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Yr 3 Infection > Travel related infections > Flashcards

Travel related infections Flashcards

1
Q

What makes travelers more vulnerable to infection?

A
  • Temptation to take risks away from home (sex, food)
  • Different epidemiology of some diseases
  • Incomplete understanding of health hazards
  • Stress of travel
  • Refugees: deprivation, malnutrition
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2
Q

What infections are common worldwide?

A
  • Influenza
  • Community acquired pneumonia
  • Meningococcal disease
  • STIs
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3
Q

What are some climate/environmental related health problems?

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

What are infections controlled by public health measures? Eg sanitation immunization education

A

Sanitation
-Travellers diarrhoea, viral gastroenteritis, food poisoning, cholera, shigella dysentery, hep A or E

Immunisation
-Poliomyelitis, diphtheria

Education
-HIV, STDs

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5
Q

What are some water related infections?

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

What are some arthropod borne infections?

A
  • Malaria (mosquitoes)
  • Dengue fever (mosquitoes)
  • Rickettsial infections (ticks)
  • Leishmaniasis (sand flies)
  • Filariasis (mosquitoes)
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7
Q

What are some infectious diseases?

A
  • Zika: Latin America, Caribbean
  • Ebola: W Africa
  • MERS-CoV: Middle East
  • Swine flu: worldwide
  • Avian flu: China
  • SARS: worldwide
  • West Nile virus: USA
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8
Q

What are some important tropical diseases?

A
  • Malaria
  • Typhoid
  • Dengue fever
  • Schistosomiasis
  • Rickettsiosis
  • Viral haemorrhagic fevers
  • Zika fever
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9
Q

How many reported cases per year is there of malaria?

A

200 million cases per year. Most common in Africa, Latin America, India

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10
Q

What is the life cycle of malaria?

A
  • Mosquito infects human
  • Human carries malaria in blood
  • Female mosquito bites human and now carries malaria parasite
  • Gives birth and the child also has malaria parasite
  • Goes off to infect other humans
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11
Q

What are the 5 species of malaria parasite?

A

Potentially severe
-Plasmodium falciparum

Benign
-Plasmodium vivax/ovale/malariae/knowlesi

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12
Q

What are symptoms of malaria?

A
  • Fever
  • Rigors
  • Aching bones
  • Abdo pain
  • Headache
  • Dysuria
  • Frequency
  • Sore throat
  • Cough
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13
Q

What are signs of malaria?

A
  • Can be none
  • Splenomegaly
  • Hepatomegaly
  • Mild jaundice
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14
Q

What are some complications of malaria?

A
  • Cerebral malaria (encephalopathy): convulsions, hypoxia
  • Blackwater fever: severe haemolysis, high parasitaemia, acute renal failure, haemoglobinuria
  • Pul. oedema
  • Jaundice
  • Severe anaemia
  • Algid malaria (gram -ve septicaemia)
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15
Q

How is malaria diagnosed?

A
  • Thick and thin blood films (Giemsa, Field’s stain)
  • Quantitative buffy coat (centrifugation, UV microscopy)
  • Rapid antigen tests (OptiMal, ParaSight-F)
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16
Q

There is a severity assessment for malaria. Having ‘complicated malaria’ = one or more of what?

A
  • Impaired consciousness/seizures
  • Hypoglycaemia
  • Parasite count at least 2%
  • Haemoglobin 8mg/dL or less
  • Renal impairment/pH <7.3
  • Pul oedema or ARDS
  • Shock (algid malaria)
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17
Q

What are treatment options for uncomplicated P. falciparum malaria?

A
  • Riamet 3 days
  • Eurartesim (artemisinin) 3 days
  • Malarone 3 days
  • Quinine 7 days plus oral doxycycline (or clindamycin)
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18
Q

What are treatment options for complicated/severe P. falciparum malaria?

A
  • IV artesunate (unlicensed in UK)

- IV quinine plus oral doxycycline (or clindamycin)

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19
Q

Treatment of P. vivax/ovale/malariae/knowlesi malaria?

A
  • Chloroquine 3 days
  • Riamet 3 days
  • Add primaquine (14d) in vivax and ovale to eradicate liver hypnozoites
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20
Q

What are some malaria control programmes?

A
  • Mosquiro breeding sites (draining standing water)
  • Larvacides
  • Mosquito killing sprays
  • Human behaviour (bed nets, mesh windows)
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21
Q

Typhoid fever is widespread and happens due to poor sanitation and unclean drinking water. What organisms cause this?

A
  • Salmonella typhi

- Salmonella paratyphi

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22
Q

What is the incubation period for typhoid fever?

A

1-4 weeks

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23
Q

What clinical features are seen in the first week of disease onset?

A
  • Fever
  • Headache
  • Abdo discomfort
  • Constipation
  • Dry cough
  • Relative bradycardia
  • Neutrophilia
  • Confusion
24
Q

What clinical features are seen in the second week of disease onset?

A
  • Fever
  • Rose spots
  • Diarrhoea
  • Tachycardia
  • Neutropenia
25
Q

What clinical features are seen in the third week of disease onset? (complications arise)

A
  • Intestinal bleeding
  • Perforation
  • Peritonism
  • Metastatic infections
26
Q

What clinical features are seen in the fourth week of disease onset?

A

Usually recovery begins. 10-15% relapse

27
Q

How do you diagnose typhoid fever?

A

Clinical
-Spot evolution of features

Lab

  • Blood/urine/stool/bone marrow culture
  • Looking for Salmonella typhi/paratyphi
28
Q

How do you treat typhoid fever?

