INFECTIOUS DISEASE: Traveller with fever/ travel infections Flashcards

(51 cards)

1
Q

Cause of malaria?

A

Blood protozoan (single celled organism) parasite - Plasmodium species. Spread via bites from female Anopheles mosquito carrying the disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of Plasmodium species causing malaria?

A

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation of malaria - symptoms?

A

NON SPECIFIC

Abrupt onset rigors
High fever
Sweats
Severe headache
Myalgia
Malaise
Nausea
Vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Main investigation for malaria?

A

Malaria blood film - need 3 to diagnose malaria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do blood results for malaria show?

A

Anaemia
Thrombocytopenia
Leukopenia
Abnormal Liver enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management for complicated or severe malaria?

(Dr Tom said this is more likely to come up in exam)

A

Has to be IV:

  1. Artesunate (most effective, but not licensed)
  2. Quinine dihydrochloride
  • a parasite counts of more than 2% will usually need parenteral treatment irrespective of clinical state
  • intravenous artesunate is now recommended by WHO in preference to intravenous quinine
  • if parasite count > 10% then exchange transfusion should be considered
  • shock may indicate coexistent bacterial septicaemia - malaria rarely causes haemodynamic collapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications from malaria by Plasmodium falciparum?

A

Cerebral malaria
Seizures
Reduced consciousness
AKI —> renal failure
Pulm oedema
DIC - disseminated intravascular coagulopathy
Severe haemolytic anaemia
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Blood film for malaria has been done. What other investigations to order?

A

Rapid antigen test
FBC - haemolysis, low HB, low platelets, thrombocytopenia
U&Es - AKI. high creatinine.
LFTs - ALT, jaundice (pre hepatic)
Glucose - reduced
Coagulation screen
Head CT if CNS symptoms - confusion - can see bleeding or signs of cerebral malaria
CXR - see ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management for uncomplicated malaria?

A

Admit P falciparum pts for treatment
Discuss with local ID unit

Oral options as follows:
1 Artemether with lumefantrine (called Riamet)
2 Proguanil and atovaquone (Malarone)
3 Quinine sulphate
4 Doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management for complicated or severe malaria?

(Dr Tom said this is more likely to come up in exam)

A

Has to be IV:

  1. Artesunate (most effective, but not licensed)
  2. Quinine dihydrochloride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Main management for malaria with Plasmodium falciparum?

A

Admit
IV artesunate treatment
Monitor for complications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Blood film for malaria has been done. What other investigations to order?

A

Rapid antigen test
FBC - haemolysis, low HB, low platelets, thrombocytopenia
U&Es - AKI. high creatinine.
LFTs - ALT, jaundice (pre hepatic)
Glucose - reduced
Coagulation screen
Head CT if CNS symptoms - confusion - can see bleeding or signs of cerebral malaria
CXR - see ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Malaria prophylaxis advice to give pts?

A

Know where is high risk
Mosquito spray
Mosquito nets and barriers when sleeping
Antimalarial medication.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should a travel Hx include about a persons acivity when they return unwell from abroad?

A
  • Countries - stop overs / time
  • Activities - lakes (water contact ) / rural backpacking
  • water supply - bruhsing teeth / drinking
  • Types of Food
  • Insect bites - repellent / nets at night
  • Accomodation
  • Vaccination status / Prophylaxis for malaria taken
  • Any symptoms? then or anyone travelling with
  • Sexual Hx - condom use/ sex worker/ MSM
  • Medical conditons - predispose to infection e.g. diabetes / immunosuppressive therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What DDx could a patient traveller coming form aboard have if they describe insect bites?

A
  • Malaria
  • Dengue fever
  • Leishmaniasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What DDx could a patient traveller coming form aboard have if they describe Diarrhoea?

A
  • Giardia
  • E.coli
  • Ameobiasis
  • typhoid / para typhoid
  • schistomiasis
  • tapeworm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What DDx could a patient traveller coming form aboard have if they describe abdominal pain?

A
  • Typhoid / para typhoid
  • schistomiasis
  • giardia
  • amoedbiais
  • tapeworm / hookworm / roundworm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What DDx could a patient traveller coming form aboard have if they describe haematemesis?

A
  • Dengue fever
  • viral haemorrhagic fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What DDx could a patient traveller coming form aboard have if they describe urinary symptoms?

A
  • Schistomiasis - urinary freq / dysuria / haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What DDx could a patient traveller coming form aboard have if they describe rigors / high fevers?

A
  • classic for malaria
21
Q

What DDx could a patient traveller coming form aboard have if they describe night sweats?

A
  • malaria
  • TB
  • Brucellosis
  • Visceral leishmaniasis
22
Q

What DDx could a patient traveller coming form aboard have if they describe cough?

A
  • Typhoid / paratyphoid
  • schistomiasis
  • visceral leishmaniasis
23
Q

What DDx could a patient traveller coming form aboard have if they describe chest pain?

