Tropical Gastro Flashcards
What questions should be asked to a returned travellers
Where they have been When did they go When did they get back When did they start to become unwell Did they have insect bites What are their symptoms Is anyone else unwell What activities did they do when they were away Any chance of HIV / STI What precautions did they take?
What are common symptoms of a returned traveller
Fever Rash Hepatosplenomegaly Lymphadenopathy Insect bites Wounds
What can fever be a symptom for?
Respiratory tract infections Travellers diarrhoea Malaria Enteric fever (typhoid / paratyphoid fever) Arboviruses (dengue or chikungunya)
How can we diagnose acute traveller’s diarrhoea
3 loose stools within 24 hours
Fever
What is the pathogen usually identified>
It usually is not identified
What 2 types of viruses are picked up on cruise ships
Norovirus and rotavirus
What investigations do we do for acute traveller’s diarrhoea
Stool culture
Stool wet prep on recently passed stool for amoebic trophozoites
What is the treatment for Acute traveller’s diarrhoea
Suportive with fluids
Usually they will get better themselves
What symptom would warrant further treatment?
Bloody diarrhoea
What drug can stop worsening
Fluoroquinolone (ciprofloxacin) single dose
What are the symptoms of enteric fever
Headache
Constipation or diarrhoea
Dry cough
Where is enteric fever most common
Indian subcontinent and south east asia
What is the incubation period for enteric fever
7-18 days
What are 4 complications of enteric fever
GI Bleeding
GI perforation
Encephalopathy
Bone and joint infection
What is the causative organism for enteric fever
Salmonella typhi or paratyphi
What precautions should be taken for enteric fever
Water, food and hand hygiene
What can cause pre-hepatic fever and jaundice
Malaria
What can cause hepatic fever and jaundice
Hepatitis A and E Leptospirosis Malaria Enteric fever Typhus Viral haemorrhagic fever
What investigations do we do for Malaria
Blood film and rapid antigen
What other investigations do we do for Traveler’s diarrhoea
Blood film for red cell fragmentation FBC/ UE/ LFT / Coagulation Blood cultures USS abdomen Serological testing for viruses
What management and treatment is used for Traveler’s diarrhoea
Appropriate isolation and infection control proceudres
Supportive - may need sialysis if acute kidney injury
If acute liver failure - hepatology / transplant unit
Directed to pathogen isolated
Discussion with infectious diseases
What are the common presentations of amoebic liver abscess.
When do they develop?
Fever cough aching abdominal pain hepatomegaly usually male Usually 2-4 weeks
What investigations are appropriate for amoebic liver abscess
CXR raised right hemi-diaphragm LFTs - abnormal USS/ CT Serology Stool microscopy- often negative
Where are helminth infections usually found
In the gut or the tissue
What are Helminth infections often associated with
Eosinophilia
What is the other name for Roundworms
Nematodes
What is the other name for Flukes
Trematodes
What is the other name for Tapeworms
Cestodes
What is the most common helminthic infection in the world
Intestinal nematodes (round worms)
What is the cycle of helminth infections
Eff ingested, hatched in small intestine, invade the gut wall Travel into the venous system Reaches the liver, heart and lungs Break into the alveoli Ascend the tracheobronchial tree Swallowed in the gut Develop into adult worm Adult worm starts to produce eggs
Where can we get Taenia solium from?
Pork
Where can we get saginatum from?
Beef
Where can we get Taenia solium eggs from?
Autpinoculation or from human faeces
What can Taenia solium eggs cause
Cystticercosis - tissue cysts in the muscle and brain
What are the symptoms of Giardia lamblia
Diarrhoea (chronic), malabsorption and weight loss
What type of infection is Giardia lamblia?
Protozoan infection
How can we diagnose Giardia lamblia?
Look for cytes or parasites in the stool
What is the treatment for Giardia lamblia?
Metranidazole
What is the triatome known as?
The kissing bug
What does Chagas’ Disease cause?
parasympathetic denervation affecting the colon / oesophagus
Megaoesophagus
What parasite causes Chagas’ Disease
Trypanasoma cruzi
