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Infection (Milly's) > Travel Related Infections > Flashcards

Travel Related Infections Flashcards

1
Q

Why is it so important to always take a travel history?

A

There is increased global travel

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2
Q

What is the difference between calendar and relative time?

A

Calendar time- duration of symptoms

Relative time- how long ago did they go away

*think about incubation periods

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3
Q

Why is a travel history important?

A
  1. Recognise important disease (that may be rare or unknown in the UK)
  2. Different strains of pathogen may be found elsewhere in the world. (Antigenically different, impacts on protection/detection, antibiotic resistance)
  3. Infection prevention ( on the ward and in the lab- samples may nee to be handled differently )
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4
Q

What do you need to consider when looking at someone who may have a travel infection?

A

Where (have they been)
When (did symptoms begin)
What (are the symptoms/signs)
How (did they acquire it)

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5
Q

List some regions that are known to harbour travel infections?

A

Sub-Saharan Africa
S.E asia
S/C america

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6
Q

List some methods by which someone may acquire an infection abroad?

A 
Food/water
Insect/tick bite
Swimming
Sexual contact
Animal contact (bite/safari)
Beach/recreational activities
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7
Q

What are the key aspects of travel history that we need to know?

A
  • any unwell travel companions/ contact?
  • pre-travel vaccinations/ preventative measures?
  • recreational activities?
  • healthcare exposure?
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8
Q

What is the most important foreign infection you need to consider?

A

Malaria

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9
Q

What are the vectors for malaria?

A

Female anopheles mosquitos

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10
Q

What are the 3 most common species of malaria virus?

A 
Plasmodium falciparum (africa)
Plasmodium vivax (india)
Plasmodium ovale (india)
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11
Q

What is the incubation period of malaria?

A

Minimum 6 days

P.falciparum: up to 6/12
P.vivax/ovale: up to 1 year +

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12
Q

What is the common history taken from someone with malaria?

A

Fever chills and sweats- cycle every 3rd or 4th day

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13
Q

What are the signs seen with someone with malaria. Upon examination?

A

Often few signs except fever

+/- splenomegaly

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14
Q

What organism causes typhoid/enteric fever?

A

Salmonella typhi

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15
Q

What are the features of severe malaria in adults?

A
  1. Impaired consciousness or seizures
  2. Renal impairment
  3. Acidosis
  4. Hypoglycaemia
  5. Pulmonary oedema or acute respiratory distress syndrome (ARDS)
  6. Hb <80 g/L
  7. Spontaneous bleeding/disseminated intravenous coagulation
  8. Haemoglobinuria (without G6PD deficiency)
  9. Parasitaemia >10%
  10. Tachycardia
  11. Hypotension
  12. Arrhythmias
  13. GIT-diarrhoea, abnormal LFTs, bilirubin raised
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16
Q

Where would you go to look up information on travel related infections?

A

WHO

Public health England

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17
Q

What investigations would you ask for when dealing with someone who you suspect of having malaria?

A

Blood smears (need 3 negatives to rule out malaria)
FBC, U&Es, LFTs, glucose, coagulation
Head CT if CNS symptoms (are they slipping in and out of consciousness)
CXR (if there are respiratory complications)

*malaria should be managed by an ID physician

18
Q

What treatment should be given for malaria (plasmodium falciparum)?

A
  • 1st line is IV artesunate for 7 days, switch to oral when improving
  • if not available, can give IV quinine plus PO doxycycline; monitor blood glucose on treatment
19
Q

What treatment should be given for malaria? (Plasmodium vivax/ovale)

A

Chloroquine + primaquine
And hypnozoites to combat the dormant liver stage

*the problem with this form of malaria is that is can lay dormant in the liver for some time and then recurs months later, the drugs given are designed to stop this happening

20
Q

How would you prevent someone catching malaria?

A

ABC

A: assess risk- have a knowledge of the risk areas

B: bite prevention- repellant, adequate clothing, nets.

C: chemoprophylaxis- specific to region, start before and continue after return (generally 4 weeks)

21
Q

What is another word for typhoid and paratyphoid?

