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Infection > Travel related infections > Flashcards

Travel related infections Flashcards

1
Q

What makes travelers more vulnerable to infection? [5]

A
  • Temptation to take risks away from home (sex, food)
  • Different epidemiology of some diseases
  • Incomplete understanding of health hazards
  • Stress of travel
  • Refugees: deprivation, malnutrition
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2
Q

What are some climate/environmental related health problems? [4]
(Include in your list of differentials for the returning traveller)

A
  • Sunburn, Heat exhaustion
  • Fungal infections
  • Bacterial skin infections
  • Cold injury
  • Altitude sickness
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3
Q

What are infections controlled by public health measures? [3] Eg sanitation immunization education

A

Sanitation
-Travellers diarrhoea, viral gastroenteritis, food poisoning, cholera, shigella dysentery, hep A or E

Immunisation
-Poliomyelitis, diphtheria

Education
-HIV, STDs

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4
Q

What are some water-related infections? [5]

A
  • Schistosomiasis
  • Leptospirosis
  • Liver flukes
  • Strongyloidiasis
  • Hookworms
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5
Q

What are some arthropod borne infections? [5]

A
  • Malaria (mosquitoes)
  • Dengue fever (mosquitoes)
  • Rickettsial infections (ticks)
  • Leishmaniasis (sand flies)
  • Filariasis (mosquitoes)
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6
Q

What are some important tropical diseases?

A
  • Malaria
  • Typhoid
  • Dengue fever
  • Schistosomiasis
  • Rickettsiosis
  • Viral haemorrhagic fevers
  • Zika fever
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7
Q

Name malarial vector

What is the life cycle of malaria? [5]

A

Vector: female Anopheles mosquito

  • Mosquito infects human
  • Human carries malaria in blood
  • Female mosquito bites human and now carries malaria parasite
  • Reproduces and offspring also has malaria parasite
  • Goes off to infect other humans
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8
Q

What are the 5 species of malaria parasite?

Protective factors [4]

A

Potentially severe
- Plasmodium falciparum

Benign

  • Plasmodium vivax
  • Plasmodium ovale
  • Plasmodium malariae
  • Plasmodium knowlesi

Protective factors:

  • Sickle cell trait
  • HLA-B53
  • G6PD deficiency
  • Absence of Duffy antigens
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9
Q

What are symptoms of malaria? [7]

A
  • Fever (alternating days), rigors
  • Aching bones
  • Abdo pain
  • Headache
  • Dysuria, frequency
  • Cough, sore throat
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10
Q

What are signs of malaria? [4]

A
  • Can be none: asymptomatic
  • Splenomegaly
  • Hepatomegaly
  • Mild jaundice
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11
Q

What are 6 complications of malaria?

A
  • Cerebral malaria (encephalopathy)
  • Blackwater fever
  • Pulm. oedema or ARDS
  • Jaundice
  • Severe anaemia
  • Algid malaria (gram -ve septicaemia)
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12
Q

What blood work is required? [5]

A

-FBC (thrombocytosis without leucocytosis)
- U&E, LFT
-Thick and thin blood films (Giemsa, Field’s stain)
> Schizonts seen in severe malaria and parasitemia 2%
-Quantitative buffy coat (centrifugation, UV microscopy)
-Rapid antigen tests (OptiMal, ParaSight-F)

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13
Q

There is a severity assessment for malaria. Having ‘complicated P. Falciparum malaria’ = one or more of what? [7]

A
  • Impaired consciousness/seizures
  • Hypoglycaemia
  • Parasite count at least 2%
  • Haemoglobin 8mg/dL or less
  • Renal impairment/pH <7.3
  • Pul oedema or ARDS
  • Shock (algid malaria)
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14
Q

What are treatment options for uncomplicated P. falciparum malaria?

