travel related infections Flashcards
what are public health measures to control infection ?
sanitation
immunisation
education
what are examples of water-related infections ?
schistosomiasis leptospirosis liver flukes strongyloidiasis hookworms guinea worms
what are examples of arthropod-borne infections ?
malaria - malaria dengue fever - malaria rickettsial infection - ticks leishmaniasis - sand flies trypanosomiasis - tsetse flies filariasis - mosquitoes (elephantiasis) onchocerciasis - black flies (river blindness)
what malaria species is the potentially severe infective type ?
plasmodium falciparum
what are symptoms of malaria ?
fever rigor aching bones abdo pain headache dysuria frequency sore throat cough
what are signs of malaria ?
splenomegaly
hepatomegaly
mild jaundice
what are complications of malaria ?
cerebral malaria - convulsions, hypoxia blackwater fever - intravascular haemolysis, profound anaemia, haemoglobinuria, acute renal failure pulmonary oedema jaundice severe anaemia algid malaria - gram -ve septicaemia
how do you diagnose malaria ?
thick and thin blood films - Giesma, Field’s stain
quantitative Buffy coat - UV microscopy
rapid antigen test
what features would indicate a complicated malaria ?
impaired consciousness or seizures hypoglycaemia parasite count >2% haemoglobin <8mg/dl DIC haemoglobinuria renal impairment pH <7.3 pulmonary oedema shock
how do you treat uncomplicated malaria ?
quinine 7 days, plus oral doxycycline or clindamycin
riamet, euratesim, malarone
how do treat complicated malaria ?
IV quinine plus oral doxycycline or clindamycin
what are side effects of quinine ?
nausea tinnitus deafness rash hypoglycaemia
IV - cardiac depression, cerebral irritation, nausea + vomiting
what are some malaria control programmes ?
mosquito breeding site drainage
larvacides
mosquito killing spray DDT
human behaviour - mesh
what is the causative organism of typhoid (enteric) fever ?
salmonella typhi
salmonella paratyphi
what is the clinical progression of typhoid fever ?
incubation 1-4 weeks
1st week- fever, headache, abdo discomfort, constipation, bradycardia, neutrophilia, confusion
2nd week - fever peaks, rose spots, diarrhoea, tachycardia, neutropenia
3rd week - intestinal bleeding, perforation, peritonism, metastatic infection
week 4 recovery
how do you diagnose typhoid fever ?
clinical
lab - culture urine and stool, marrow
how do you treat typhoid fever ?
oral azithromycin
IV ceftriaxone - increasing resistance
what is the commonest arbovirus worldwide ?
Dengue fever
what is the classical presentation of dengue fever ?
sudden fever severe headache, retro-orbital pain severe myalgia, arthralgia macular/macropapular rash haemorrhagic signs - petechiae, purport, positive tourniquet test
how do you diagnose dengue fever ?
clinical - thrombocytopenia, leucopenia, elevated transaminases, +ve tourniquet
lab - PCR, serology
how do you manage dengue fever ?
no specific therapeutic agents
dengue haemorrhage fever and dengue shock syndrome - fluids, FFP, platelets
prevent bites and get vaccine
what are the causative organisms of schistosomiasis ?
S. haematobium
S. mansoni
S. japonicium
what are the stages and clinical features of schistosomiasis ?
swimmers itch 1st few hours - clears 24-48hrs
invasive stage >24 hours - cough, abdo discomfort, splenomegaly, eosinophilia
katakana fever 15-20 days - prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
acute disease 6-8 weeks - eggs in bowel and bladder, dysentery/heamaturia
how is schistosomiasis diagnosed ?
clinical
antibody test
ova in stools and urine
rectal snip
how do you treat schistosomiasis ?
praziquantel 20mg/kg, two doses 6 hours apart
prednisolone if severe
what is rickettsiosis ?
tick typhus
R. conorii, R.africae
what are clinical features of rickettsiosis ?
abrupt onset swinging fever headache confusion endovasculitis rash - macular, petechial bleeding
what are examples of viral haemorrhage fevers ?
ebola
congo-crimea haemorrhagic fever
lassa fever
Marburg disease
maximum incubation is 3 weeks
how do you manage viral haemorrhagic fevers ?
rule out common severe infection
isolation
supportive treatment
what is Zika virus ?
flavivirus
transmitted by mosquito, sexual contact, blood transfusion
related to dengue, yellow, Jam B
what are clinical features of Zika virus ?
no or mild symptoms headache rash fever malaise conjunctivitis joint pain Guillain-Barre syndrome
can cause microcephaly in pregnancy
what diseases give you rash ?
typhoid
typhus
dengue
what diseases give you jaundice ?
hepatitis
malaria
yellow fever
what diseases affect the lymph nodes ?
leishmaniasis
trypanosomiasis
what diseases affect the liver ?
malaria
typhoid
amoebic abscess
what diseases affect the spleen ?
visceral leishmaniasis
typhoid
malaria
