Travel Related Infections Flashcards
Why are travel related infections important to consider nowadays?
Exotic destinations are more accessible.
More complex medical patients doing more traveling.
War and natural disasters involve multi-national teams
Increased migration
Increased emergence of infections
Accidents are common in low socioeconomic countries- its not just infections that impact us when to comes to travel
What info do we need about a patients travels?
Where have they been in the last 6 months?
How long were they in each individual place?
When did they get back?
Any unwell fellow travellers?
Did the patient get pre- travel vaccinations?
Did he patient take preventative measures while traveling?
What activities did they do while travelling?
Were they exposed to healthcare abroad?
What is Rickettsia/ spirochaete?
Obligate intracellular bacteria requiring a vector for trnasmission
Why is a travel history important?
Recognise imported diseases
Infection prevention on the ward and in the lab (label samples )
Gifferent strains which impacts protection/ detection and resistance
What time scale labels an infection as
- acute
- sub-acute
- chronic
length of symptoms:
- acute <10 days
- suacture 10-21days
- chronic >21days
How do people get travel related infections?
Food, water, insects, tick bites, swimming, sex, animal contact, beaches and recreational activities
Name some clinical signs and symptoms of Malaria
High Temp, HR Low Sats and BP Multiple bite marks Hepatoslenomegaly Icterus (yellow conjunctiva) Pan thrombocytopenia High urea, creatinine, bilirubin, CRP Some LFT may be normal
What do you look for on a blood smear for malaria?
Parasites in the RBCs
How many species of Malaria are there and what are they called?
4 Species: Plasmodium flaciparum Plasmodium vivax Plasmodium Ovale Plasmodium Malariae
What is the vector for malaria?
female anopheles mosquito
Who is Malaria most harmful to?
Young children and pregnant women
What is the most severe strain of malaria and where is it contracted?
Falciprum
Africa
Vivax and Ovale are strains of malaria commonly acquired where?
India
Compare incubation times for P falciparum and P Ovale/ Vivax
P falciparum 6-12 days
P Vivax/ Ovale up to 1 yr
What symptoms arise and 3-4 days of having malaria?
Fever sweats, chills
Hardly any clinical signs just a temp (maybe some splenomegaly)
What percentage parasite indicates severe malaria infection?
2% or more
Who should manage Malaria?
Infectious disease physician
What tests do you order if you suspect Malaria?
Blood smear
FBC, U+E, LFT, glucose, coagulation , Head CT and CXR
How do you treat P. Falciparum?
Artesunate and quinine and doxycycline
How do you treat P. vivid, oval or malariae?
Chloroquine and primaquine to target the hypnotise in the liver phase.
What is the ABC of malaria prevention?
Assess risk - area of travel
Bite Prevention - repellent, clothes, nets
Chemoprophylaxis - region specific
List some common differentials in travel diseases?
Malaria
Dengue Fever
Rickettsial infection
Non -travel related (sepsis?)
What is the gram stain of salmonella typhi?
Aerobic gram negative rod
List the virulence factors of salmonella typhi.
Grame negative endotocxin
VI antigen
Invasin
Fimbriae attach to epithelium covering lymphoid tissue
Outline signs and symptoms of enteric fever (typhoid).
bacteraemia
7-14 day incubation
Fever, HA, abdo discomfort , constipation, dry cough
Normal HR
Intestinal haemorrhage and perforation if left
Moderate anaemia Lymphopenia Raised LFT Culture faeces and blood Serology is unrelaible
How do you treat enteric fever?
Ceftriaxone or azithromycin for 7-14 days
Note high resistance
A patient comes in about to travel around Asia and has read on google that Typhoid is common over there. She wants some advice on how to avoid catching it. Please outline general prevention for typhoid.
Food and water hygiene precautions
Vaccinate
What is non-typhoidal salmonella?
Food poisoning - tend to be self limiting but can disseminate
What travel infection is linked to a macculopapular rash?
Rickettsia
Dengue Fever
How do we detect Dengue?
Viral PCR
Dengue IgM serology
What type of virus is Dengue? How many serotypes are there.
Arbovirus- 4 serotypes
The first Dengue infection tends to last 1- 5 days with improvement seen 3 days after rash development. Only supportive treatment is needed. So what happens if reinfected with a second infection with a different serotype?
Antibody dependent enhancement leads to dengue haemorrhagic fere ot dengue shock syndrome.
Is influenza a travel related disease?
It can be in new strain epidemics
Viral haemorrhagic fever has recently been in the news, name the virus recently reported on? How is it spread? What are the symptoms? How does it kill?
Ebola a filovirus
Flu like illness, v and d, HA, confusion and rash
Spread by direct contact with bodily fluids
Internal and external bleeding at 5-7 days
What is pika virus?
Arbovirus with 20% of people getting mild dengue like symptoms. Can be sexually transmitted - retained in semen for 6/12.
Congenital mircocephaly and foetal loss occur if caught in pregnancy.
