Travel Medicine

Question 1

Travelers’ Diarrhea

Answer 1

mostly bacterial (E. Coli)
Onset usually w/in first week
Most resolve 1-2 days w/o Tx

Question 2

Travelers’ Diarrhea Treatment

Answer 2

Replacement fluids/electrolytes
Mostly clear liquids
Antibiotics

Antimotility Agents???
Loperamide (Imodium) OTC, except with:
Secretory/Bloody diarrhea

Question 3

Malaria

Answer 3

Fever, chills, sweats, headaches, muscle pains, nausea and vomiting) are often not specific
Severe malaria (caused by Plasmodium falciparum)- confusion, coma, neurologic focal signs, severe anemia, respiratory difficulties.
Diagnosed by direct visualization and antigen detection

Question 4

Malaria Prophylaxis Treatment

Answer 4

Bednets, insecticides, and antimalarial drugs
Atovaquone & proguanil (Malarone)
Chloroquine (most strains of Plasmodium show resistance)
Primaquine
Doxycycline
Mefloquine(Larium)
**Chloroquine and Mefloquine are safe with pregnancy

Question 5

Typhoid

Answer 5

Salmonella typhi
Lives only in humans in intestinal tract and blood
Spread by oral/fecal route
Raw fruits & vegetables, milk and shellfish

Question 6

Typhoid Clinical Features

Answer 6

Sustained high fever as high as 104
Weakness
Abdominal pain
Headache
Diarrhea
Intestinal bleeding or perforation (after 2-3 weeks without treatment)
Septicemia
“Rose spots” – macular rash

Question 7

Typhoid VaccineContraindications and Precautions

Answer 7

Severe allergic reaction to vaccine component or following a prior dose
Immunosuppression
Moderate or severe acute illness
Acute GI illness
Pregnancy
Age < 5years

Question 8

Yellow Fever

Answer 8

Acute viral hemorrhagic disease
RNA virus in the Flaviviridae family
Transmitted by mosquitoes
Found in Africa (90%), S. America 
Get vaccine within 2 weeks of traveling

Question 9

Yellow Fever Clinical Features

Answer 9

Incubation period of 3-6 days
85% of cases will have only mild symptoms including:
Fever
Headache
Chills
Back pain
Nausea and vomiting
Loss of appetite

Question 10

Yellow Fever VaccineContraindications and Precautions

Answer 10

Immunosuppression
Thymic disorders
Age < 9 months
Hypersensitivity
Egg allergy
Moderate or severe acute illness
Pregnancy/Lactating

Question 11

Rabies

Answer 11

Caused by the rabies virus which is almost always fatal
RNA virus, is part of the family of Rhabdoviruses
Virus is transmitted through a bite or scratch from an infected animal:
Raccoons
Skunks
Foxes
Coyotes
Bats

Question 12

Rabies Clinical Features

Answer 12

Prodrome: HA, fever, rhinorrhea, sore throat, myalgias, GI upset, back pain and muscle spasms

Agitation and anxiety may result in diagnosis of psychosis or intoxication

Paresthesias, pain or severe itching at site may be the first neurological symptom

Question 13

Rabies Vaccine Pre exposure vaccine schedule

Answer 13

1st dose
7 days later
21 or 28 days after the first dose

Question 14

Japanese Encephalitis

Answer 14

Mosquito-borne flavivirus
The most common vaccine-preventable cause of encephalitis in Asia
RNA virus

Question 15

Japanese Encephalitis Clinical Features

Answer 15

Incubation period: 6 to 8 days
Most asymptomatic or mild signs
Acute encephalitis
Paralysis, seizures, convulsions, coma, and death
Neuropsychiatric sequelae
In utero infection possible-Abortion of fetus

Question 16

Cholera

Answer 16

epidemic diarrhea throughout the developing world. Ongoing global pandemic in Asia, Africa and Latin America for the last four decades.
Rice water diarrhea

Question 17

Tuberculosis (TB)

Answer 17

Caused by the bacteria Mycobacterium tuberculosis
Coughing up blood
Without treatment, tuberculosis can be fatal.

Question 18

TB Vaccine

Answer 18

Bacille Calmette-Guérin (BCG) is a live strain of Mycobacterium bovis
Most widely administered vaccine in the world;
Immunization lasts ~10 years
Given intradermally
Given in countries with high Tb (Africa/Asia)
Pregnancy is a contraindication