Immigrants / Travelers Flashcards
(8 cards)
Latin America
Chagas disease (Trypanosoma cruzi)
• Clue: Cardiomyopathy + megacolon + megaesophagus
• Transmission: Reduviid (kissing) bug
• Complication: Dilated cardiomyopathy with apical aneurysm
• Neurocysticercosis (Taenia solium) • Clue: Seizures in immigrant • Findings: Brain cysts with calcification on imaging • Transmission: Ingesting eggs from human feces (not pork) • Cutaneous leishmaniasis • Clue: Chronic non-healing ulcer • Vector: Sandfly
Sub-Saharan Africa
Schistosomiasis
• Clue: Hematuria (S. haematobium), liver fibrosis (S. mansoni)
• Transmission: Freshwater snails
• Complication: Bladder cancer (squamous cell), portal hypertension
• Onchocerciasis (“River blindness”) • Vector: Blackfly • Clue: Blindness + skin nodules + eosinophilia • Malaria (Plasmodium species) • Clue: Cyclical fevers, splenomegaly, anemia • P. falciparum is most severe (irregular fevers, cerebral malaria) • HIV: High prevalence, especially in young adults
Asia
HBV and HCC
• Clue: Immigrant with liver mass
• Transmission: Vertical (especially in Asia)
Strongyloides stercoralis
• Clue: GI symptoms + eosinophilia + larva currens rash
• Autoinfection can lead to fatal hyperinfection in immunocompromised
Liver flukes (Clonorchis sinensis)
• Clue: Biliary disease or cholangiocarcinoma
• Transmission: Undercooked freshwater fish
Middle East / South Asia
TB (Mycobacterium tuberculosis)
• Clue: Night sweats + hemoptysis + weight loss
• Findings: Cavitary lung lesions, Ghon focus
Brucellosis
• Clue: Undulating fevers + unpasteurized dairy
• Transmission: Cattle, sheep
Hydatid cyst (Echinococcus granulosus)
• Clue: Liver cyst + exposure to sheep/dogs
• Avoid needle aspiration → risk of anaphylaxis
Travelers to Developing Countries
• Traveler’s diarrhea (ETEC)
• Clue: Watery diarrhea in traveler; toxin ↑ cAMP (heat-labile) and cGMP (heat-stable)
Giardia lamblia
• Clue: Fatty diarrhea + recent hiking/camping or water contamination
• Diagnosis: Trophozoites or cysts in stool
Entamoeba histolytica
• Clue: Bloody diarrhea + liver abscess (“anchovy paste”)
• Transmission: Contaminated food/water
Dengue virus
• Clue: Fever + retro-orbital pain + rash + thrombocytopenia
• Complication: Hemorrhagic fever
Vaccination-Preventable Illnesses (Immigrant/Traveler Risk)
Measles (if not vaccinated)
• Koplik spots → descending rash
Polio (check travel to endemic areas)
• Flaccid paralysis
Yellow fever (Africa, South America)
• Required for entry to some countries
Tips
• Vignette red flags:
• “Immigrant” + seizure = neurocysticercosis
• “Traveler” + watery diarrhea = ETEC
• “Sheep farmer” + liver cyst = echinococcus
• “Freshwater” + hematuria = schistosomiasis
• Eosinophilia = parasitic infection (especially helminths)
• Always ask: “Where are they from or where did they go?”
Geography is often the key to the right diagnosis.
