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Tropical Medicine Flashcards

1
Q

What group of microorganisms?

African trypanosomiasis
(sleeping sickness), American trypanosomiasis
(Chagas disease), amoebiasis, babesiosis,
coccidiosis and microsporodiosis,
cryptosporidiosis, giardiasis, leishmaniasis—
cutaneous and visceral (kala-azar), malaria,
toxoplasmosis, trichomonas

A

Protozoan

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2
Q

What group of microorganisms?

Cysticercosis ( Taenia
solium, T. saginata ), echinococcus (hydatid
disease

A

Cestodes (tapeworms

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3
Q

What group of microorganisms?

Schistomiasis (bilharziasis),
clonorchiasis, paragonimiasis

A

Trematodes (flukes):

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4
Q

What group of microorganisms?

Ascariasis, enterobiasis
(pinworm), Dracunculus medinensis (Guinea
worm), filariasis, hookworm, larva migrans
(cutaneous and visceral), strongyloidiasis,
trichinosis ( Trichinella spiralis ), trichuriasis
(whipworm)

A

HIV

seroconversion infection.Nematodes (roundworms):

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5
Q

Problems in the returned tropical traveller:

Most will present within 2 weeks except ____

A

HIV

seroconversion infection.

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6
Q

Problems in the returned tropical traveller:

Common infections encountered are

A

dengue
fever, giardiasis, hepatitis A and B, gonorrhoea
or Chlamydia trachomatis, malaria and helminthic
infestations.

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7
Q

Problems in the returned tropical traveller:

An important non-infection problem requiring
vigilance is _________ and ______________

A

deep venous thrombosis (DVT) and

thromboembolism.

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8
Q

returned tropical traveller:

What to do in patients with mild diarrhea:

A

Stool microscopy and culture
• Look for and treat associated helminthic
infestation (e.g. roundworms, hookworms

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9
Q

Etiology of Moderate or prolonged (>3 weeks)

diarrhoea

A

Usually due to Giardia lamblia, Entamoeba histolytica,
Campylobacter jejuni, Salmonella, Yersinia enterocolitica
or Cryptosporidium

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10
Q

Consider exotic causes such as _______, ______, ______ in unusual
chronic post-travel ‘gastroenteritis

A

schistosomiasis,

strongyloidiasis and ciguatera

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11
Q

What type of rash:

dengue, HIV, typhus, syphilis, arbovirus infections, leptospirosis, Q fever

A

• Maculopapular:

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12
Q

What type of rash:

________ viral haemorrhagic fevers,
leptospirosis, dengue
_______: typhoid
_________typhus (tick and scrub), anthrax
_________ African trypanosomiasis, syphilis

A
  • Petechiae:
  • Rose spots
  • Eschar:
  • Chancre:
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13
Q

An Australian study of fever in returned
travellers 3 revealed the most common diagnosis
was
_____ (27%) followed by________ (24%), _______(14%), ________ (8%) and bacterial pneumonia (6%).

A

malaria

respiratory tract infection

gastroenteritis

dengue fever

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14
Q

The common serious causes of fever are

A

malaria, typhoid,
hepatitis (especially A and B), dengue fever and
amoebiasis

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15
Q

Most deaths from malaria have occurred after
at least ________ days of symptoms that may be
mild. Death can occur within 24 hours

A

3 or 4

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16
Q

Be vigilant for ________—can present with a
toxic megacolon, especially if antimotility drugs
are given

A

amoebiasis

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17
Q

If well but febrile, first-line screening tests:

A

— full blood examination and ESR

— thick and thin films

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18
Q

Malaria

• Incubation period: P. falciparum _____ days; others
12–40 days
• Most present within 2 months of return
• Can present up to ______

A

7–14

2 or more years

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19
Q

What needs to be ruled out in patients with malaria?

A

G6PD deficiency?

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20
Q

How to treat?