A

artemisinin based combination therapies e.g. oral ARTESUNATE + MEFLOQUINE

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15
Q

What are treatment options for complicated/severe P. falciparum malaria? [3]
If patient is in shock what does this indicate? [2]

A

Parasite count >2%
-IV artesunate (unlicensed in UK)
-IV quinine plus oral doxycycline (or clindamycin)
Parasite count >10%: exchange transfusion

Shock may indicate co-existent gram -ve bacterial sepsis (algid malaria) as malaria rarely causes shock

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16
Q

Treatment of P. vivax/ovale/malariae/knowlesi malaria? [3]

A
  • ACT (Artemisin based combination therapy) or
  • Chloroquine
  • Add primaquine (14d) in vivax and ovale to eradicate liver hypnozoites
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17
Q

What are some malaria control programmes? [4]

A
  • Mosquito breeding sites (draining standing water)
  • Larvacides
  • Mosquito killing sprays
  • Human behaviour (bed nets, mesh windows)
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18
Q

Typhoid fever
2 causes
What organisms cause this? [2]
Incubation period

A

Typhoid fever is widespread and happens due to poor sanitation and unclean drinking water.

  • Salmonella typhi
  • Salmonella paratyphi
  • 1-4 weeks
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19
Q

What clinical features are seen in the first week of disease onset?
5 generalized flu-like symptoms
3 signs

A

Generalised flu-like symptoms

  • Fever
  • Headache
  • Abdo discomfort
  • Constipation
  • Dry cough
  • Relative bradycardia
  • Neutrophilia
  • Confusion
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20
Q

What clinical features are seen in the second week of disease onset? [5]

A
  • Fever
  • Rose spots
  • Diarrhoea
  • Tachycardia
  • Neutropenia
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21
Q

What clinical features are seen in the third week of disease onset? (complications arise) [4]

A
  • Intestinal bleeding
  • Perforation
  • Peritonism
  • Metastatic infections
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22
Q

Typhoid fever
What clinical features are seen in the fourth week of disease onset?
Rate of relapse

A

Usually recovery begins in 4th week of disease onset

10-15% relapse

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23
Q

How do you diagnose typhoid fever? [3]

A

Clinical dx
Lab
Cultures: blood, stool, urine, bone marrow (Looking for Salmonella typhi/paratyphi)

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24
Q

How do you treat typhoid fever? [3]

A
  • Notifiable disease
  • Oral azithromycin 1g
  • IV Ceftriaxone (esp if complicated)
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25
Q

Dengue fever is the commonest human arbovirus infection. Ax and transmission? [2]

A 
Dengue arbovirus spread by
Aedes aegypti (type of mosquito)
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26
Q

What are the symptoms and signs of classical dengue fever? [5]
Includes one clinical test

What are features of severe dengue? [3]

A
  • Sudden fever
  • Sudden headache, retro-orbital pain
  • Severe myalgia and arthralgia
  • Macular/maculopapular rash
  • Haemorrhagic signs: petechiae, purpura, positive tourniquet test

Severe dengue: severe plasma leakage, severe bleeding, organ failure

27
Q

How is dengue fever diagnosed? [6]

What is the tourniquet test

A
  • Positive tourniquet test
  • PCR
  • Serology
  • FBC (leukopenia, thrombocytopenia)
  • LFT (elevated AST and ALT)
  • clotting (DIC = prolonged APTT and INR, increased D-dimer, reduced fibrinogen)

Tourniquet test
- This test is performed by inflating a blood pressure cuff on the upper arm to midway between diastolic and systolic blood pressures for 5 minutes. The results are considered to be positive if more than 20 petechiae per square inch are observed on the skin in the area that was under pressure

28
Q

What is the management of Dengue fever? [3]

What are 2 complications?

A

Supportive
-Mx: IV fluids, fresh frozen plasma, platelets

Complications

  • Dengue haemorrhagic fever
  • Dengue shock syndrome
29
Q

Schistosomiasis is spread via freshwater snails. What are the 3 water born parasites that cause this?

A
  • Schistosomiasis haematobium
  • Schistosomiasis mansoni
  • Schistosomiasis japonicum
30
Q

What is the schistosomiasis life cycle? [5]

A
  • Infected snails penetrate human skin while swimming etc
  • Circulate in body, lose tails to become schistosomulae in body upon penetration
  • Migrate to portal blood in liver/mesenteric venules of bowel/rectum/venous plexus of bladder
  • Released in urine/faeces into sea
  • Parasite infects snail and cycle continues
31
Q

The first clinical feature of schistosomiasis is Swimmers Itch, which presents after a few hours and stops after a day or two.

