.
Patients often get it when travelling in Africa or south/southeast Asia.

Question 12

How does Typhoid present?

Answer 12

1-4 week incubation period
1st week- fever, headache,abdo discomfort,constipation,dry cough,bradycardia, confusion
2nd week- fever peaks days 7-10, rose spots, diarrhoea,tachycardia,neutropenia
3rd week- (complications) intestinal bleeding, perforation
4th week- 10-15% relapse, rest of patients recover

Question 13

How is typhoid diagnosed?

Answer 13

In laboratory by blood,urine,stool or bone marrow culture.

Clinical diagnosis is difficult.

Question 14

How is typhoid diagnosed?

Answer 14

Oral Azithromycin

IV Ceftriaxone if is complicated

Question 15

How is Dengue transmitted?

Answer 15

Aedes aegypti mosquito. It is a daytime biting mosquito Lives in small pools of standing water near humans (e.g. birdbath, bucket) in South Asia, South America and some parts of Africa.

Question 16

How does Dengue fever present?

Answer 16

Sudden fever, severe headache, retro-orbital pain, arthralgia, myalgia, macular/maculopapular rash, haemorrhagic signs (purpura, petachiae, positive touniquet test)

for diagnosis can do positive tourniquet test, elevate transaminses, thrombocytopenia or PCR and serology.

Question 17

How is dengue fever treated?

Answer 17

No specific therapeutic agents
Complications treated with IV fluids, fresh frozen plasma and platelets
Prevention- avoid bites and vaccine

Question 18

Where is Schistosomiasis found?

Answer 18

In fresh water lakes in Africa

Question 19

Clinical features of Schistosomiasis?

Answer 19

Swimmers itch (clears after 24-48hrs)
Cough,abdo discomfort,splenamegoly
After 15-20days fever,lymphadenopathy, splenomegaly,diarrhoea,eosinophilla
6-8 weeks (acute disease) eggs deposited in bowel- dysentery or bladder- haematuria
Chronic disease- can get spinal or genital infection.

Question 20

How is schistosomiasis diagnosed and treated?

Answer 20

Antibody tests, Ova in stools or urine

Treatment- Praziquantel (and prednisolone if severe)

Question 21

What is Rickettsiosis and where is it found?

Answer 21

Tick typhus is found in Mediterranean, Southern Africa and Arabian Gulf.

Question 22

What are the symptoms of Tick typhus/rickettsiosis and how is it treated?

Answer 22

Abrupt onset of swinging fever,headache, confusion,rash (macular and petechial),bleeding
Treated with tetracycline