P. vivax, P. ovale, P. malariae

A

(Riamet)
4 tablets with food at 0, 8, 24, 36, 48, 60 hours
(i.e. 24 tablets) in 60 hours
+
primaquine dose by weight to achieve a total dose
of 6 mg/kg. For most people this equals 30 mg (o)
daily for 14–21 days

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21
Q

How to treat?

P. falciparum uncomplicated

A 
Riamet (as above)
or
quinine sulphate 600 mg (o) 8 hourly, 7 days
\+
doxycycline 100 mg (o) 12 hourly, 7 days
or
clindamycin 300 mg (o) tds, 7 days (children,
pregnancy)
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22
Q

How to treat

complicated (severe):

A

artesunate 2.4 mg/kg IV statim, 12 hours, 24 hours,
then once daily until oral therapy (Riamet) is possible
or
quinine dihydrochloride 20 mg/kg up to 1.4 g IV
(over 4 hours) then after 4-hour gap 7 mg/kg IV 8
hourly until improved (ECG/cardiac monitoring)
then
quinine (o) 7 days

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23
Q

• Insidious onset
• Headache prominent
• Dry cough
• Fever gradually increases in ‘stepladder’ manner
over 4 days or so
• Abdominal pain and constipation (early)
• Diarrhoea (pea soup) and rash—rose spots (late)
• ± splenomegaly

A

Typhoid fever

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24
Q

How to diagnose Typhoid fever?

A
  • On suspicion—blood and stool culture

* Serology not very helpful

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25
Q

How to Tx Typhoid fever

A

• Azithromycin l g (o) for 7 days
or
• Ciprofloxacin 500 mg (o) bd for 7–10 days

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26
Q

What is the dx?

• Subclinical
• Mild, uncomplicated episode of diarrhoea
• Fulminant lethal form with severe water and
electrolyte depletion, intense thirst, oliguria,
weakness, sunken eyes and eventually collapse

A

Cholera

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27
Q

fever + vomiting + abrupt onset

‘rice water’diarrhoea

A

cholera

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28
Q

Mx of cholera

A

Treatment
• In hospital with strict barrier nursing
• IV fluid and electrolytes
• Doxycycline

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29
Q

VIRAL HAEMORRHAGIC FEVERS

These include:

A

yellow fever, Lassa fever etc., dengue

fever and chikungunya

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30
Q

In yellow fever,

Milder cases may present with flu-like symptoms and
relative bradycardia, what sign?

A

Faget’s sign

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31
Q

Signs and symptoms of yellow fever

A

abrupt fever then prostration, jaundice and abnormal

bleeding from the gums and possibly haematemesis

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32
Q

These rare but deadly tropical diseases usually
commence with a flu-like illness, gastrointestinal
symptoms with thrombocytopenia, anaemia and,
if severe, findings consistent with disseminated
intravascular coagulation leading to bleeding and
possibly shock and frank haemorrhage

A

Lassa fever, Ebola virus, Marburg

virus, Hanta virus

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33
Q

Also known as ‘breakbone’ fever, it is widespread in
the south-east Pacific and endemic in Queensland. A
returned traveller with myalgia and fever <39 ° C is
more likely to have dengue than malaria.

A

Dengue fever

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34
Q

vector of DFS

A

Mosquito-borne ( Aedes aegyptii ) viral infection

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35
Q

DX:

Abrupt onset fever, malaise, headache, nausea,
pain behind eyes, severe backache, prostration

A

DFS

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36
Q

DFS, what type of rash?

_____________ →
trunk (hand pressure for 30 seconds causes
blanching

A

Maculopapular rubelliform rash on limbs

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37
Q

Kind of erythema in DFS

A

Generalised erythema with ‘islands of sparing’

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38
Q

Diagnosis of DFS

A

• Dengue-specific IgM serology—best on day 5
• PCR
• FBE: leukopenia; thrombocytopenia in
haemorrhagic form

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39
Q

This is an alpha-viral mosquito-borne infection with
a similar clinical picture to dengue fever; it can cause
haemorrhagic fever. It is encountered in tropical
South-East Asia, Indian Ocean islands and parts of
Africa.

