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Infection > Travel related infection > Flashcards

Travel related infection Flashcards

1
Q

what are unfamiliar features of imported disease?

A

Presenting features hepatomegaly
Isolation requirements ecoli
Diagnostic methods
Treatment/Management
Unexpected complications bleeding coma shock seizures

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2
Q

what can affect vulnerability of travellers to infection?

A

Temptation to take risks away from home
food, water, animals, sex
Different epidemiology of some diseases
HIV, TB, polio, diphtheria
Incomplete understanding of health hazards
Stress of travel
Refugees: deprivation, malnutrition, disease, injury

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3
Q

what are common infections worlwide?

A

influenza
community-acquired pneumonia
meningococcal disease
sexually transmitted diseases

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4
Q

what are climate ir environment related health problems?

A

Sunburn
Heat exhaustion and heatstroke
Fungal infections
Bacterial skin infections
Cold injury
Altitude sickness

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5
Q

what are infections controllable by sanitation?

A

Travelers’ diarrhoea
Typhoid
Hepatitis A or E
Giardiasis
Amoebiasis
Helminth infections
Viral gastroenteritis
Food poisoning
Shigella dysentery
Cholera
Cryptosporidiosis

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6
Q

what are infections controlled by immunisation?

A

Poliomyelitis
Diphtheria

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7
Q

what infections are controlled by education?

A

HIV
STD’s

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8
Q

what are water related infections?

A

Schistosomiasis
Leptospirosis
Liver flukes
Strongyloidiasis
Hookworms
Guinea worms

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9
Q

what are arthropods borne infections?

A

Malaria (mosquitos)
Dengue fever (mosquitos)
Rickettsial infections (ticks: typhus)
Leishmaniasis (sand flies: Kala-azar)
Trypanosomiasis (tsetse fly: sleeping sickness)
Filariasis (mosquitoes: elephantiasis)
Onchocerciasis (black flies: River Blindness)

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10
Q

what are important tropical diseases?

A

Malaria
Typhoid
Dengue Fever
Schistosomiasis
Rickettsiosis
Viral haemorrhagic fevers
Zika fever

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11
Q

what is the life cycle of malaria?

A
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12
Q

what are 5 species causative of malaria?

A

Plasmodium falciparum
SEVERE

BENIGN
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi (like P malariae; Far East, 2004)

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13
Q

what are symptoms of malaria?

A

fever
rigors
aching bones
abdo pain
headache
dysuria
frequency
sore throat
cough

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14
Q

what are signs of malaria?

A

none
splenomegaly
hepatomegaly
mild jaundice

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15
Q

what are complications of malaria?

A

Cerebral malaria (encephalopathy)
non- immune visitors, children in endemic areas hypoglycaemia, convulsions, hypoxia
Blackwater fever
severe intravascular haemolysis, high parasitaemia, profound anaemia, haemoglobinuria, acute renal failure
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria
Gram-negative septicaemia

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16
Q

how is malaria diagnosed?

A

Thick & thin blood films
Giemsa, Field’s stain
Quantitative buffy coat (QBC)
centrifugation, UV microscopy
Rapid antigen tests
OptiMal
ParaSight-F

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17
Q

how is the severity of malaria assessed?

A

Complicated malaria = one or more of…
Impaired consciousness or seizures

Hypoglycaemia

Parasite count ≥2%

Haemoglobin ≤ 8mg/dL

Spontaneous bleeding / DIC

Haemoglobinuria

Renal impairment or pH <7.3

Pulmonary oedema or ARDS

Shock (algid malaria)
?Gram negative bacteraemia

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18
Q

what are malaria treatment drugs?

A

Quinine from Chinchona
Artemisinins from Quinghaosu

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19
Q

what are treatment options for Treatment options for
uncomplicated P. falciparum malaria?

A

Riamet ® (artemether-lumefantrine) 3 days

Eurartesim ® (dihydroartemisinin-piperaquine) 3 days

Malarone ® (atovaquone-proguanil) 3 days

Quinine 7 days
S/E nausea, tinnitus, deafness (cinchonism), rash, hypoglycaemia
plus oral doxycycline (or clindamycin)

20
Q

Treatment options for
complicated or severe P. falciparum malaria?

A

IV artesunate (unlicensed in UK)

IV quinine
(S/E cardiac depression, cerebral irritation, N&V)
plus oral doxycycline (or clindamycin)

When patient is stable & able to swallow, switch to oral treatments

21
Q

Treatment of
P. vivax, P. ovale, P. malariae, P. knowlesi?

A

chloroquine 3 days

Riamet ® (artemether-lumefantrine) 3 days

add primaquine* (14 days) in vivax and ovale, to eradicate liver hypnozoites

*check for G6PD deficiency

22
Q

Malaria Control Programmes?

A

Mosquito breeding sites
Drainage of standing water
Larvacides
(Paris green), temphos, biological
Mosquito killing sprays
DDT, malathion, (dieldrin)
Human behaviour
Bed nets
Mesh windows

23
Q

what is Typhoid (Enteric) Fever?

A

Salmonella typhi
Salmonella paratyphi

Global cases: 27 million infections/yr
Global deaths: over 200,000/yr
UK cases: 500/yr

Widespread
poor sanitation, unclean drinking water

24
Q

what are clinical features of typhoid fever?