A
  • Oral azithromycin

- IV Ceftriaxone (esp if complicated)

29
Q

Dengue fever is the commonest human arbovirus infection. How is it transmitted?

A

Aedes aegypti (type of mosquito)

30
Q

What are the symptoms and signs of classical dengue fever?

A
  • Sudden fever
  • Sudden headache, retro-orbital pain
  • Severe myalgia and arthralgia
  • Macular/maculopapular rash
  • Haemorrhagic signs: petechiae, purpura, positive tourniquet test
31
Q

How is dengue fever diagnosed?

A

Clinical

  • Thrombocytopenia
  • Leucopenia
  • Elevated transaminases
  • Positive tourniquet test

Lab

  • PCR
  • Serology
32
Q

What is the management of Dengue fever?

A

No specific therapeutic agents

Complications

  • Dengue haemorrhagic fever
  • Dengue shock syndrome
  • Rx: IV fluids, fresh frozen plasma, platelets

Prevention

  • Avoid bites
  • New vaccine
33
Q

Schistosomiasis is spread via freshwater snails. What are the different water born parasites that cause this?

A
  • Schistosomiasis haematobium (found in urine and faeces)
  • Schistosomiasis mansoni (found in faeces)
  • Schistosomiasis japonicum (found in urine and faeces)
34
Q

What is the schistosomiasis life cycle?

A
  • Infected snails penetrate human skin while swimming etc
  • Circulate in body, lose tails to become schistosomulae in body upon penetration
  • Migrate to portal blood in liver/mesenteric venules of bowel/rectum/venous plexus of bladder
  • Released in urine/faeces into sea
  • Parasite infects snail and cycle continues
35
Q

The first clinical feature of schistosomiasis is swimmers itch, which presents after a few hours and stops after a day or two. What clinical features occur in the invasive stage?

A
  • After 24h
  • Cough
  • Abdo discomfort
  • Splenomegaly
  • Eosinophilia
36
Q

What clinical features are seen in the Katayama fever seen in schistosomiasis?

A
  • After 15-20 days
  • Prostate
  • Fever
  • Urticaria
  • Lymphadenopathy
  • Splenomegaly
  • Diarrhoea
  • Eosinophilia
37
Q

What happens in acute disease of schistosomiasis? (also get chronic disease)

A

-Eggs deposited in bowel (dysentery) or bladder (haematuria)

38
Q

How is schistosomiasis diagnosed?

A
  • Clinical diagnosis
  • Antibody tests
  • Ova in stools and urine
  • Rectal snip
39
Q

What is the treatment for schistosomiasis?

A
  • Praziquantel (2 doses 6hr apart)

- Prednisolone if severe

40
Q

What are the different types of rickettsiosis diseases and what organism causes them?

A
  • Tick typhus (rickettsia conorii/africae)
  • Rocky mountain spotted fever (rickettsia rickettsii)
  • Epidemic typhus (rickettsia prowazekii)
  • Scrub typhus (rickettsia tsutsugamushi)
41
Q

What is the most common rickettsiosis disease imported to UK?

A

Tick typhus (from S Africa, Mediterranean, Arabian Gulf)

42
Q

What are the clinical features of rickettsiosis?

A
  • Abrupt onset swinging fever
  • Headache
  • Confusion
  • Endovasculitis
  • Rash (macular, petechiae)
  • Bleeding
43
Q

How is rickettsiosis diagnosed?

A
  • Clinical features

- Serology

44
Q

What is the treatment for rickettsiosis?

A

Tetracycline

45
Q

What are serious viral haemorrhagic fevers that are rare in the UK but deadly?

A
  • Ebola
  • Congo-Crimea haemorrhagic fever
  • Lassa fever
  • Marburg disease
46
Q

How do you deal with someone who contracts a viral haemorrhagic fever?

A
  • High security infection unit

- Supportive treatment

47
Q

How is Zika virus transmitted?

A
  • Aedes mosquitoes
  • Sexual contact
  • Blood transfusion
48
Q

What are the clinical features of Zika virus?

A
  • none/mild symptoms
  • Headache
  • Rash
  • Fever, malaise
  • Conjunctivitis
  • Joint pains
  • Microcephaly and other neuro problems in pregnancy
  • Can cause GBS
49
Q

What treatment is there for Zika virus?

A
  • No antiviral therapy
  • Mosquito control measures
  • Vaccines in development
50
Q

What should be focused on in a patient history in a returning traveller with symptom onset?

A
  • Is it tropical?
  • Travel history
  • Precautions taken
  • Risks
  • Symptoms/signs
  • Incubation history
51
Q

Upon examination, what diseases does rash point to?

A
  • Typhoid
  • Typhus
  • Dengue
52
Q

Upon examination, what diseases does jaundice point to?

A
  • Hepatitis
  • Malaria
  • Yellow fever
53
Q

Upon examination, what diseases does lymphadenopathy point to?

A
  • Leishmania

- Trypanosomiasis

54
Q

Upon examination, what diseases does liver symptoms point to?

A
  • Malaria
  • Typhoid
  • Amoebic abscess
55
Q

Upon examination, what diseases does splenomegaly point to?

A
  • Visceral leishmaniasis
  • Typhoid
  • Malaria
56
Q

What general investigations should be done for travel acquired infections? (as well as specific investigations)

A
  • FBC
  • Malaria films
  • LFTs
  • Stool microscopy and culture
  • Urine analysis and culture
  • Blood culture
  • CXR
57
Q

General treatment for travel acquired infections?

A
  • Isolation: (PPE, single rooms)
  • Supportive measures
  • Empirical treatment
  • Specific treatment once diagnosis established

Yr 3 Infection (12 decks)

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