A

Chikungunya

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40
Q

Dx of Chikungunya

A

Positive serology

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41
Q

presents with fever, nausea and
vomiting then progressing to stupor, coma and
convulsions.

A

Encephalitis

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42
Q

Encephalitis:

Mosquito-borne cases include

A

Japanese

B encephalitis and West Nile fever

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43
Q

the Gram-negative bacillus Burkholderia pseudomallei,
a soil saprophyte that infects humans mainly
by penetrating through skin wounds, especially
abrasions.

A

Melioidosis

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44
Q

Where is Melioidosis obtained?

A

It is mostly acquired while wading in rice

paddie

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45
Q

Presentation of Melioidosis

A

It may manifest as a focal infection
or as septicaemia with abscesses in the lung, kidney,
skin, liver or spleen.

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46
Q

It is called the ‘Vietnamese time
bomb’ because it can present years after the initial
infection, as seen in Vietnamese war veterans

A

Melioidosis

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47
Q

Fever, headache, cough, pleuritic pain and

generalised myalgia

A

Melioidosis

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48
Q

Dx of Melioidosis

A

Blood culture, swabs from focal lesions,

haemagglutination test

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49
Q

Tx of Melioidosis

A 
Treatment (adults) 8
• Ceftazidime 2 g IV, 6 hourly
or
• Meropenem 1 g IV, 6 hourly
or
• Imipenem 1 g IV, 6 hourly
• All for at least 14 days, followed by
oral cotrimoxazole ± doxycycline bd + folic acid
for 3 months
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50
Q

Prevention of Melioidosis

A

Traumatised people with open wounds (especially
diabetics) in endemic areas (tropical South-East
Asia) should be carefully nursed

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51
Q

Plague (Black Death), which is caused by the Gramnegative bacterium _______ , is endemic in parts of Asia, Africa and the Americas

A

Yersinia pestis

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52
Q

2 forms of plague

A

bubonic plague and pneumonic plague

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53
Q 
painful suppurating inguinal or
axillary lymphadenitis (buboes)
A

bubonic plague

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54
Q

flu-like symptoms
with haemoptysis, septicaemia and a fatal
haemorrhagic illness ( ± buboes

A

pneumonic plague

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55
Q

Plague:

There is a rapid onset of high fever and prostration
with black patches of skin due to _______

A

subcutaneous

haemorrhage.

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56
Q

Dx of plague

A

• Serology and smear/culture of buboes

57
Q

†x of plague

A

• Streptomycin and doxycycline

58
Q

________ is a rhabdovirus acquired by bites from an
infected mammal, for example a dog, cat, monkey,
fox or bat.

A

Rabies

59
Q

What kind of rabies sx: malaise, headache,

abnormal behaviour including agitation and fever

A

Prodromal symptoms

60
Q

Type of rabies

A

‘dumb rabies’ and ‘furious rabies

61
Q

excessive
salivation and excruciating spasms of the pharyngeal
muscles on drinking water (in particular).

A

‘furious rabies’,

62
Q

Tx of rabies

A

Post-bite prophylaxis (endemic area)
Wash the wound immediately then clean it. Administer
rabies vaccine (if unimmunised) and rabies immune
immunoglobulin ASAP (within 48 hours).

63
Q

This is a type of food poisoning caused by eating
tropical fish, especially large coral trout and large
cod, caught in tropical waters (

A

Ciguatera

64
Q

How does ciguatera kill?

A

The problem is caused by a
type of poison that concentrates in the fish after
they feed on certain micro-organisms around reefs.

65
Q

Ciguatera poisoning presents within hours as a

bout of ______

A

‘gastroenteritis

66
Q

Neuro Sx of Ciguatera

A

muscle aching and weakness,
paraesthesia and burning sensations of the skin,
particularly of the fingers and lips

67
Q

Hansen’s disease (Gerhard Hansen, 1869) is caused

by the acid-fast bacillus_________

A

Mycobacterium leprae

68
Q

Leprosy:

It is
a disorder of tropical and warm temperate regions,
especially

A

South-East Asia.

