Tropical infections Flashcards
Examination findings on returned traveller?
FEVER RASH HEPATOSPLENOMEGALY LYMPHADENOPATHY INSECT BITES WOUNDS
What is acute traveller’s diarrhea associated with?
Enterotoxigenic E coli Campylobacter Salmonella Shigella Norovirus, rotavirus
Treatment for acute traveller’s diarrhea?
Supportive - fluid rehydration
BLOODY DIARRHEA with systemic upset may warrant treatment
CIPROFLOXACIN (fluoroquinolone) - broad spectrum, if areas high antibiotic resistance narrow spec more useful AZITHROMYCIN (macrolide)
Investigations for acute traveller’s diarrhea?
Stool culture
Stool wet prep for amoeba trophozoites
What is enteric fever?
Fever caused by salmonella - can be typhoid or paratyphoid depending on strain
salmonella typhi or paratyphi
Where is enteric fever common?
Returned travellers from indian subcontinent and SE asia
Treatment enteric fever?
IV Ceftriaxone if severe sepsis (cephalosporin)
Can treat with ciprofloxacin or azithromycin but resistance
T/F
Vaccination provided complete protection against typhoid and paratyphoid
F
incomplete against typhoid
none para
Prehepatic jaundice related to infection?
- Sickle cell crisis triggered by infection
- Malaria: replicates in RBCs and bursts em
- Haemolytic uraemic syndrome: complication of E coli infection which is hemolysis and kidney failure (uremia)
hepatic jaundice related to infection?
- Malaria: also replicates in hepatocytes
- Hepatitis A n E
- Ricksettia
- enteric fever
posthepatic jaundice related to infection?
helminths
ascending cholangitis
How does amoebic liver abscess present?
Fever Sweats Upper abdominal pain GI upset (dysentry) Hepatomegaly Point tenderness over right lower ribs
How does amoebic liver abscess develop?
Carried from bowel to liver via portal system
Causes portal inflammation which leads to development of abscess
Investigations for amoebic liver abscess?
CXR - raised RIGHT hemi-diaphragm Ultrasound or CT to look for it Serology for amoeba Stool microscopy often negative Abnormal LFTs - abnormal liver
Management for amoebic liver abscess?
Metronidazole or tinidazole
Management for giardiasis?
Metronidazole or tinidazole
What does giardiasis look under microscope?
Smiley creepy cells
Where does giardiasis invade?
duodenum and proximal jejunum
Presentation of giardiasis?
Watery, malodorous diarrhea
Bloating, flactulance
Abdominal cramps
weight loss
What are the most common helminth infections?
Intesinal nematodes/round worms/ascariasis
What is the life cycle of intestinal nematodes?
egg ingested hatches in small intestine Invade gut and go into venuous system reach lungs and swallowed gut again to lay eggs
How do you get schistomiasis?
Fresh water exposure (helminthic)
How does schistomiasis manifest in chronic infection?
Adult worms located in portal venules, can lead to hepatomegaly and liver fibrosis and portal hypertension
How do you get tapeworm?
Undercooked beef or pork (helminthic)
