Τravel Related Infections

Question 0

What do you need to find out about the place?

Answer 0

Specific location
When they went
How they got there
Stop anywhere en route?
Accommodation type
Were preventative measures taken eg vaccines?

Question 1

What is it important to find out about if a patient has been travelling

Answer 1

Where they went
How long for
Time of year they went (so when)
What they did there

Question 2

What can you find out about the person?

Answer 2

Did they take any preventative measures?

Question 3

Why is it important to find out about the pathogen?

Answer 3

Can get different strains in different places which are antigenically different.
Impacts on protection and detection
Can get different antibiotic resistance depending on which antibiotics are regularly used in that country

Question 4

Why is it important to identify if the infection is travel related?

Answer 4

Patient may need to be isolated

Labs should be alerted to potential hazards

Question 5

What are the four species of malaria?

Answer 5

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

Question 6

What is the vector of malaria?

Answer 6

Female Anopheles mosquito

Question 7

Where is malaria common?

Answer 7

Tropics of Africa
Asia
Middle East
South and Central America

Question 8

What is the incubation period of malaria?

Answer 8

1-3 weeks

Question 9

History of malaria?

Answer 9

Fever chills and sweats every 3rd/4th day
Malaise
Headache
Cough
Fatigue
Arthralgia

Question 10

What investigations should be done for malaria?

Answer 10

LFTs
U&Es
Head CT if there are CNS symptoms
Glucose
Blood smear to detect parasites
FBC

Question 11

Treatment of malaria?

Answer 11

P. falciparum (malignant) - quinine/artemisinin

P. vivax, ovale, malariae (benign) - chloroquine, primaquine

Question 12

How does malaria get to humans?

Answer 12

Mosquito carries the parasite in its salivary gland and gut

Bites the human

Question 13

What are the two cycles of malaria?

Answer 13

Liver - exo-erythrocytic

Blood - erythrocytic

Question 14

How can malaria be prevented

Answer 14

Assess risk - knowledge of risk areas
Bite prevention - repellant, clothing, nets, chemoprophylaxis
Chemoprophylaxis - specific to region, start before and continue after return

Question 15

Reasons why patients don’t take malarial prophylaxis properly?

Answer 15

Don’t know or think they need to take it

Don’t take it for the required period

Question 16

What is entered fever?

Answer 16

Typhoid paratyphoid

Caused by salmonella

Question 17

Where is enteric fever common?

Answer 17

Asia
Africa
South America

Question 18

How is enteric fever spread?

Answer 18

Fecal-oral route from food and water
Due to poor sanitation
The only source is another infected human only

Question 19

What causes enteric fever?

Answer 19

salmonella
Subspecies is enterica
Part of the Enterobacteriacea genus/family?

Question 20

Features of salmonella?

Answer 20

Anaerobe
Gram negative bacilli
Does not ferment lactose

Question 21

How does salmonella cause disease?

Answer 21

Produces Gram negative endotoxin
Invasin allows intracellular growth
Fimbriae adhere to epithelium over ileal lymphoid tissue (Peyer’s patches) where they multiply
Gain entry into the reticuloendothelial system

Question 22

Symptoms and signs of enteric fever?

Answer 22

Systemic disease with fever and headache
Abdominal discomfort
Constipation
Dry cough
Hepatosplenomegaly
Rash on abdomen (rare)
Bradycardia

Question 23

Incubation period of enteric fever?

Answer 23

7-14 days

Question 24

Complications of enteric fever?

Answer 24

Intestinal haemorrhage | Perforation around Peyer's patches

Question 25

Investigations for enteric fever?

Answer 25

Moderate anaemia Lymphopenia (low lymphocytes) Raised LFTs (transaminase and bilirubin) Blood and faeces cultures

Question 26

Treatment of enteric fever?

Answer 26

Ceftriaxone or azithromycin

Question 27

Prevention of enteric fever?

Answer 27

Food and water hygiene | Vaccine for high risk travel and lab personnel

Question 28

What can non-typhoidal salmonella infections be caused by?

Answer 28

Salmonella typhimurium and enteritidis

Question 29

Symptoms of non-typhoidal salmonella infections?

Answer 29

``` Diarrhoea Fever Vomiting Abdominal pain (Food poisoning) ```

Question 30

Complications of non-typhoidal salmonella infections?

Answer 30

Normally self-limiting Bacteraemia Deep-seated infection

Question 31

What type of virus is influenza?

Answer 31

Enveloped Negative Single-stranded RNA

Question 32

What are the three subtypes of influenza and what is the subtype defined by?

Answer 32

A, B, C Nucleoproteins -haemagglutin -neuraminidase

Question 33

What is antigenic drift?

Answer 33

Mutations within the genes that code for antibody binding sites This is what changes the antigens annually

Question 34

What is antigenic shift?

Answer 34

Process by which two or more strains of a virus combine to form a new antigen having a mixture of the surface antigens of the two and of the original strains

Question 35

Is it A or N which normally undergoes antigenic shift?

Answer 35

A

Question 36

Does antigenic shift or drift lead to pandemics?

Answer 36

Shift

Question 37

Incubation period of influenza?

Answer 37

1-4 days

Question 38

Signs and symptoms of influenza?

Answer 38

Headache Myalgia Fever Cough

Question 39

When is influenza infectious?

Answer 39

The day preceding and first 3 days of symptoms

Question 40

Complications of influenza?

Answer 40

Primary viral pneumonia | Secondary bacterial pneumonia

Question 41

Characteristics of Legionella pneumophilia?

Answer 41

Fastidious Gram negative Pleomorphic

Question 42

Where is Legionella pneumophilia found?

Answer 42

Water between 20 and 40*C

Question 43

How is Legionella pneumophilia spread?

Answer 43

When aerosols are generated eg showers and AC systems

Question 44

What is Legionella pneumophilia associated with?

Answer 44

Previous lung disease Smoking High alcohol intake Immunocompromised patients in hospital are vulnerable if AC is not adequately maintained

Question 45

Clinical features of Legionella pneumophilia

Answer 45

Mild, flu like illness sometimes Other times - pneumonia with severe respiratory failure and high mortality Can have GI symptoms before lung symptoms Unproductive cough Progressive dyspnoea Confusion

Question 46

How is Legionella pneumophilia diagnosed?

Answer 46

Sputum/bronchoalveolar lavage fluid cultured | Colonies identified serologically

Question 47

Treatment of Legionella pneumophilia

Answer 47

Macrolide | Rifampicin

Question 48

What type of bacteria is the one that causes Brucellosis?

Answer 48

Gram negative | Coccobacillus

Question 49

How is the brucellosis pathogen (Brucella melitensis, abortus, suis) transmitted?

Answer 49

Direct contact with animals or their products though skin breaks/ingestion abortus - cattle suis - pigs melitensis - goats

Question 50

How does Brucella cause disease?

Answer 50

Lives in cells of the reticulo-endothelial system | Uses superoxide dismutase and nucleotide-like substances to inhibit intracellular killing mechanisms of host

Question 51

Symptoms of Brucellosis?

Answer 51

``` High fever Myalgia Arthralgia Lumbosacral tenderness Epidydimitis ```

Question 52

How is brucellosis diagnosed?

Answer 52

Blood cultures

Question 53

How is brucellosis treated?

Answer 53

Doxycycline | Rifampicin