Travel Related Infection Flashcards
(77 cards)
1
Q
International travel health advice
A
Risk assessment
Requirements change
Up-to-date information
Individual advice regarding general measures, immunisation and drug prophylaxis
2
Q
Risk assessment of the traveller
A
Health of the traveller Areas to be visited Duration of visit Accommodation Activities Remote areas Previous immunisation and prophylaxis
3
Q
Sources of information on travel advice
A
British national formulary
Immunisation against infectious diseases
Health information for overseas travel
Institutions e.g. schools of tropical medicine
Internet
4
Q
Common immunisations for travellers
A
Tetanus Polio Typhoid Hepatitis A Yellow fever
5
Q
Immunisation for travellers in special circumstances
A
Meningococcus Rabies Diptheria Hepatitis B Japanese B encephalitis Tick borne encephalitis Pneumococcus Influenza
6
Q
Who should be given malaria chemoprophylaxis and how long should the course of treatment be?
A
Essential for all travellers to endemic areas, including children and pregnant women
Commence 1-3 weeks before travel and continue for up to 4 weeks after leaving
7
Q
Examples of viral haemorrhagic fevers that travellers may be at risk of
A
Yellow fever Dengue haemorrhagic fever Hentavirus infections Lessa fever Marburg fever Ebola fever Congo-Crimea haemorrhagic fever
8
Q
Examples of zoonoses that travellers may be at risk of
A
Brucellosis
Rabies
Tularaemia
Anthrax
9
Q
Unfamiliar features of imported disease
A
Presenting features Isolation requirements Diagnostic methods Management requirements Unexpected complications
10
Q
Factors increasing the vulnerability of travellers to infection
A
Temptation to take risks away from home
Different epidemiology of some diseases
Incomplete understanding of health hazards
Stress of travel
Refugees - deprivation, malnutrition, disease or injury
11
Q
Infections common worldwide
A
Influenza
Community-acquired pneumonia
Meningococcal disease
STDs
12
Q
Conditions caused/exacerbated climate/environment
A
Sunburn Heat exhaustion Heat stroke Fungal infections Bacterial skin infections Cold injury Altitude sickness
13
Q
Infections controllable by sanitation
A
Traveller's diarrhoea Typhoid Hepatitis A or E Giardiasis Amoebiasis Helminth infections Viral gastroenteritis Food poisoning Shigella dysentery Cholera Cryptosporidiosis
14
Q
Infections controllable by immunisation
A
Poliomyelitis
Diphtheria
15
Q
Infections controllable by education
A
HIV
STDs
16
Q
Infections transmitted in water and mud
A
Schistosomiasis Leptospirosis Liver flukes Strongyloidiasis Hookworms Guinea worms
17
Q
Infections transmitted by arthropod vectors
A
Malaria Dengue fever Rickettsial infections Leishmaniasis Trypanosomiasis Filariasis Onchocerciasis
18
Q
Emerging infectious diseases
A
Zika Ebola MERS-CoV Swine flu Avian flu SARS West Nile virus
19
Q
Important tropical diseases
A
Malaria Typhoid Dengue fever Schistosomiasis Rickettsiosis Viral haemorrhagic fevers Zika fever
20
Q
Epidemiology of malaria
A
Tropical
Most important imported disease
Vector is the female anopheles mosquito
21
Q
Cases of malaria per year according to WHO 2012
A
207 million cases/year
781,000 deaths/year
22
Q
Species of malaria
A
Plasmodium falciparum (potentially severe) Plasmodium vivax Plasmodium ovale Plasmodium malariae Plasmodium knowlesi
23
Q
Symptoms of malaria
A
Fever Rigors Aching bones Abdominal pain Headache Dysuria Frequency Sore throat Cough
24
Q
Signs of malaria
A
May be none
Splenomegaly
Hepatomegaly
Mild jaundice
25
Complications of malaria
```
Cerebral malaria (encephalopathy)
Blackwater fever
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria
```
26
Features of cerebral malaria (encephalopathy)
Hypoglycaemia
Convulsions
Hypoxia
27
Features of blackwater fever
```
Severe intravascular haemolysis
High parasitaemia
Profound anaemia
Haemoglobinuria
Acute renal failure
```
28
Diagnosis of malaria
Thick and thin blood films
Quantitative buddy coat
Rapid antigen tests
29
When assessing malaria severity, one or more of what features are indicative of complicated malaria?
```
Impaired consciousness or seizures
Hypoglycaemia
Parasite count 2% or more
Haemoglobin 8mg/dL or less
Spontaneous bleeding
Haemoglobinuria
Renal impairment or pH < 7.3
Pulmonary oedema or ARDS
Shock
```
30
Traditional malaria drugs
Quinine
| Artemisinins
31
Management of uncomplicated P. falciparum malaria
Quinine 7 days plus oral doxycycline or clindamycin
Malarone 3 days
Riamet 3 days
32
Side effects of quinine
Nausea
Tinnitus
Deafness
Rash
33
Management of complicated or severe P. falciparum malaria
IV quinine plus oral doxycycline or clindamicin
| Switch to oral therapy when patient is stable and able to swallow
34
Side effects of IV quinine
Cardiac depression
Cerebral irritation
Nausea
Vomiting
35
Management of P. vivax, ovale, knowlesi and malariae
Chloroquine 3 days
Riamet 3 days
Plus primaquine 14 days in vivax and ovale to eradicate liver hypnozoites
36
Malaria control programmes
Drainage of standing water at mosquito breeding sites
Temphos/biological management of larvicides
Mosquito killing sprays
Human behaviour e.g. bed nets, mesh windows
37
Adjuvant measures for malaria infection
```
O2 or ventilation if pulmonary oedema
Maintain blood glucose
Correct anaemia
Dialysis if acute renal failure
Exchange transfusion if high parasitaemia
```
38
Examples of prophylaxis for malaria
Malarone
Mefloquiine
Doxycycline
39
Causative organisms of typhoid fever
Salmonella typhi
| Salmonella paratyphi
40
How many global cases of typhoid fever are there?