A
  • Typhoid / paratyphoid
24
Unwell traveller from abroad - what are some differencials if 0-10 days?
* Dengue * Rickettsia * Viral (including mononucleosis) * GI ( bacterial / amoeba)
25
Unwell traveller from abroad - what are some differencials if 10-21 days?
* Malaria * Typhoid * Primary HIV infection
26
Examinatioin of pt returned from abroad what should you examine the eyes for?
Conjunctival pallor - Anameia: * Malaria - haemolysis * Typhoid / paratyphoid * typhus Conjunctival Suffusion * Leptospirosis
27
Examinatioin of pt returned from abroad and see: jaunice .....what DDx you thinking?
* Malaria * Hep A - viral hepatitis from food poisoning breakout
28
Examinatioin of pt returned from abroad and see: ROSE SPOTS (pink macules 2 -3 mm on chest / abdomen) .....what Diagnosis you thinking?
* Typhoid / paratyphoid
29
Examinatioin of pt returned from abroad and see: crusted ulcer healing by scarring .....what Diagnosis you thinking?
Hallmark of cutaeneous Leishmaniasis
30
Investigations for pt returned from abroad: what abnormalities are you looking for in a FBC and why might this be?
Haemolytic anaemia : * Malaria * Typhoid / paratyphoid * typhus Eoisinophilia: * worm infections
31
Investigations for pt returned from abroad: what abnormalities are you looking for in a Renal Function U&E and why might this be?
Impaired in: * Malaria * Typhus
32
Investigations for pt returned from abroad: what abnormalities are you looking for in a LFTs and why might this be?
Derranged in: * Typhoid / paratyphoid * ameobic abscesses * schistomiasis
33
Investigations for pt returned from abroad: what abnormalities are you looking for in a thick and thin blood film ?
3 sets required separate in time * detect malaria parasite and species * ring form in Plasmodium falciparum * Crenulated edge
34
Investigations for pt returned from abroad: why would you do blood cultures and blood glucose?
* cultures - look for organism * Glucose - critical in treatment of falciparium as treatment with quinine can cause hypoglycaemia
35
Investigations for pt returned from abroad: bedside tests might you do?
* urine dip - haemoglobinuria in falciparum malaria * commericial malaria antigen test kit
36
What lab required tests might you send off for when investigation a patient returned from abroad ?
* Stool culutes - inclide test for Ova, Cysts and Parasites * urine specimens for M&S * Skin lesion biopsy * Liver biopsy - inflamm response schistomiasis * lymph node biopsy - leishmaniasis * Bone marrow cultues -typhoid / paratyphoid / leishmania
37
Unwell traveller from abroad : \>21 days what are your differencials
* Malaria * Chronic bacterial (brucella. coxiella, endocarditis, bone and hoint infections) * TB * Parasitic infection (helminths / protozoa
38
Examination of a unwell returned traveller from abroad - black necrotic ulcer with erythematous margins what are you thinking?
Rickettsia (tick exposure)
39
Examination of unwell returned traveller - what could a maculopapular rash indicate?
Dengue fever Leptospiroiss Rickettsia Infection mononucleosis (EBV, CMV) childhood : rubella, parovirus B19 primary HIV infection
40
Examination of unwell returned traveller - what could splenomegaly indicate?
Mononucleosis Malaria visceral leishmaniasis typhoid fecer brucellosis
41
What neurological symptoms can you get in a returned traveller who is unwell? How serious is this?
Fever and altered mental state - meningo-encephalitis (EMERGENCY) e.g. cerebral malaria, Japanese encephalitis, West Nile virus (also common causes N. meningitis, Strep. pmeumonia, Herpes Simplex virus)
42
What vaccinications should you ask about in returning traveller who is unwell?
Hep A / B Typhoid Tetanus Childhood vaccines (MMR, yellow fever, rabies)
43
Treatment for typhoid?
IV ceftriaxone 2g OD (empirical - before sensitivity known) Once sensitivities known - switch to PO Ciprofloxacin 500mg BD or Azithromycin 500mg OD
44
Classical definition of Pt with PUO?
Temp 38\< (on many occasions) Illness for 3+ weeks No diagnosis despite having inpaient investigations for 1+ week
45
Common causes of Pyrexia with unknown origin?
Infective - TB, abscess, infective endocarditis, brucellosis AutoImmune/connective tissue - temporal arteritis, Wegener's granulomatosis Neoplastic - leukaemias, lymphomas, renal cell carcinoma Other - drugs, VTE, hyperthyroidism, adrenal insufficiency
46
What to ask in Hx of Pt with pyrexia of unknown origin?
Chrolonolgy of Sx Pets/animal exposure? Travel - in last year? Occupation? Meds? FHx? Vaccination history? Sexual contacts?
47
What to examine in a patient with Pyrexia of unknown origin?
LN? - swollen? where? Stigmata of endocarditis? Weight loss/cachexia? Joint abnormalities?
48
What investiagtions to do in pt with pyrexia of unknown origin?
***Bloods:*** FBC, U+Es, LFTs, bone profile CRP, clotting, TFTs, MULTIPLE sets of blood cultures (2-3), LDH, B12, ferritin, folate. If you think is related to AI disease = immunoglobulins, RF, ANA, dsDNA etc ***Microbiology/virology:*** HIV, HEP B+C, syphillis, MSU, sputum cultures, malaria films (x3 from 3 diff sites at diff times, for pts w/ travel Hx). Viral swabs, CMV+EBV serology, Brucella serology, fungal serology ***Imaging:*** CXR, CT TAP, MR head, MR spine, PET scan (if relevant) ***Biopsies:*** MC+S, TB culture, histology done on all samples. Need biopsy from bone marrow, LN, abscess, liver
49
What needs to be monitered when pt is on TB treatment?
LFTs Visual aquity tests
50
What is Rickettsial disease?
* occur worldwide and are associated with the patient having been bitten by an ectoparasite such as a louse, mite, flea, mosquito, or most commonly, a tick. * usually divided into the spotted fever group, where patients present with fever and spots, and the typhus group.