What clinical features occur in the invasive stage? [4]

A
  • Cough
  • Abdo discomfort
  • Splenomegaly after 24h
  • Eosinophilia
32
Q

What clinical features are seen in the Katayama fever seen in schistosomiasis? [4]
Onset?

A
  • Fever
  • Urticaria
  • Lymphadenopathy
  • Splenomegaly
  • After 15-20 days
33
Q

What happens in acute disease of schistosomiasis? [2] (also get chronic disease)

A
  • S. haematobium: frequency, haematuria and urinary calcification after 6-8w
  • S mansoni and S. japonicum: dysentery after 6-8w
34
Q

How is schistosomiasis diagnosed? [4]

A
  • Clinical diagnosis
  • Antibody tests
  • Ova in stools and urine
  • Rectal snip
35
Q

What is the treatment for schistosomiasis? [2]

A
  • Praziquantel (2 doses 6hr apart)

- Prednisolone if severe

36
Q

What are the different types of rickettsiosis diseases and what organism causes them?

A
  • Tick typhus (rickettsia conorii/africae)
  • Rocky mountain spotted fever (rickettsia rickettsii)
  • Epidemic typhus (rickettsia prowazekii)
  • Scrub typhus (rickettsia tsutsugamushi)
37
Q

What is the most common rickettsiosis disease imported to UK?

A

Tick typhus (from S Africa, Mediterranean, Arabian Gulf)

38
Q

What are the clinical features of rickettsiosis? [8]

A
  • Abrupt onset swinging fever
  • Headache
  • Confusion
  • Endovasculitis
  • Rash (macular, petechiae)
  • Bleeding
  • Reactive arthritis, neck myalgia
  • Tick bite eschar
39
Q

What are the investigations for rickettsiosis? [3]

What is the treatment for rickettsiosis?

A

Ix: serology (IgM or IgG), FBC (leukopenia, thrombocytopenia), U&E and electrolytes (hyponatraemia)

Doxycycline

40
Q

How is Zika virus transmitted? [3]

A
  • Aedes mosquitoes
  • Sexual contact
  • Blood transfusion
41
Q

What are the clinical features of Zika virus? [8]

A
  • none/mild symptoms
  • Headache
  • Rash
  • Fever, malaise
  • Conjunctivitis
  • Joint pains
  • Fetal problems: microcephaly and other neuro problems
  • Can cause GBS
42
Q

What treatment is there for Zika virus? [3]

A
  • No antiviral therapy
  • Mosquito control measures
  • Vaccines in development
43
Q

What should be focused on in a patient history in a returning traveller with symptom onset? [6]

A 
o	Geographical location: urban/rural, geographical/travelled through 
o	Risk activities: swimming, game park 
o	Trip purpose 
o	Accommodation 
Sexual hx
o	Contacts
o	Vaccines and malaria prophylaxis
44
Q

Upon examination, what diseases does rash point to? [3]

A
  • Typhoid (salmonella)
  • Tick Typhus
  • Dengue
45
Q

Upon examination, what diseases does jaundice point to? [3]

A
  • Hepatitis
  • Malaria
  • Yellow fever
46
Q

Upon examination, what diseases does lymphadenopathy point to? [2]

A
  • Leishmania

- Trypanosomiasis

47
Q

Upon examination, what diseases does liver symptoms point to? [3]

A
  • Malaria
  • Typhoid
  • Amoebic abscess
48
Q

Upon examination, what diseases does splenomegaly point to? [3]

A
  • Visceral leishmaniasis
  • Typhoid
  • Malaria
49
Q

What general investigations should be done for travel acquired infections? (as well as specific investigations)

A
  • FBC
  • Malaria films
  • LFTs
  • Stool microscopy and culture
  • Urine analysis and culture
  • Blood culture
  • CXR
50
Q

General treatment for travel acquired infections? [4]

A
  • Isolation: (PPE, single rooms)
  • Supportive measures
  • Empirical treatment
  • Specific treatment once diagnosis established
51
Q

