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Flashcards in Global health, tropical and travel medicine. Deck (37):
1

Place with the highest 1 week risk of travellers diarrhoea?

India - 54%

2

Key things to assess when your patient is travelling abroad?

When are they going. - how long for vaccinations, is it rainy season?

Where are they going.

What are they doing. - Healthcare? Aid agency? Duration? Access to healthcare?

Past Medical history. Drug interactions, safe to travel?

3

ABCD of malaria advice?

A - Awareness of Risk: Fever for up to 6 months after returning could be malaria.

B - Bite avoidance: DEET, Nets, Dusk till dawn, long sleeved clothing.

C - Chemoprophylaxis - Duration pre, post and during, S/Es and cost

D - Diagnose early

4

Malaria prophylaxis choices?

Malarone (Atovaquone + Proguanil)

- 1 tablet a day, good S/E profile
- 1 day before, 1 week afterwards

Doxycycline

- 1 Tablet a day
- 20% risk of photosensitivity
- 1 week before 4 weeks after return. (cheap)

Mefloquine

- 1 tablet a week
- Neuropsychiatric S/Es
- 3 weeks before 4 weeks when returning (cheap)

5

Legally required vaccine for Saudi Arabia?

Meningococcal vaccine

6

What are the most common types of illness following travel?

GI illness - 34%
Systemic febrile illness - 23.3%
Dermatological - 19.5%

7

Where are systemic febrile illnesses most likely caused from?

Sub-saharan africa

8

Where is acute diarrhoea most likely caused from?

SC asia

9

Pathogenesis of Giardia bacteria?

Causes inflammatory process by attaching to enterocytes in the jejunum - acute diarrhoea

10

Most common bacterial causes of acute diarrhoea?

Campylobacter

11

Whats more common parasitic/viral/bacterial infection causing diarrhoea?

Parasitic more common presentation.

12

Most likely cause of fever presentation?

Malaria

13

Difference in Vivax and falciparum malaria?

Falciparum a bit worse generally

14

What is cutanea larva migrans? Where is it most likely caught from?

Infection from hookworms from cats/dogs. Won't get further than skin as man is not desired host. Most likely caught from Caribbean - C. America

15

Risks for travellers who are visiting friends and family?

Unlikely to seek pre-travel advice and so more likely to acquire a vaccine preventable illness

62% of falciparum occurred amongst travellers visiting friends and relatives

16

Which group of Travellers get respiratory illness commonlly

Business travellers

17

Which group of travellers are most likely to become ill abroad?

Tourists.

18

Investigations you should do for returning unwell travellers?

Blood culture.
Malaria blood test.
HIV test
Urine/stool culture
throat swab

Standard: FBC, U+Es, CRP, LFTs, CXR

19

Most common cause of parasitic diarrhoea?

Giardia

20

Clinical features of falciparum malaria?

Fevers, rigors, vomiting, headache, arthralgia, malaise (cough, diarrhoea)

Fevers are usually daily or continuous

Commonly presents within 4 weeks of return from endemic area but can be delayed for much longer

21

What species of mosquito cause malaria

Female anopheles mosquitos

22

Serious complications of malaria?

AKI
Cerebal Malaria
Pulmonary oedema
Alkolosis/acidosis

23

Types of malaria testing?

Blood film - look for it
Antigen testing

24

Treatment of falciparum malaria?

Non severe:

PO (oral): Malarone
PO: Co-artem

Severe:

IV artesunate

25

Where are you most likely to see flaciparum and where are you most likely to see vivax?

Falciparum - sub saharan Africa

Vivax South and South east asia

26

Vivax malaria diagnosis?

Blood film only (antigen not sensitive) need several

27

Vivax malaria treatment?

PO Chloroquinine

Followed by primaquine to eliminate liver (hypnozoite) stage

28

Pattern of Fever in vivax malaria?

Every 3 days there is a peak of fever

29

How many cases of imported malaria were reported in 2015?

1500

30

What proportion of falciparum and vivax caused imported malaria?

Falciparum - 75%

Vivax - 15%

31

Ebola infection management?

IV zmapp - monoclonal antibodies

Blood transfusion

32

LFTs in ebola infection?

Derranged

33

Clinical presenting signs and symptoms of ebola?

Fever
Headache
Weakness
Dizziness
Diarrhoea
Abdo pain
etc...

34

What is MERS

Middle eastern respiratory syndrome

Caused by a virus

>85% in saudi arabia

35

Treatment of MERS?

Oseltamivir

Extracorporeal membrane oxygenation

36

Treatment of Avian flu?

Oseltamivir

37

Maximum incubation period for MERS?

14 days