69
Q

Transmission of leprosy

A

It is considered to be
transmitted by nasal secretions with an incubation
period of 2–6 years

70
Q

WHO Guidelines for Leprosy

Diagnosis is one or more of:

• Skin lesions—usually anaesthetic;
________or reddish maculopapules or
______ lesions

• Thickened peripheral nerves with loss of sensation,
e.g___, ______, ________, ______); also
peripheral neuropathy or motor nerve impairment

A

hypopigmented

annular

. ulnar (elbow), median (wrist), common
peroneal (knee) and greater auricular (neck

71
Q

Cont..

WHO Guidelines for Leprosy

Diagnosis is one or more of:

• Demonstration of ______ in a skin smear
or on biopsy

• It can be localised ______ or _______
(lepromatous

A

acid-fast bacilli

(tuberculoid)

generalised

72
Q

Leprosy diagnosis:

Diagnosis is by ____, _____
cultivation of the organisms or by PCR tests

A

biopsy, the lepromin test,

73
Q

WHO Tx options for Leprosy

A

multiple
drug therapy, e.g. rifampicin, clofazimine
and dapsone, but therapy is constantly being
evaluated

74
Q

Scrub typhus is found in South-East Asia, northern
Australia and the western Pacific. It is caused by
________, which is transmitted by
mites

A

Rickettsia tsutsugamushi

75
Q

SSX of scrub typhus:

• Abrupt onset febrile illness with headache and
myalgia

• A________ at the site of the bite with regional
and generalised lymphadenopathy
• Short-lived______

• Can develop severe complications (e.g.
________

A

black eschar

macular rash

pneumonitis, encephalitis

76
Q

Treatment of scrub typhus:

A

• Doxycycline 100 mg bd for 7–10 days

77
Q

Queensland tick typhus, which is caused by
_______is directly related to a tick bite.
The symptoms are almost identical to scrub typhus,
although less severe, and the treatment is identical

A

Rickettsia australis,

78
Q

2 stages of African trypanosomiasis

A 
Stage 1 (haemolymphatic)
Stage 1 (haemolymphatic)
79
Q

Other name of African trypanosomiasis

A

(sleeping

sickness)

80
Q

What stage of (sleeping sickness)

  • Incubation period about 3 weeks
  • Fever, headache and a skin chancre or nodule
  • Lymphadenopathy, hepatosplenomegaly
A

Stage 1 (haemolymphatic)

81
Q

What stage of (sleeping sickness)

  • weeks or months later
  • cerebral symptoms including hypersomnolence
A

Stage 2 (meningoencephalitic)

82
Q

Dx of African trypanosomiasis (sleeping
sickness:

Demonstrating _______ in peripheral
blood smear or chancre aspirate

A

trypomastigotes

83
Q

Dx of African trypanosomiasis (sleeping

sickness:

A
  • Suramin IV

* Infectious disease consultation essential

84
Q

Prevention African trypanosomiasis

• Avoid bites of the_____.

If visiting areas of
East, Central and West Africa, especially the
safari game parks, travellers should use insect
repellent and wear protective light-coloured
clothing, including long sleeves and trousers.

A

tsetse fly

85
Q

This is transmitted by bites of sand flies and by blood

transfusions and IV drug use.

A

Visceral leishmaniasis (kala-azar)

86
Q

Visceral leishmaniasis (kala-azar)

The _________ is targeted and
presenting features include fever, wasting,
hepatosplenomegaly and lymphadenopathy

A

haemopoietic system

87
Q

Visceral leishmaniasis (kala-azar)

• Among other signs is __________
hence the Hindu name kala-azar (‘black fever’)

• Most cases are

A

hyperpigmentation of the skin,

subclinical

88
Q

This may be encountered in travellers and servicemen
and servicewomen returning from the Middle East,
especially the Persian Gulf, and also travellers
returning from Central and South America

A

Cutaneous leishmaniasis

89
Q

Cutaneous leishmaniasis

The protozoa is transmitted by a ______ and has an
average incubation period of 9 weeks.