A

Enteric fever

Mainly in asia, but also Africa and s america

22
Q

What is the mechanism of infection for enteric fever?

A

-faecal oral from contaminated food/water

23
Q

What causes salmonella?

A

Salmonella enterica serovar typhi

Salmonella enterica serovar paratyphi

24
Q

What type of bacteria is salmonella enterica?

A

Gram-negative bacilli

25
Q

What virulence factors does salmonella enterica have? (3)

A
  1. Gram negative endotoxin, VI antigen
  2. Invasin (allows intracellular growth)
  3. Fimbriae adhere to epithelium over ileal lymphoid tissue (peyers patches)
26
Q

What are some of the times and symptoms of enteric fever?

A
  1. Incubation: 7-14 days
  2. Fever
  3. headache
  4. abdominal discomfort
  5. constipation
  6. dry cough
  7. Relative bradycardia
  8. Complications (intestinal haemorrhaged and perforation)

*paratyphoid is generally milder

27
Q

What sort of thing would you be look for (during your investigations) to confirm the theory of enteric fever?

A
  • moderate anaemia
  • relative lymphopenia
  • raised LFTs (bilirubin and transaminase)
28
Q

How can enteric fever be prevented?

A
  • food and water hygiene precautions

- typhoid vaccine (eg for travellers and lab personnel): live vaccine or antigen

29
Q

What are non-typhoidal salmonella infections? What causes them and what are the symptoms?

A

‘Food poisoning’ salmonellas

S. Typhimurium/ S. Enteritidis

Symptoms: diarrhoea, fever, vomiting, abdominal pain

30
Q

Is someone presents with a fever and rash, what sort of things might it be?

A
  1. Childhood viruses: measles, rubella, parvovirus
  2. Infection mononucleosis (EBV/CMV)
  3. Acute HIV infection
  4. Rickettsia (spotted fever)
31
Q

What is myalgia?

A

General muscle pain

32
Q

What is dengue fever?

A

a debilitating viral disease of the tropics (Africa, Asia and India), transmitted by mosquitoes, and causing sudden fever and acute pains in the joints.

**Most common arbovirus

33
Q

What is the method of pathogenesis with dengue fever?

A

First infection ranges from asymptomatic to severe febrile illness: usually 1-5 days, improves 3-4 days after rash, supportive treatment only

Re-infection with different serotonin is when the problems occur

34
Q

The second infection from dengue fever can cause a huge inflammatory response, what can this lead to?

A
  • dengue haemorrhagic fever

- dengue shock syndrome

35
Q

What is ebola?

A

A viral haemorrhagic fever causing flu like illnesses with vomiting, diarrhoea, headaches, confusion and rashes

Someone may experience internal/external bleeding at days 5-7

36
Q

How is ebola spread?

A

Direct contact with body fluids

37
Q

What is the vector for zika virus?

A

Aedes mosquito that carries the arbovirus (flavivirus)

38
Q

What occurs when someone has zips virus?

A

Usually person is asymptomatic but some people will experience mild dengue-like symptoms

In pregnant women it will cause congenital microcephaly of baby and foetal loss

39
Q

Give the names of the stages of plasmodium family life cycles (causing malaria) (4)

A
  1. Sporozoite
  2. Schizont
  3. Merozoite
  4. Gametocyte

(Before becoming a sporozoite again)

40
Q

Describe the lifecycle of malaria causing organisms

A
  1. Mosquito feeds on human
  2. Sporozoite enters blood stream
  3. Travels to and infects hepatocytes
  4. Here the sporozoites mature into schizonts
  5. Which produce merozoites
  6. The hepatocyte burst, releasing these merozoites
  7. These go on to infect healthy red blood cells
  8. They reproduce and RBCs burst to release more merozoites (process continues)
  9. Some merozoites remain in RBCs and become gametocytes (which stay in blood for a few days)
  10. These can then be taken in by mosquitoes feeding on the human
  11. In the mosquito, the gametocyte becomes the sporozoite again
  12. Process continues…

Infection (Milly's) (32 decks)

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