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Year 3 Medicine Block > INFECTIOUS DISEASE: Traveller with fever/ travel infections > Flashcards

INFECTIOUS DISEASE: Traveller with fever/ travel infections Flashcards

1
Q

Cause of malaria?

A

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

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2
Q

Types of Plasmodium species causing malaria?

A

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

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3
Q

Presentation of malaria - symptoms?

A

NON SPECIFIC

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

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4
Q

Main investigation for malaria?

A

Malaria blood film - need 3 to diagnose malaria

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4
Q
A
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5
Q

What do blood results for malaria show?

A

Anaemia
Thrombocytopenia
Leukopenia
Abnormal Liver enzymes

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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
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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

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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

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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

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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
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11
Q

Main management for malaria with Plasmodium falciparum?

A

Admit
IV artesunate treatment
Monitor for complications.

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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

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13
Q

Malaria prophylaxis advice to give pts?

A

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

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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
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15
Q

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

A
  • Malaria
  • Dengue fever
  • Leishmaniasis
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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
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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
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18
Q

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

A
  • Dengue fever
  • viral haemorrhagic fever
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19
Q

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

A
  • Schistomiasis - urinary freq / dysuria / haematuria
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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
Q

Unwell traveller from abroad - what are some differencials if 0-10 days?

A
  • Dengue
  • Rickettsia
  • Viral (including mononucleosis)
  • GI ( bacterial / amoeba)
25
Q

Unwell traveller from abroad - what are some differencials if 10-21 days?

A
  • Malaria
  • Typhoid
  • Primary HIV infection
26
Q

Examinatioin of pt returned from abroad what should you examine the eyes for?

A

Conjunctival pallor - Anameia:

  • Malaria - haemolysis
  • Typhoid / paratyphoid
  • typhus

Conjunctival Suffusion

  • Leptospirosis
27
Q

Examinatioin of pt returned from abroad and see: jaunice …..what DDx you thinking?

A
  • Malaria
  • Hep A - viral hepatitis from food poisoning breakout
28
Q

Examinatioin of pt returned from abroad and see: ROSE SPOTS (pink macules 2 -3 mm on chest / abdomen) …..what Diagnosis you thinking?

A
  • Typhoid / paratyphoid
29
Q

Examinatioin of pt returned from abroad and see: crusted ulcer healing by scarring …..what Diagnosis you thinking?

A

Hallmark of cutaeneous Leishmaniasis

30
Q

Investigations for pt returned from abroad: what abnormalities are you looking for in a FBC and why might this be?

A

Haemolytic anaemia :

  • Malaria
  • Typhoid / paratyphoid
  • typhus

Eoisinophilia:

  • worm infections
31
Q

Investigations for pt returned from abroad: what abnormalities are you looking for in a Renal Function U&E and why might this be?

A

Impaired in:

  • Malaria
  • Typhus
32
Q

Investigations for pt returned from abroad: what abnormalities are you looking for in a LFTs and why might this be?

A

Derranged in:

  • Typhoid / paratyphoid
  • ameobic abscesses
  • schistomiasis
33
Q

Investigations for pt returned from abroad: what abnormalities are you looking for in a thick and thin blood film ?

A

3 sets required separate in time

  • detect malaria parasite and species
  • ring form in Plasmodium falciparum
  • Crenulated edge
34
Q

Investigations for pt returned from abroad: why would you do blood cultures and blood glucose?

A
  • cultures - look for organism
  • Glucose - critical in treatment of falciparium as treatment with quinine can cause hypoglycaemia
35
Q

Investigations for pt returned from abroad: bedside tests might you do?

A
  • urine dip - haemoglobinuria in falciparum malaria
  • commericial malaria antigen test kit
36
Q

What lab required tests might you send off for when investigation a patient returned from abroad ?

A
  • 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
Q

Unwell traveller from abroad :

>21 days what are your differencials

A
  • Malaria
  • Chronic bacterial (brucella. coxiella, endocarditis, bone and hoint infections)
  • TB
  • Parasitic infection (helminths / protozoa
38
Q

Examination of a unwell returned traveller from abroad - black necrotic ulcer with erythematous margins what are you thinking?

A

Rickettsia (tick exposure)

39
Q

Examination of unwell returned traveller - what could a maculopapular rash indicate?

A

Dengue fever

Leptospiroiss

Rickettsia

Infection mononucleosis (EBV, CMV)

childhood : rubella, parovirus B19

primary HIV infection

40
Q

Examination of unwell returned traveller - what could splenomegaly indicate?

A

Mononucleosis

Malaria

visceral leishmaniasis

typhoid fecer

brucellosis

41
Q

What neurological symptoms can you get in a returned traveller who is unwell? How serious is this?

A

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
Q

What vaccinications should you ask about in returning traveller who is unwell?

A

Hep A / B

Typhoid

Tetanus

Childhood vaccines (MMR, yellow fever, rabies)

43
Q

Treatment for typhoid?

A

IV ceftriaxone 2g OD (empirical - before sensitivity known)

Once sensitivities known - switch to PO Ciprofloxacin 500mg BD or Azithromycin 500mg OD

44
Q

Classical definition of Pt with PUO?

A

Temp 38< (on many occasions)

Illness for 3+ weeks

No diagnosis despite having inpaient investigations for 1+ week

45
Q

Common causes of Pyrexia with unknown origin?

A

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
Q

What to ask in Hx of Pt with pyrexia of unknown origin?

A

Chrolonolgy of Sx

Pets/animal exposure?

Travel - in last year?

Occupation?

Meds?

FHx?

Vaccination history?

Sexual contacts?

47
Q

What to examine in a patient with Pyrexia of unknown origin?

A

LN? - swollen? where?

Stigmata of endocarditis?

Weight loss/cachexia?

Joint abnormalities?

48
Q

What investiagtions to do in pt with pyrexia of unknown origin?

A

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
Q

What needs to be monitered when pt is on TB treatment?

A

LFTs

Visual aquity tests

50
Q

What is Rickettsial disease?

A
  • 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.

Year 3 Medicine Block (56 decks)

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