Name 3 features of cerebral malaria

Name 4 features of blackwater fever

A

-Cerebral malaria (encephalopathy): convulsions
hypoxia
hypoglycemia

-Blackwater fever: 
severe haemolysis
high parasitaemia
acute renal failure
haemoglobinuria - black urine
52
Q

Anti-malaria prophylaxis [4]

A

Malarone
Chloroquine
Doxycycline
Mefloquine

53
Q

Anti-malaria prophylaxis: Malarone and Chloroquine

Describe timing, SE, CI

A

Malarone

  • take 1-2d before travel
  • SE: GI upset
  • CI: pregnancy unless folate supplementation

Chloroquine

  • Take 1w before travel
  • Retake weekly
  • SE: headache
  • CI: epilepsy
  • suitable in pregnancy
54
Q

Anti-malaria prophylaxis: Doxycycline and Mefloquine

Describe timing, SE, CI

A

o DOXYCYCLINE: take 1-2d before travel (SE: photosensitivity, oesophagitis; CI: pregnancy, children)
o MEFLOQUINE: taken 1w before and re-taken weekly (CI: hx depression)

55
Q

What is dengue shock syndrome [4]

A
  • poor peripheral perfusion
  • narrow pulse pressure
  • reduced cerebral perfusion
  • shock early in disease
56
Q

Viral hemorrhagic fever
Ax [4]
Pathophysiology [3]

A
  • Ax:
    yellow fever, dengue, Ebola (2-21d incubation peroid), Lassa fever

Px:

  • viremia attacks vascular system
  • leading to increased vascular permeability
  • causing haemorrhage, hypotension and shock
57
Q

Viral hemorrhagic fever
Describe early signs [4], initial signs [6]
What are florid signs of this syndrome? [3]

A
  • early signs: non-specific w/ pyrexia, headache, myalgia and N&V
  • initial signs: high fever, oedema conjunctival injection, maculopapular or petechial rash, jaundice and altered mental state
  • florid signs are coagulopathy and haemorrhagic cx and multi-system organ failure
58
Q

Viral hemorrhagic fever - describe what are complications of hemorrhage [3]
Mx [2]

A

hepatic damage, myocarditis, encephalopathy

  • High security infection unit
  • Supportive treatment
59
Q

Yellow fever
Ep [2]
Ax [2]
Incubation period

A

Ep: Africa and South America
Ax: flavivirus spread by Aedes mosquito
Px: 2-4d incubation period

60
Q

Yellow fever
Presentation [5]
Ix [3]

A
  • sudden onset high fever, rigors
  • N&V
  • bradycardia
  • brief remission
  • followed by jaundice, hematemesis and oliguria

Ix: serology, ELISA, PCR

61
Q

Yellow fever
Describe what you would see on FBC, LFT, U&E, Cr
Mx [2]
Complication

A

FBC (leukopenia, thrombocytopenia if coagulopathy)
LFT (elevated AST and ALT)
U&E and creatinine (AKI)

Mx: rehydration therapy, notifiable disease

Cx: viral hemorrhagic fever

62
Q 
Lassa fever
Ep 
Vector
Causative organism
Describe a mild presentation [2]
Describe neurological sequelae [3]
A

Endemic in West Africa
Vector: multimammate rat
Lassavirus
Presentation
- 1-3w
- Mild symptoms: slight fever, malaise, headache
- neuro: hearing loss, tremors, encephalitis

63
Q

Describe serious symptoms of Lassa fever [6]

Risk factor [3]

A

Serious (20%):

  • hemorrhage: mucosal bleeding
  • conjunctivitis
  • respiratory distress
  • vomiting
  • facial swelling
  • chest pain, back, abdomen
  • shock

Risk factors:

  • Endemic areas
  • HCW
  • Butchering or eating rodent meat
64
Q

Lassa fever investigations [4]

Treatment

A
  • RT-PCR
  • Serology
  • rapid diagnostic lateral flow assay
  • Check for typhoid & malaria (usually co-endemic and as differential)

Mx:
- Ribavirin IV

Infection (20 decks)

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