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Medical Ethics & Law > Travel Related Infections > Flashcards

Travel Related Infections Flashcards

1
Q

What is vulnerability of travelers to infection impacted by?

A
  • Temptation to take risks away from home
    • food, water, animals, sex
  • Different epidemiology of some diseases
    • HIV, TB, polio, diphtheria
  • Incomplete understanding of health hazards
  • Stress of travel
  • Refugees: deprivation, malnutrition, disease, injury
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2
Q

What are some common infections worldwide?

A
  • influenza
  • community-acquired pneumonia
  • meningococcal disease
  • sexually transmitted diseases
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3
Q

What are some climate or environmental health problems?

A
  • Sunburn
  • Heat exhaustion and heatstroke
  • Fungal infections
  • Bacterial skin infections
  • Cold injury
  • Altitude sickness
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4
Q

What are some public health measures to control infection?

A
  • Sanitation
    • Travelers’ diarrhoea
    • Typhoid
    • Hepatitis A or E
    • Giardiasis
    • Amoebiasis
    • Helminth infections
    • Viral gastroenteritis
    • Food poisoning
    • Shigella dysentery
    • Cholera
    • Cryptosporidiosis
  • Immunization
    • Poliomyelitis
    • Diphtheria
  • Education
    • HIV
    • STD’s
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5
Q

What are some water related infections?

A
  • Schistosomiasis
  • Leptospirosis
  • Liver flukes
  • Strongyloidiasis
  • Hookworms
  • Guinea worms
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6
Q

What are some arthropod-borne infections?

A
  • Malaria (mosquitos)
  • Dengue fever (mosquitos)
  • Rickettsial infections (ticks: typhus)
  • Leishmaniasis (sand flies: Kala-azar)
  • Trypanosomiasis (tsetse fly: sleeping sickness)
  • Filariasis (mosquitoes: elephantiasis)
  • Onchocerciasis (black flies: River Blindness)
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7
Q

What is the malaria vector?

A

Malaria vector is the female anopheles mosquito

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8
Q

Describe the malaria lifecycle?

A

1) Bite
2) Sporozoite released
3) Becomes merozoitres in liver
4) Infects red blood cells

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9
Q

What are the 5 species of malaira?

A
  • Potentially severe
    • Plasmodium falciparum
  • Benign
    • Plasmodium vivax
    • Plasmodium ovale
    • Plasmodium malariae
    • Plasmodium knowlesi
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10
Q

What are the clinical features of malaria?

A
  • Symptoms
    • fever
    • rigors
    • aching bones
    • abdo pain
    • headache
    • dysuria
    • frequency
    • sore throat
    • cough
  • Signs
    • none
    • splenomegaly
    • hepatomegaly
    • mild jaundice
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11
Q

What are some potential complications of malaria?

A
  • Cerebral malaria (encephalopathy)
  • Blackwater fever
  • Pulmonary oedema
  • Jaundice
  • Severe anaemia
  • Algid malaria
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12
Q

How is malaria diagnosed?

A
  • Thick and thin blood films
  • Quantitative buffy coat (QBC)
  • Rapid antigen tests
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13
Q

How is severity of malaria measured?

A

Severity assessment, complicated malaria has one or more of:

  • Impaired consciousness or seizures
  • Hypoglycaemia
  • Parasite count ³2%
  • Haemoglobin £ 8mg/dL
  • Spontaneous bleeding / DIC
  • Haemoglobinuria
  • Renal impairment or pH <7.3
  • Pulmonary oedema or ARDS
  • Shock (algid malaria)
  • ?Gram negative bacteraemia
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14
Q

What is the 1st and 2nd line treatment of malaria?

A
  • 1) Quinine
  • 2) Artemisinins
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15
Q

What are the treatment options for malaria?

A
  • Uncomplicated malaria
    • Riamet (3 days)
    • Eurartesim (3 days)
    • Malarone (3 days)
    • Quinine (7 days) plus oral doxycycline
  • Complicated or severe P. Falciparum malaria
    • IV artesunate (unlicensed in UK)
    • IV quinine plus oral doxycycline
  • Treatment of P. Vivax, P. Ovale, P. Malariae, P. Knowlesi
    • Chloroquine 3 days
    • Riamet 3 days
    • Add primaquine 14 days in vivax and ovale to eradicate liver hyponozoites
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16
Q

What are some methods of controlling malaria?

A
  • Mosquito breeding sites
    • Drainage of standing water
  • Larvacides
    • (Paris green), temphos, biological
  • Mosquito killing sprays
    • DDT, malathion, (dieldrin)
  • Human behaviour
    • Bed nets
    • Mesh windows
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17
Q

Typhoid fever is also known as what?

A

Enteric fever

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18
Q

Typhoid is caused by what organisms?

A
  • Salmonella typhi
  • Salmonella paratyphi
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19
Q

What are the clinical features of typhoid?

