Unwell traveller Flashcards
IF they’ve gone on holiday, what is important to ask about
Where they went
What infectious diseases can travellers have
Malaria Gastroenteritis Enteric fever Hepatitis UTI, upper and lower RTI TB HIV and STI Soft tissue infection Typhus Dengue fever
Common presenting complaints
Fever+
Diarrhoea, jaundice, other
How to take a travel history
- HPC e.g. symptoms and systems review, timeline
- Where they’ve been: country and city/town/villages. Rural, urban, seaside, jungle? Dates and stop-overs on the way back. When they went
- Any other relevant travel in the last few years
- Timeline and location of when symptoms began
- Beach holiday, city, working. IF working, what did they do.
- Where did they stay? hut or hotel?
- Swimming- sea or fresh? where?
- Other outdoor activities e.g. jungle treks
- Contact with animals
- Whay did they eat
- Insect/mosquito bites? did they try to cover up?
- Drug use? New tattoos? unprotected sex?
- Fever: when? acute or insidious? how long? when and where did it start? how often?
- Diarrhoea: how many times a day? how long? colour? blood? mucous?
- Associated symptoms: diarrhoea, sore throat, cough, ear ache, muscle ache, dysuria, vomiting, swollen joints, headache
- Did they visit the doctors or oversea hospitals?
- PMH, allergies, SHx
- IN drugs, ask about pre-trip immunisations and malaria prophylaxis
Onset of bacterial and viral gastroenteritis
Will start when patient is abroad or shortly after return
Onset of protozoal diarrhoea
up to 2 weeks. Chronic onset
onset of typhoid/paratyphoid diarrhoea
starts around week 3 of illness
Cause of bloody diarrhoea
E.coli, campylobacter, shigella or amoebiasis
Cause of mucuous diarrhoea
Mucous is suggestive of large bowel pathology
Mucous + blood common in dysentry
Pus in diarrhoea
Likely bacterial
Watery diarrhoea e.g. rice water
CHOLERA
Colour of c.diff diarrhoea
Green
Diagnosis?
PHYSICAL exam stool- OCP, cultures Blood culturesmand malaria investigations if pyrexic Typhoid fever diagnosed by blood culture malaria or ibd?
bacterial causes
All the normal causes of an acute gastroenteritis (such as the range of viral causes) still exist abroad
Viral causes include rotavirus and norovirus
Bacterial toxins tend to cause disease within a few hours
Again less exotic causes such as bacillus cereus (classically from rice) and staph aureus fit this
Otherwise an incubation period is required (anything from 6-72 hours)
What is the likely cause of bloody diarrhoea. Gram?
Incubation period?
Shigellosis (gram -)
-3 days
Features of a shigellosis infection
Gut wall invasion plus shiva toxin production. Inflammation, ulceration, micro-abscesses and bleeding in large bowel.
Presentation of shigellosis
Complications
Can be mild like Water diarrhoea or severe diarrhoea which contains blood mucus and pus. Can cause:
- Shock
- MAssive haemorrhage
Diagnosis of shigellosis
Recurrent jelly stool- MC&S or rectal swab
Features of campylobacter
Flu like pro-drone then abdo pain, fever and diarrhoea (may be bloody)
Complication of campylobacter
Guillain barre syndrom
E.coli presentation
Diarrhoea with nausea and abdo cramps, initially watery and may become bloody
Complication of e.coli
Haemolytic urea syndrom
What is typhoid fever caused by
Salmonella type or paratyphi strains
Incubation of typhoid fever and its presentation
5-21 days
1st week- headache, cough, anorexia, sore throat, weak and achey, gradual onset fever and abdo discomgert
2nd week- patient is toxic- sustained fever, rose spots, abdo pain, diarrhoea or constipation, hepatosplenomegaly
3rd week- fever begins to break and patient slowly settles or complications can occur
Complication of typhoid fever
Perforation, GI haemorrhage or severe toxaemia and shock
Diagnosis of typhoid
Stool and blood culture
Serology- not useful in endemic areas (can’t distinguish past infection)
Management of typhoid fever
Supportive, abx and management of complications
What cause can diarrhoea lasting over 14 days have
parasites. also have a longer incubation period
Symptoms of Giardia
Bloating, flatulence and burping. Prolonged diarrhoea is water/ greasy
Symptoms of entamoeba
Can be asymptomatic. ON endoscopy can find ulcers. Insidious onset abdo discomfort and diarrhoea. May be blood and mucuous
Symptoms of cyclospora and cryptosporium
Bloating, weight loss, fever, malaise, watery diarrhoea and abdo cramps