A

1st week:
fever, headache, abdo. discomfort, constipation, dry cough, relative bradycardia, neutrophilia, confusion
2nd week:
fever peaks at 7-10 days, Rose spots, diarrhoea begins, tachycardia, neutropenia
3rd week (Complications):
intestinal bleeding, perforation, peritonism, metastatic infections
week 4 (Recovery):
10 - 15% relapse

25
Q

how is typhoid fever diagnosed?

A

Clinical
not easy
evolution of features

Laboratory (Salmonella typhi, S. paratyphi)
Culture blood, urine & stool
Culture bone marrow

26
Q

what is the treatment for typhoid fever?

A

Oral Azithromycin
now drug of choice for Asian-acquired, uncomplicated enteric fever
IV Ceftriaxone
if complicated, or concerned regarding absorption

Increasing ciprofloxacin resistance

27
Q

what is dengue?

A

Swahili: “Ki-Dinga pepo”
Commonest human arbovirus infection
Dengue infection: 100 million cases/year
Dengue Deaths: 25,000/year

28
Q

what is the classical presentation of dengue fever?

A

Sudden fever
Severe headache, retro-orbital pain
Severe myalgia and arthralgia
Macular/ maculopapular rash
Haemorrhagic signs: petechiae, purpura, positive tourniquet test

29
Q

how is dengue diagnosed?

A

Clinical
Thrombocytopenia
Leucopenia
Elevated transaminases
Positive tourniquet test

Laboratory: PCR, serology

30
Q

how is dengue managed?

A

No specific therapeutic agents

Complications
Dengue haemorrhagic fever (DHF)
Dengue shock syndrome (DSS)
Rx: IV fluids, fresh frozen plasma, platelets

Prevention
avoid bites
new vaccine (Dengvaxia), 2016; limited use

31
Q

where is schistosomiasis trasmitted from?

A

fresh water/snails

32
Q

how is schistosomiasis distributed?

A

S. haematobium
S. mansoni
S. japonicum

33
Q

what are clinical features of schitosomiasis?

A

Swimmers Itch (1st few hrs)
clears 24-48hrs
Invasive stage (after 24hrs)
cough, abdo discomfort, splenomegaly, eosinophilia
Katayama Fever (after 15-20 days)
prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
Acute disease (6-8 weeks)
eggs deposited in bowel (dysentery) or bladder (haematuria)
Chronic disease

34
Q

how is schistosomiasis diagnosed?

A

Clinical diagnosis
Antibody tests
Ova in stools and urine
Rectal snip

35
Q

how is schistosomiasis treated?

A

PRAZIQUANTEL 20mg/kg, two doses 6hrs apart
Prednisolone if severe

36
Q

what are clinical features of tick typhus?

A
37
Q

what is rickettsiosis?

A

Tick typhus (R. conorii, R. africae)

Rocky Mountain Spotted Fever (R. rickettsii)
Epidemic typhus (R. prowazekii)
Murine or endemic typhus (R. mooseri)
Scrub typhus (R. tsutsugamushi)
others

38
Q

what are clinical features of rickettsiosis?

A

abrupt onset swinging fever, headache, confusion, endovasculitis, rash (macular, petechial), bleeding

39
Q

how is rickettsiosis diagnosed?

A

clinical features, serology

40
Q

how is rickettsiosis managed?

A

tetracycline

41
Q

what are viral haemorrhagic fevers?

A

Serious infections but rare in UK
Ebola
Congo-Crimea haemorrhagic fever
Lassa fever
Marburg disease

Maximum incubation period 3 weeks
Rule out common severe infections
Isolation: High Security Infection Unit
Treatment: supportive!

42
Q

what is Zika?

A

flavivirus
Transmitted by daytime-biting Aedes mosquitos
Also by sexual contact, blood transfusion
Related to dengue, yellow fever, Jap B encephalitis and West Nile viruses
Pacific outbreak 2013-14
Latin America pandemic 2015-16

43
Q

what are clinical features of Zika?

A

Clinical: no or mild symptoms - headache, rash, fever, malaise, conjunctivitis, joint pains (like dengue)
In pregnancy, can cause microcephaly and other neurological problems
Can cause Guillain-Barre syndrome
No antiviral therapy
Mosquito control measures
Vaccines in development

44
Q

If a patient has travelled what should be covered in the history?

A

Is it tropical?
Travel history
Precautions taken
Risks
Symptoms
Incubation periods

45
Q

what examination signs should be lookse for In a travelled patient?

A

rash - typhoid, typhus, dengue

jaundice - hepatitis, malaria, Yellow fever

lymph nodes - leishmania, trypanosomiasis

liver - malaria, typhoid, amoebic abscess

spleen – visceral leishmaniasis, typhoid, malaria

46
Q

what investigations should be done in a patient who has travelled?

A

FBC
malaria films
liver function tests
stool microscopy & culture
urine analysis & culture
blood culture(s)
CXR

Specific tests (as indicated)
dengue
respiratory viral/atypical
hepatitis A, B, C
tick typhus (Rickettsia)
schistosomiasis
amoebic
leptospirosis/hantavirus
viral haemorrhagic fevers

47
Q

how should a travelled patient be treated in general?

A

Isolation: ?personal protective equipment
Supportive measures (resuscitation)
Empirical treatment if patient unwell
Antimicrobial therapy based on likely diagnosis
aim to treat life-threatening conditions
e.g. typhoid, septicaemia
Specific treatment
once diagnosis is established

Infection (14 decks)

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