A
  • Incubation period: 7 days - 4 week
  • 1st week:
    fever, headache, abdo. discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion
  • 2nd week:
    fever peaks at 7-10 days, Rose spots, diarrhoea begins, tachycardia, neutropenia
  • 3rd week (Complications):
    intestinal bleeding, perforation, peritonism, metastatic infections
  • week 4 (Recovery):
    10 - 15% relapse
20
Q

How is typhoid diagnosed?

A
  • Clinical is not easy, done by evolution of features
  • Laboratory
    • Culture blood, urine and stool
    • Culture bone marrow
21
Q

What is the treatment of typhoid?

A
  • Oral azithromycin
    • If uncomplicated
  • IV ceftriaxone
    • If complicated or concerned regarding absorption
22
Q

What is dengue caused by?

A

Dengue virus

23
Q

What is the vector of dengue?

A

Mosquito borne (aedes aegypti)

24
Q

What are the clinical features of dengue?

A
  • Sudden fever
  • Severe headache, retro-orbital pain
  • Severe myalgia and arthralgia
  • Macular/ maculopapular rash
  • Haemorrhagic signs: petechiae, purpura, positive tourniquet test
25
Q

How is dengue diagnosed?

A
  • Clinical
    • Thrombocytopenia
    • Leucopenia
    • Elevated transaminases
    • Positive tourniquet test
  • Laboratory
    • PCR
    • Serology
26
Q

Describe the management of dengue?

A
  • No specific therapeutic agents
  • Complications
    • Dengue haemorrhagic fever (DHF)
    • Dengue shock syndrome (DSS)
    • Rx: IV fluids, fresh frozen plasma, platelets
  • Prevention
    • Avoid bites
    • New vaccine (Dengvaxia)
27
Q

What is schistosomiasis also known as?

A

Snail fever

28
Q

What is schistosomiasis caused by?

A

Parasite flatworms called schistosomes

29
Q

What is the vector of schistosomiasis?

A

Freshwater snails

30
Q

What are different species of schistosomes?

A
  • S. haematobium
  • S. mansoni
  • S. japonicum
31
Q

What are the different kinds of schistosomiasis?

A

Can be hepatic or urinary infection (or a mix)

32
Q

Describe the lifecycle of schistosomiasis?

A
33
Q

What are the clinical features of schistosomiasis?

A
  • Swimmers Itch (1st few hrs)
    • clears 24-48hrs
  • Invasive stage (after 24hrs)
    • cough, abdo discomfort, splenomegaly, eosinophilia
  • Katayama Fever (after 15-20 days)
    • prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
  • Acute disease (6-8 weeks)
    • eggs deposited in bowel (dysentery) or bladder (haematuria)
  • Chronic disease
34
Q

How is schistosomiasis diagnosed?

A
  • Clinical diagnosis
  • Antibody tests
  • Ova in stools and urine
  • Rectal snip
35
Q

What is the treatment for schistosomiasis?

A
  • Praziquantel
    • 20mg/kg
  • Prednisolone if severe
36
Q

What organism caused tick thyphys?

A

Caused by rickettsiosis

37
Q

What are some different illnesses caused by rickettsiosis?

A
  • Tick typhus (R. conorii, R. africae)
  • Rocky Mountain Spotted Fever (R. rickettsii)
  • Epidemic typhus (R. prowazekii)
  • Murine or endemic typhus (R. mooseri)
  • Scrub typhus (R. tsutsugamushi)
  • others
38
Q

What are some clinical features of tick typhus?

A
  • Abrupt onset of fever
  • Headache
  • Confusion
  • Endovasculitis
  • Rash
  • Bleeding
39
Q

How is tick typhus diagnosed?

A
  • Clinical features
  • Serology
40
Q

Describe the management of tick typhus?

A
  • Tetracycline
41
Q

What are examples of viral haemorrhagic fevers?

A

These are serious infections but rare in UK:

  • Ebola
  • Congo-Crimea haemorrhagic fever
  • Lassa fever
  • Marburg disease
42
Q

What is the treatment for viral haemorrhagic fevers?

A

Rule out common severe infections

Requires isolation in high security infection unit

Only treatment is supportive

43
Q

What causes zika?

A

Flavivirus

44
Q

What is the vector of zika?

A

Transmitted by daytime-biting aedes mosquitoes, or sexual contact or blood transfusion

45
Q

What are clinical features of zika?

A
  • No or mild symptoms
    • Headache
    • Rash
    • Fever
    • Malaise
    • Conjunctivitis
    • Joint pains
  • In pregnancy can cause microcephaly and other neurological problems
46
Q

What is the treatment of zika?

A
  • No antiviral therapy
  • Mosquito control measures
  • Vaccines in development
47
Q

What illnesses have specific tests available?

A
  • dengue
  • respiratory viral/atypical
  • hepatitis A, B, C
  • tick typhus (Rickettsia)
  • schistosomiasis
  • amoebic
  • leptospirosis/hantavirus
  • viral haemorrhagic fevers

Medical Ethics & Law (52 decks)

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