A

sandfly

90
Q

Cutaneous leishmaniasis

The key clinical finding is an _____

A

erythematous papule

91
Q

Dx of Cutaneous leishmaniasis

A

Performing a punch biopsy and culturing tissue

in a special medium

92
Q

How to Tx extensive lesions of Cutaneous leishmaniasis

A

Treatment for extensive lesions is with highdosage

ketoconazole for 1 month

93
Q

How to Tx extensive lesions of Cutaneous leishmaniasis

A

Smaller lesions should be treated topically
with 15% paromomycin and 12% methyl
benzethonium chloride ointment applied bd for
10 days

94
Q

First clinical sign of Schisto

A

The first clinical sign is a local skin reaction at
the site of penetration of the parasite (it then
invades liver, bowel and bladder). This site is
known as ‘swimmer’s itch

95
Q

Dx of Schisto:

A

• Serology
• Detecting eggs in the stools, the urine or in a
rectal biopsy

96
Q

Tx of Schisto

A

• Praziquantel (may need retreatment

97
Q

_____can be diagnosed
in a sick traveller returning from an endemic area
with severe diarrhoea characterised by blood and
mucus.

A

Amoebiasis ( Entamoeba histolytica )

98
Q

Cx of Schisto

A

Complications include fulminating colitis,
amoebomas (a mass of fibrotic granulation tissue) in
the bowel and liver abscess

99
Q

Acute amoebic dysentery

is treated with oral____ or ______

A

tinidazole or metronidazole.

100
Q

What is the dx?

Clinical features
• High swinging fever
• Profound malaise and anorexia
• Tender hepatomegaly
• Effusion or consolidation of base of right chest
A

Amoebic liver abscess

101
Q

T or F Amoebic liver abscess

There is often no history of dysentery, and
jaundice is unusual

A

T

102
Q

Dx of Amoebic liver abscess

A

• Serological tests for amoeba and by imaging

CT scan

103
Q

Treatment of Amoebic Liver Abscess:

A

• Metronidazole and by percutaneous CT-guided

aspiration

104
Q

• Often asymptomatic
• Symptoms include abdominal cramps, bloating,
flatulence and bubbly, foul-smelling diarrhoea,
which may be watery, explosive and profuse.

A

Giardiasis

105
Q

Dx of Giardia:

A

Three specimens of faeces for analysis (cysts and trophozoites): ELISA/PCR

106
Q

Tx of Giardia

A

Scrupulous hygiene: metronidazole or tinidazole

107
Q

______ which refers to the infestation of body
tissues by the larvae (maggots) of flies, often presents
as itchy ‘boils’.

A

Myiasis,

108
Q

Primary myiasis invariably occurs in
travellers to tropical areas such as Africa _________
and Central and South America ______, whereby the
fly can introduce the larvae into the skin, or it can be
due to secondary invasion of pre-existing wounds

A

(Tumbu fly)

bot fly

109
Q

Tx of cutaneous myasis:

A

simplest
treatment is lateral pressure and tweezer extraction
or place paraffin jelly (Vaseline) or thick ointment
over the lesion to induce emergence by restricting
oxygen, then apply a topical antibiotic.

110
Q

Pinworm

Also known as _____ this is a ubiquitous
parasite infesting mainly children of all social classes

A

‘threadworm’,

111
Q

Clinical features of pinworm:

A 
Pruritus ani (in about 30% of cases)
• Diarrhoea (occasionally)
112
Q

Pinworm meds:

Medication

A

• Any one of pyrantel, albendazole or
mebendazole—as single dose orally

pyrantel 10 mg/kg up to 750 mg
or
mebendazine 100 mg (child <10 kg: 50 mg)
or
albendazole 400 mg (child <10 kg: 200 mg)
113
Q

How soon to repeat tx in pinworm

A

2-3 weeks

114
Q

By finding eggs in the faeces. The worm is very
sensitive to any of the three agents used for
pinworm. May give positive faecal occult blood
test.

