Travel Related Infections

Question 1

Why are travel related infections important to consider nowadays?

Answer 1

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

Question 2

What info do we need about a patients travels?

Answer 2

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?

Question 3

What is Rickettsia/ spirochaete?

Answer 3

Obligate intracellular bacteria requiring a vector for trnasmission

Question 4

Why is a travel history important?

Answer 4

Recognise imported diseases
Infection prevention on the ward and in the lab (label samples )
Gifferent strains which impacts protection/ detection and resistance

Question 5

What time scale labels an infection as

• acute
• sub-acute
• chronic

Answer 5

length of symptoms:

• acute <10 days
• suacture 10-21days
• chronic >21days

Question 6

How do people get travel related infections?

Answer 6

Food, water, insects, tick bites, swimming, sex, animal contact, beaches and recreational activities

Question 7

Name some clinical signs and symptoms of Malaria

Answer 7

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

Question 8

What do you look for on a blood smear for malaria?

Answer 8

Parasites in the RBCs

Question 9

How many species of Malaria are there and what are they called?

Answer 9

4 Species:
Plasmodium flaciparum 
Plasmodium vivax
Plasmodium Ovale 
Plasmodium Malariae

Question 10

What is the vector for malaria?

Answer 10

female anopheles mosquito

Question 11

Who is Malaria most harmful to?

Answer 11

Young children and pregnant women

Question 12

What is the most severe strain of malaria and where is it contracted?

Answer 12

Falciprum

Africa

Question 13

Vivax and Ovale are strains of malaria commonly acquired where?

Answer 13

India

Question 14

Compare incubation times for P falciparum and P Ovale/ Vivax

Answer 14

P falciparum 6-12 days

P Vivax/ Ovale up to 1 yr

Question 15

What symptoms arise and 3-4 days of having malaria?

Answer 15

Fever sweats, chills

Hardly any clinical signs just a temp (maybe some splenomegaly)

Question 16

What percentage parasite indicates severe malaria infection?

Answer 16

2% or more

Question 17

Who should manage Malaria?

Answer 17

Infectious disease physician

Question 18

What tests do you order if you suspect Malaria?

Answer 18

Blood smear

FBC, U+E, LFT, glucose, coagulation , Head CT and CXR

Question 19

How do you treat P. Falciparum?

Answer 19

Artesunate and quinine and doxycycline

Question 20

How do you treat P. vivid, oval or malariae?

Answer 20

Chloroquine and primaquine to target the hypnotise in the liver phase.

Question 21

What is the ABC of malaria prevention?

Answer 21

Assess risk - area of travel
Bite Prevention - repellent, clothes, nets
Chemoprophylaxis - region specific

Question 22

List some common differentials in travel diseases?

Answer 22

Malaria
Dengue Fever
Rickettsial infection

Non -travel related (sepsis?)

Question 23

What is the gram stain of salmonella typhi?

Answer 23

Aerobic gram negative rod

Question 24

List the virulence factors of salmonella typhi.

Answer 24

Grame negative endotocxin
VI antigen
Invasin
Fimbriae attach to epithelium covering lymphoid tissue

Question 25

Outline signs and symptoms of enteric fever (typhoid).

Answer 25

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

Question 26

How do you treat enteric fever?

Answer 26

Ceftriaxone or azithromycin for 7-14 days

Note high resistance

Question 27

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.

Answer 27

Food and water hygiene precautions

Vaccinate

Question 28

What is non-typhoidal salmonella?

Answer 28

Food poisoning - tend to be self limiting but can disseminate

Question 29

What travel infection is linked to a macculopapular rash?

Answer 29

Rickettsia

Dengue Fever

Question 30

How do we detect Dengue?

Answer 30

Viral PCR

Dengue IgM serology

Question 31

What type of virus is Dengue? How many serotypes are there.

Answer 31

Arbovirus- 4 serotypes

Question 32

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?

Answer 32

Antibody dependent enhancement leads to dengue haemorrhagic fere ot dengue shock syndrome.

Question 33

Is influenza a travel related disease?

Answer 33

It can be in new strain epidemics

Question 34

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?

Answer 34

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

Question 35

What is pika virus?

Answer 35

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.