Tropical Gastroenterology Flashcards
History of a returned traveller?
Where have they been? - rural/urban, accomodation (air con)
When did they go?
When did they get back?
When did they start becoming unwell?
Did they have insect bites – any tick bites?
What are their symptoms?
Is anyone else unwell?
What did they do when away?
Swimming/water sports/animal contact/bat caves/walking in bush/sex/work?
What precautions did they take – vaccinations/malaria prophylaxis/bite protection/condoms?
Examination of a returned traveller?
Fever Rash Hepatosplenomegaly Lymphadenopathy Insect bites Wounds
Causes of fever in a returned traveller?
Respiratory tract infections – pneumonia/influenza
Traveler’s diarrhoea
Malaria
Enteric fever (typhoid/paratyphoid fever)
Arboviruses – Dengue/Chikungunya
Typical cause of acute traveller’s causes and others (bacteria, viruses, parasitic)?
Typically enterotoxigenic E. coli
Also, Campylobacter, Salmonella, Shigella
Cruise ships – Norovirus and rotavirus
Others – Amoebic diarrhoea
Causes of dysentery?
Bacterial causes include E.coli o157 and Amoebic colitis
Causes of profuse watery diarrhoea?
Cholera - toxin mediated disease often assoc. with outbreaks in refugee camps
Treatment of acute traveller’s diarrhoea?
Supportive – fluid rehydration (oral/IV)
Bloody diarrhea with systemic upset may warrant treatment
In those travelling a fluoroquinolone (ciprofloxacin) single dose can stop worsening (a three day course is often recommended - simple gastroenteritis will resolve without treatment)
Antibiotic resistance – macrolide (azithromycin) may be more useful
What is enteric fever?
Typhoid or paratyphoid fever, caused by Salmonella typhi or paratyphi,
that is common in those returning from Indian subcontinent and SE Asia
Incubation period 7-18 days (though occasionally up to 60 days)
Symptoms and complications of enteric fever?
Fever
Non-specific:
Headache
Constipation or diarrhoea
Dry cough
Complications: GI bleeding GI perforation Encephalopathy Bone and joint infection
Pre-hepatic, hepatic and post-hepatic causes of fever and jaundice?
Pre-hepatic (haemolytic):
Malaria
HUS as complication of diarrhoeal illness – E.coli 0157, Shigella
Sickle cell crisis triggered by infection
Hepatic: Hep A and E – acute (occasionally Hep B) Leptospirosis – Weils diseases (Icteric, haemorrhagic and renal failure) Malaria Enteric fever Typhus Viral haemorrhagic fever
Post-hepatic – ascending cholangitis – and helminths
Symptoms of amoebic liver abscess?
Incubation period 8-20 weeks:
Symptoms develop over 2-4 weeks, inc. fever, cough, aching abdominal pain, hepatomegaly, sometimes a history of GI upset (dysentery)
Usually male
Ix and signs of amoebic liver abscess?
CXR - raised right hemi-diaphragm.
Abnormal LFTs
USS/CT scan
Serology
Stool microscopy often negative.
What are helminth infections??
Parasitic, e.g: Ascariasis worms
Example of protozoal infections?
Giardia lamblia