A

Human roundworm

115
Q

Tx of human roundworm

A

A first-line option is pyrantel 20 mg/kg up to
750 mg orally, as a single dose—to be repeated
after 7 days if a heavy infestation

116
Q

These used to be common in Indigenous communities,
possibly causing failure to thrive, anaemia, abdominal
pain and diarrhoea and rectal prolapse with heavy
chronic infestation. The worms are about 1–2 cm long

A

Whipworm

117
Q

Tx of whipworm

A

• Single large doses of mebendazole or albendazole

118
Q

These are found in humid tropical regions but are
now uncommon in northern Australia. About 1–1.5
cm long, the parasites are acquired by walking
barefoot (or wearing thongs or sandals) on earth
contaminated by faeces

A

Hookworm

119
Q

First sign of hookworm

A

The first sign is local irritation or ‘creeping eruption’
at the point of entry, known as ‘ground itch’, which
is often unnoticed

120
Q

Cx of hookworm

A

They can cause iron/protein

deficiency anaemia in chronic infestation

121
Q

Hookworm

infection is the commonest cause of ________ in the world

A

iron deficiency

anaemia

122
Q

Dx of hookworm

A

finding

eggs on microscopy of faeces

123
Q

Tx of hookworm

A

• A single dose of mebendazole 100 mg bd for 3

days or 400 mg single dose pyrantel

124
Q

These are tiny parasites (2 mm or so) and have
a worldwide distribution. Infestation can cause
symptoms such as recurrent abdominal pain and
swelling and diarrhoea, skin and respiratory symptoms,
with blood eosinophilia

A

Human threadworm

(Strongyloides

125
Q

Strongyloides

The problem is
aggravated by ______ therapy and may present
with a severe infection, such as septicaemia

A

corticosteroid

126
Q

Strongyloides Tx

A

• Ivermectin 200 mcg/kg (o) two doses 2 weeks
apart (not in children < 5 years) or albendazole
200 mg bd for 3 days

127
Q

___________should be suspected in any pruritic,
erythematous lesion with a serpiginous eruption
on the skin, especially the hands, legs and feet of a
person from a subtropical or tropical area

A

Cutaneous larva migrans (creeping eruption)

128
Q

Dx of CLM

A

Clinical (characteristic appearance), eosinophilia

biopsy usually not indicated

129
Q

Tx of CLM

A

Ivermectin (single dose) or Albendazole

Antihistamines for pruritus

130
Q

T or F

CLM is self-limitinf

A

T

131
Q

This nematode infection has two main forms which
are spread by mosquitoes and biting black flies
respectively

A

Filariasis

132
Q

________ causes acute
adenolymphangitis and chronic lymphoedema
with obstruction of lymph flow.

The latter
can manifest as a____, ______, _________ especially of the extremities,
genitals and breasts.

Diagnosis is by_____ and _____

A

Lymphatic filariasis

hydrocele, scrotal oedema
or elephantiasis

blood film
and serology

133
Q

__________starts as a
nodule at the bite site followed by chronic skin
disease and eye lesions such as uveitis and
optic atrophy

A

Onchocerciasis (river blindness)

134
Q

It is the second leading cause of

blindness worldwide.

A

Onchocerciasis (river blindness)

135
Q

Onchocerciasis (river blindness)

Dx and Tx

A

Diagnosis is by PCR testing,

treatment by ivermectin

136
Q

Hydatid disease is acquired by ingesting eggs of the
dog parasite __________ which is found in
sheep farming areas here and in several countries in
Asia.

A

Echinococcus granulosus,

137
Q

Sx of echinococcus:

There may be no symptoms although the patient may
complain of abdominal discomfort or cystic lesions on the
skin and other sites.

Rupture of a cyst (usually hepatic)
can cause severe ______ with possible death

A

anaphylaxis

138
Q

Tx of echinococcus

A

Treatment
• Usually surgical removal of a cyst and
albendazole

139
Q

This is the longest nematode. It is transmitted by tiny

crustaceans in water

A 
Dracunculus medinensis (Guinea
worm)

MC (90 decks)

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