27 million infections per year
Over 200,000 global deaths per year
200 UK cases per year
41
Incubation period of typhoid fever
7 days - 4 weeks
42
Features of first week of typhoid fever
```
Fever
Headache
Abdominal discomfort
Constipation
Dry cough
Relative bradycardia
Neutrophilia
Confusion
```
43
Features of second week of typhoid fever
```
Fever peaks at 7-10 days
Rose spots
Diarrhoea
Tachycardia
Neutropenia
```
44
Features of third week of typhoid fever
```
Complications
Intestinal bleeding
Perforation
Peritonism
Metastatic infections
```
45
Diagnosis of typhoid fever
Not an easy clinical diagnosis, based on evolution of features
Laboratory - blood, urine, stool and bone marrow culture
46
Treatment of typhoid fever
Azithromycin - drug of choice for Asian acquired uncomplicated typhoid fever
Ceftriaxone - if complicated or concerned regarding absorption
47
Cases of dengue fever each year
100 million infections per year
| 25,000 deaths per year
48
Features of classical dengue fever
```
Sudden fever
Sever headache, retro-orbital pain
Severe myalgia and arthralgia
Macular/maculopapular rash
Haemorrhagic signs e.g. petechiae, purpura, positive tourniquet test
```
49
Diagnosis of dengue fever
Clinical - thrombocytopenia, leucopenia, elevated transaminases, positive tourniquet test
Laboratory - PCR, serology
50
Management of dengue fever
Conservative - no specific therapeutic agents
IV fluids
fresh frozen plasma
platelets
51
Species causing schistosomiasis
S. haematobium
S. mansoni
S. japonicum
52
How is schistosomiasis contracted?
Swimming in contaminated water
53
Clinical features of first 24-48 hours of schistosomiasis
Swimmers itch
54
Features of invasive stage of schistosomiasis
```
After 24 hours
Cough
Abdominal discomfort
Splenomegaly
Eosinophilia
```
55
Features of schistosomiasis after 15-20 days
```
Katayama fevere
Prostrate
Fever
Urticarial
Lymphadenopathy
Splenomegaly
Diarrhoea
Eosinophilia
```
56
Features of acute schistosomiasis disease
After 6-8 weeks
| Eggs deposited in bowel causing dysentery or in bladder causing haematuria
57
Diagnosis of schistosomiasis
Clinical
Antibody test
Ova in stools and urine
Rectal snip
58
Treatment of schistosomiasis
Praziquantel 40mg/kg single dose
| Prednisolone if severe
59
Features of tick typhus
Tick bite eschar
| Maculopapular rash
60
Organisms causing rickettsiosis
```
R. conorii
R. africae
R. rickettsii
R. prowazekii
R. moosen
R. tsutsugamushi
```
61
Clinical features of rickettsiosis
```
Abrupt onset swinging fever
Headache
Confusion
Endovasculitis
Rash
Bleeding
```
62
Diagnosis of rickettsiosis
Clinical features
| Serology
63
Management of rickettsiosis
Tetracycline
64
Management of viral haemorrhagic fevers
```
Rule out common severe infections
Isolation in high security infection unit
No specific treatment
Supportive treatment
May be fatal
```
65
How is zika virus transmitted?
By daytime biting aedes mosquito
66
Features of zika virus
```
No or mild symptoms
Headache
Rash
Fever
Malaise
Conjunctivitis
Joint pains
Microcephaly and other neurological problems in unborn babies
```
67
Features of amoebic liver abscess
Fever
| Right upper quadrant pain
68
Treatment of amoebic liver abscess
Drainage and metronidazole then diloxanide
69
Important features of history of a traveller returning with a febrile illness
```
Is it tropical
Travel history
Precautions taken
Risks taken
Symptoms
Incubation periods
```
70
What travel-related infection might a rash be a sign of?
Typhoid
Typhus
Dengue
71
What travel-related infection might jaundice be a sign of?
Hepatitis
Malaria
Yellow fever
72
What travel-related infection might enlarged lymph nodes be a sign of?
Leishmania
| Trypanosomiasis
73
What travel-related infection might a palpable liver be a sign of?
Malaria
Typhoid
Amoebic abscess
74
What travel-related infection might a palpable spleen be a sign of?
Kala-Azar
Typhoid
Malaria
75
Common investigations into travellers returning with an illness
```
FBC
Malaria films
LFTs
Stool microscopy and culture
Urinalysis and culture
Blood cultures
CXR
```
76
Specific serology tests for travellers returning with an illness
```
Dengue
Respiratory viral/atypical
Hepatitis A, B, C
Tick typhus
Schistosomiasis
Amoebic
Leptospirosis/hantavirus
Brucellosis
Viral haemorrhagic fevers
```
77
General treatment measures for travel related infections
Isolation
Supportive measures
Empirical treatment
Specific treatment
