Tropical Medicine Flashcards
what are some febrile illnesses that cause splenomegaly?
malaria, typhoid
EBV –> splenomegaly
CMV –> hepatomegaly
besides a blood smear positive forthe organism, anemia, and hyperbilirubinemia causedbythistropicalillness
malaria
sxs=fever,sleepiness
complication=cerebral malaria –>LOC,death
Malaria with “circular”organisms
“diamond ring” == falciparum
what is the treatment for scabies?
permethrine 5% overnight
Benzyl benzoate 10-25%
PO ivermectin 200 mcg/kg
permetrhine 2-3% is used for?
head lice
what protozoa can be found in a immunocompetent kid traveling near fresh water, with watery diarrhea
Giardia
–> metronidazole
8mo girl came in acute fever and lethargy for 1d. the rash was seen in her body and legs –> petechial rash: microvascular collapse. diagnosis?
esp. the lethargy, quick progression
+ thrombocytopena
Neisseria meningitidis
–> concerns about airway, obtundation, septic shock
traveler’sdiarrhea is usuallycaused by bacteria. but in wha tage group is it more often caused by viruses?
<2yo –>b/c not a a very good cytotoxic immune system.
noro/virus/adeno viruses
adults: bacterial
name 3 laboratory abnormalities typical of typhoid fever
thrombocytopenia anemia leukopenia -->inhibit WBC production high LFTs --> RBCs sequestered in the liver (more easily hemolyzed) high ESR
name a type of malaria can persent months after coming back from an endemic area
plasmodium vivax / ovale
==> mature parasitic RBcs –> ready to burst
more mild = lasts longer
3yo boy in mexico presents with 2d of diarrhea with in loose and mucousy stools. you suspect dysentery. name 3 organisms that can cause this
dysentery == bloody diarrhea
Entomoeba histolotica E. coli Shigella Salmonella Campylobacter
what is the current recommneded antibiotics regimen for traveler’s diarrhea
Azithromycin 10mg/kg for 5d
an 8yo boy returning from iran 1w ago presents with 2d of fever, jheadache, myalgias, cough, and a petechial rash,. you suspect an rickettsial infection. what’s the treatment?
Doxycycline
overnight you admit several children from the same village in Bangladesh who are dehydrated from profuse nonbloody diarrhea and vomting. you suspect cholera. what is the golden standard to diagnose cholera?
stool culture for Vibrio cholerae
special media. -can be done
tx=flagyl
15yo girl with no PMh, livign gin the DR. fever for 2d with mild hA, joint swelling and muscle pains. you suspect chikungunya. she wnats to how long symptoms are expected and whether she’s protected from future episodes
10% of chikungunya == monthsto years of joint pain
- sxs expected for 7d
- she is likely to be protected from future einfecgtion
usually not as severe are dengue (not as much thrombocytopenias, bone pain)
==> 7 different types of dengue –> can be worse
what types of viral illness are spread by mosquitoes that are during the day?
==> aedes aegypti
Dengue
Chikungunya
Who recommends the use of ORS and zinc for the management of acute dirrhea. what is the WHo zinc regimen for a child <6yo?
10mg/day for 10-14d
for any kid with malnutrition / pneumonia ==> can reduce length of time
Zinc = cofactor for immune system
15mo boy comes in with fever and diarrhea. you measure his wieght and mid-uppe arm circumferrence to be bothbelow -3SD of the mean (== moderate malnutrition).
you decide to admit him to severe malnutrition. name 5 treatments you would start him on right away.
1) Nutrition = slow
2) Fluids = lightly d/t hypoalbuminemia and third spacing
3) Antibiotics (Amox, if severe ceftriaxone)
4) antipyretic - acetaminophen
5) Vitamins = Zinc (malnourished, diarrhea); VitA (reduce mortality in kids with chornic vitamin deficiency); folic acid (for likely severe anemia)
what can VitA help with
prevent night blindness
chrinic vitamin deficiency
Measles
what tropical febrile illlness presents mrore commonly with abdominal pain and contipation rathe than with diarrhea?
typhoid fever ==> perforated bowel
anemia + leukopenia, thrombocytopenia + elevated LFTs
tx = ceftriaxone, amox, fluids
what infectious illnesses can look like appendicitis
yersinia
typhoid
9yo haitian boy has a rash that caused swelling and pruritis for 2d. what is the diagnosis?
angioedema + lack eschar
cutaneous anthrax
tx = fluoroquinolone/doxycycline
what bugs can cause eschar
bacillus anthrax
Leishmaniasis
thin child who recently immigrated form Guatemala is asyptomatic but has an absolute eosinophil count of 1100/uL on her intake CBC. what test would you ordernext
OMP = ovum, parasite
==> parasites
3w after traveling to afghanistan, a 12yo boy develops an ulcerated skin lesion surrounded by a raised, indurated border.
cutaneous leishmaniasis
== ulcerated
overnight ouadmit several children from the same village in Haiti who are dehydrated from profuse, nonbloody diarhea and vomiting. you dont’ have stool culture at the hospital but you do have a rapid test. how sensitive and specific is it?
92%, 91%
rapid test == much more expensive
stool culture== takes longer
name 5 tropical diseases that present with persistent fevers >14d
Plasmodium ovale / vivax Yellow fever Leischmaniasis enteric fever EMV, CMV, toxoplasmosis acute HIV Acute schistomiasis brucellosis TB Q fever visceral leishmaniasis == migrated to liver.
Tropical disease that have quick fevers
Typhoids
Ebola
anme the rash associated with tropical fever 2-4mml, blanching, irregular macules in trunk. + abd pain and splenomegaly
Rose spots
typhoid fever
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever and rash
- dengue
- chikungunya
- rickettsial infection
- enteric fever (+/- skin lesions)
- acute HIV infection
- measles
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever and abd pain
- enteric fever
- amoebic liver abscess
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- undifferentiated fever, nml/low WBC
- dengue
- malaria
- rickettsial infection
- enteric fever
- chikungunya
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever and hemorrhage
- viral hemorrhagic fevers (e.g. dengue)
- meningococcemia
- leptospirosis
- rickettsial infection
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever and eosinophilia
- acute schistosomiasis
- drug hypersensitivity rxn
- parasitic infection (e.g. fascioliasis)
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever and pulmonary infiltrates
- common bacterial / viral pathogens
- legionellosis
- acute schistosomiasis
- q fever
- leptospirosis
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever and altered mental status
- cerebral malaria
- viral/bacterial meningoencephalitis
- African trypanosomiasis
- scrub typhus
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- mononucleosis syndrome
- EBV
- CMV
- toxoplasmosis
- acute HIV
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever persisting >2w
- malaria, enteric fever
- EBV
- CMV
- toxoplasmosis
- acute HIV
- acute shicstosomiasis
- brucellosis
- TB
- Q fever
- visceral lesihmaniasis
What infections do you have to consider when your patient traveled to a tropical place for vacation and now comes in with:
- fever with onset >6w after travel
- plasmodium vivax / ovale
- acute hepatitis (B, C, E)
- TB
- amoebic liver abscess
