Tropical infections

Question 1

Examination findings on returned traveller?

Answer 1

FEVER
RASH
HEPATOSPLENOMEGALY
LYMPHADENOPATHY
INSECT BITES
WOUNDS

Question 2

What is acute traveller’s diarrhea associated with?

Answer 2

Enterotoxigenic E coli
Campylobacter
Salmonella 
Shigella 
Norovirus, rotavirus

Question 3

Treatment for acute traveller’s diarrhea?

Answer 3

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)

Question 4

Investigations for acute traveller’s diarrhea?

Answer 4

Stool culture

Stool wet prep for amoeba trophozoites

Question 5

What is enteric fever?

Answer 5

Fever caused by salmonella - can be typhoid or paratyphoid depending on strain
salmonella typhi or paratyphi

Question 6

Where is enteric fever common?

Answer 6

Returned travellers from indian subcontinent and SE asia

Question 7

Treatment enteric fever?

Answer 7

IV Ceftriaxone if severe sepsis (cephalosporin)

Can treat with ciprofloxacin or azithromycin but resistance

Question 8

T/F

Vaccination provided complete protection against typhoid and paratyphoid

Answer 8

F
incomplete against typhoid
none para

Question 9

Prehepatic jaundice related to infection?

Answer 9

• 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)

Question 10

hepatic jaundice related to infection?

Answer 10

• Malaria: also replicates in hepatocytes
• Hepatitis A n E
• Ricksettia
• enteric fever

Question 11

posthepatic jaundice related to infection?

Answer 11

helminths

ascending cholangitis

Question 12

How does amoebic liver abscess present?

Answer 12

Fever
Sweats
Upper abdominal pain
GI upset (dysentry)
Hepatomegaly 
Point tenderness over right lower ribs

Question 13

How does amoebic liver abscess develop?

Answer 13

Carried from bowel to liver via portal system

Causes portal inflammation which leads to development of abscess

Question 14

Investigations for amoebic liver abscess?

Answer 14

CXR - raised RIGHT hemi-diaphragm
Ultrasound or CT to look for it
Serology for amoeba
Stool microscopy often negative 
Abnormal LFTs - abnormal liver

Question 15

Management for amoebic liver abscess?

Answer 15

Metronidazole or tinidazole

Question 16

Management for giardiasis?

Answer 16

Metronidazole or tinidazole

Question 17

What does giardiasis look under microscope?

Answer 17

Smiley creepy cells

Question 18

Where does giardiasis invade?

Answer 18

duodenum and proximal jejunum

Question 19

Presentation of giardiasis?

Answer 19

Watery, malodorous diarrhea
Bloating, flactulance
Abdominal cramps
weight loss

Question 20

What are the most common helminth infections?

Answer 20

Intesinal nematodes/round worms/ascariasis

Question 21

What is the life cycle of intestinal nematodes?

Answer 21

egg ingested
hatches in small intestine
Invade gut and go into venuous system
reach lungs and swallowed
gut again to lay eggs

Question 22

How do you get schistomiasis?

Answer 22

Fresh water exposure (helminthic)

Question 23

How does schistomiasis manifest in chronic infection?

Answer 23

Adult worms located in portal venules, can lead to hepatomegaly and liver fibrosis and portal hypertension

Question 24

How do you get tapeworm?

Answer 24

Undercooked beef or pork (helminthic)

Question 25

How does tapeworm manifest?

Answer 25

Cysticerosis
tissue cysts in muscle and brain
seizures

Question 26

How do you get Chagas disease?

Answer 26

from kissing bug (protozoa)

Question 27

How does chagas disease manifest?

Answer 27

Parasympathetic denervation affecting colon and esophagus

results in megaesophagus