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Infection > Travel Related Infections > Flashcards

Travel Related Infections Flashcards

1
Q

Why are travellers vulnerable to infection?

A
  • tempted to take risks away from home
  • different disease epidemiology
  • incomplete understanding health hazards
  • stress of travel
  • refugees; deprivation, malnutrition, disease, injury
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2
Q

What are common worldwide infections?

A

Influenza, community acquired pneumonia, meningococcal disease, STDs

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3
Q

What are climate/environmental health problems?

A 
Sunburn
Heat exhaustion and heatstroke
Fungal infections
Bacterial skin infections
Cold injury
Altitude sickness
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4
Q

What traveler infections are controlled through sanitation?

A
  • travelers’ diarrhoea
  • typhoid
  • hep A or E
  • giardiasis
  • amoebiasis
  • helminth infections
  • viral gastroenteritis
  • food poisoning
  • shigella dysentery
  • cholera
  • cryptosporidiosis
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5
Q

What traveler infections are controlled through immunisation?

A

Poliomyelitis

Diphtheria

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6
Q

What are some water related infections?

A
  • schistosomiasis
  • leptospirosis
  • liver flukes
  • strongyloidiasis
  • hookworms
  • guinea worms
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7
Q

What are some arthropod borne infections?

A
  • malaria, dengue fever
  • rickettsial infections
  • leishmaniasis
  • trypanosomiasis
  • filariasis
  • onchocerciasis
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8
Q

What arthropod causes malaria and dengue fever?

A

Mosquitoes

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9
Q

What arthropod causes rickettsial infections?

A

Ticks; typhus

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10
Q

What arthropod causes leishmaniasis?

A

sand flies; Kala-azar

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11
Q

What arthropod causes trypanosomiasis?

A

tsetse fly; sleeping sickness

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12
Q

What arthropod causes onchocerciasis?

A

black flies; river blindness

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13
Q

Describe the species of malaria

A

Plasmodium falciparum (potentially severe)

Plasmodium vivax

Plasmodium ovale

Plasmodium malariae

Plasmodium knowlesi

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14
Q

What are the clinical features of malaria?

A

Non-specific

Fever, rigors, aching bones, abdo pain, headache, dysuria, frequency, sore throat, cough

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15
Q

What are the major complications of malaria?

A

6 major

  • cerebral malaria; hypoglycaemia, convulsions, hypoxia
  • blackwater fever; dark urine due to intravascular haemolysis - acute renal failure
  • pulmonary oedema
  • jaundice
  • severe anaemia
  • algid malaria
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16
Q

Describe management of malaria

A

Diagnosis through thick and thin blood films, quantitative buffy coat, rapid antigen tests

Severity assessment; complicated or not

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17
Q

How is malaria assessed for severity?

A

Complicated malaria is one or more of

  • impaired consciousness or seizures
  • hypoglycaemia
  • parasite count >2%
  • haemoglobin <8mg/dL
  • spontaneous bleeding / DIC
  • haemoglobinuria
  • renal impairment or pH <7.3
  • pulm oedema or ARDS
  • shock (algid malaria)
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18
Q

What are drugs for malaria?

A

Quinine (from chinchona) and artemisinins (from Quinghaosu)

19
Q

How is uncomplicated falciparum malaria treatment?

A
  • Riamet 3 days
  • Eurartesim 3 days
  • Malarone 3 days
  • Quinine 7 days + oral doxycycline
20
Q

How is complicated or severe falciparum malaria treated?

A
  • IV artesunate
  • IV quinine + oral doxycycline
  • once stable and can swallow switch to oral
21
Q

How are vivax, ovale, malariae and knowlesi malaria treated?

A
  • Chloroquine 3 days
  • Riamet 3 days
  • add primaquine in vivax and ovale to eradicate liver hypnozoites
22
Q

Describe some malaria control programmes

A

Mosquito breeding site drainage of standing water

Larvacides

Mosquito killing sprays

Human behaviour i.e. ned nets and mesh windows

23
Q

What are the two typhoid viruses?

A

Salmonella typhoid and salmonella paratyphi

24
Q

Describe the clinical features of typhoid

A

1st week; fever, headache, abdo discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion

2nd week; fever peaks at 7-10days, rose spots, diarrhoea begins, tachycardia, neutropenia

3rd week; intestinal bleeding, perforation, peritonism, metastatic infections

Week 4; 10-15% relapse but recover generally

25
Q

Describe diagnosis of typhoid

A

Lab culture blood, urine and stool

Culture bone marrow

26
Q

What is the treatment of typhoid?

A

Oral azithromycin

IV ceftriaxone (if complicated or concerned regarding absorption)

27
Q

Describe the clinical features of dengue fever

A
  • Sudden fever
  • severe headache
  • retro-orbital pain
  • severe myalgia
  • arthralgia
  • macular/maculopapular rash
  • haemorrhagic signs; petechiae, purpura, positive tourniquet test
28
Q

Describe the diagnosis of dengue fever

A

Thrombocytopaenia, leucopenia, elevated transaminases, positive tourniquet test

Lab; PCR, serology

29
Q

Describe the management of dengue fever

A

No specific therapeutic agent

Complications; dengue haemorrhagic fever, dengue shock syndrome

Rx; IV fluids, fresh frozen plasma, platelets

Prevention; avoid bites, new vaccine

30
Q

What causes schistosomiasis?

A

S haematobium
S mansoni
S japonicum

31
Q

Describe schistosomiasis clinically

A

Swimmer’s itch (first few hours)

After 24hrs; cough, abdo discomfort, splenomegaly, eosinophilia

Katayam fever after 15-20 days

Acute disease 6-8 weeks

Chronic disease

32
Q

Describe diagnosis of schistosomiasis

A

Clinical diagnosis
Antibody tests
Ova in stools and urine
Rectal snip

33
Q

Describe the treatment of schistosomiasis

A

Praziquantel; 20mg/kg, two doses 6hrs apart

Prednisolone if severe

34
Q

Describe tick typhus organisms

A

R conorii
R africae

Causes Rickettsiosis

35
Q

Describe rickettsiosis

A

Caused by tick typhus

Abrupt onset swinging fever, headache, confusion, endovasculitis, rash, bleeding

36
Q

How is tick typhus/rickettsiosis managed?

A

tetracycline

37
Q

Describe viral haemorrhagic fevers

A

Serious but rare in UK

  • ebola
  • Congo-Crimea haemorrhagic fever
  • lassa fever
  • marburg disease

Max incubation period 3 weeks

38
Q

How do you treat viral haemorrhagic fevers?

A

Isolation; high security infection unit

Treatment; supportive

39
Q

Describe Zika virus

A

Flavivirus

No or mild symptoms; headache, rash, fever, joint pains, fever, malaise

Can cause Guillain barre syndrome

No antiviral therapy

mosquito control measures and vaccines in development

40
Q

What can zika virus cause in pregnancy?

A

Microcephaly and other neurological problems

41
Q

How do you approach management of a fever in a returning traveler?

A

History; tropical, travel, precautions, risks, symptoms, incubation periods

Examination signs; rash, jaundice, lymph nodes, liver, spleen

Investigations; FBc, malaria films, LFTs, stool microscopy and culture, urine analysis and culture, blood culture, CXR

Treatment; isolation? PPE?, supportive measures, empirical treatment if unwell

42
Q

What is the malaria vector?

A

female anopheles mosquito

43
Q

Describe katayama fever

A

15-20 days after schistosomiasis

  • prostrate
  • fever
  • urticaria
  • lymphadenopathy
  • splenomegaly
  • diarrhoea
  • eosinophilia

Infection (15 decks)

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