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Infection > Travel Related Infection > Flashcards

Travel Related Infection Flashcards

1
Q

What are the unfamiliar features of imported diseases?

A 
Presenting features
Isolation requirements
Diagnostic methods
Treatment
Unexpected complications
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2
Q

Why are travellers vulnerable to infection?

A

Temptation to take risks e.g. food, water, animals, sex
Different epidemiology of diseases
Incomplete understanding of health hazards
Stress of travel
Refugees

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3
Q

What infections are common worldwide?

A

Influenza
community acquired pneumonia
Meningococcal disease
STIs

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4
Q

What climate/ environment related health problems are there?

A 
Sunburn
Heat exhaustion
Fungal infections
Bacterial skin infections
Cold injury
Altitude sickness
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5
Q

What methods are infections controllable by public health measures?

What infections are controllable though these measures?

A

Sanitation:

  • Traveller’s diarrhoea
  • Typhoid
  • Giardiasis
  • Amoebiasis
  • Food poisoning
  • Chloera

Immunisation:

  • Poliomyelitis
  • Diptheria

Education:

  • HIV
  • STDs
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6
Q

What water related infection are there?

A

Schistosomiasis
Leptospirosis
Liver Flukes
Hookworms

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7
Q

What arthropod borne infections are there?

A

Malaria, Dengue fever - mosquitos
Rickettsial infections - ticks
Leishmaniasis - sand flies

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8
Q

What emerging infectious diseases are there?

A 
Zika virus
Ebola virus
Swine Flu
Avian flu
West Nile virus
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9
Q

What important tropical diseases are there?

A
  • Malaria
  • Typhoid
  • Dengue Fever
  • Schistosomiasis
  • Rickettsiosis
  • Viral Haemorrhagic fevers
  • Zika fever
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10
Q

What is the vector for malaria?

A

Female Anopheles mosquito

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11
Q

What is the parasite called causing malaria?

A

Plasmodium falciparum - can potentially be severe

The benign forms of the parasite include:
•	Plasmodium vivax 
•	Plasmodium ovale 
•	Plasmodium malariae
•	Plasmodium knowlesi
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12
Q

What are the symptoms of malaria?

A

Fever
Rigors
Aching
Malaise

(abdominal pain, headache dysuria, frequency, sore throat, cough, non-specific)

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13
Q

What are the signs of malaria?

A

Can be none

Splenomegaly, hepatomegaly, mild jaundice

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14
Q

What are the complications of malaria?

A 
Cerebral malaria (encephalopathy)
Blackwater fever (dark urine, renal failure)
Pulmonary oedema
Jaundice
Severe anaemia
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15
Q

How is malaria diagnosed?

A

Thick + thin blood films

Rapid antigen tests

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16
Q

How is the severity of malaria assessed?

A 
Complicated malaria indicated by one or more of:
•Impaired consciousness or seizures
•Hypoglycaemia
•Parasite count >2%
•Haemoglobin < 8mg/dL
•Spontaneous bleeding
•Haemoglobinuria
•Renal impairment or pH < 7.3
•Pulmonary oedema or ARDS
•Shock (algid malaria): gram negative bacteraemia
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17
Q

What is the prophylaxis for malaria?

Who needs to take prophylaxis?

A

Malarone, Mefloquine, Doxcycline

All travellers going to an endemic area including children and pregnant women need to take prophylaxis

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18
Q

What are the treatment options for uncomplicated Plasmodium falciparum?

A

Riamet - 3 days
or Malarone - 3 days
or Quinine - 7 days (plus doxycycline)

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19
Q

What are the treatment options for complicated Plasmodium falciparum?

A

IV quinine plus oral doxycycline

20
Q

What are the treatment options for P. vivax, P. ovale, P. malariae, P. knowlesi?

A

Chloroquine - 3 days
Riamet - 3 days

NoteL add primaquine (14 days) in P. vivax and P. ovale

21
Q

What adjuvant measures are there for malaria?

A 
Ventilation (if pulmonary oedema)
Maintain glucose level
Correct anaemia (blood transfusion)
Dialysis if renal failure
Exchange transfusion if high parasitaemia
22
Q

What malaria control programmes are there?

A

Drainage of stagnant water to prevent mosquito breeding sites
Larvacides against larval life stage
Mosquito killing sprays - DDT
Bed nets, mesh windows

23
Q

What is the bacterium causing typhoid fever?

A

Salmonella typhi

Salmonella paratyphi

24
Q

What are the risk factors for typhoid fevers?

A

Poor sanitation, unclean drinking water

25
Q

What are the symptoms of typhoid fever at each stage?

A

Incubation period of 7 days 4 weeks

1st week: Fever, headache, abdo discomfort, constipation, neutrophilia, confusion

2nd week: fever peaks, diarrhoea begins

3rd week (complications): intestinal bleeding, perforation

4th week: recovery

10-15% relapse

26
Q

How is typhoid fever diagnose?

A

Culture blood, urine + stool

Culture bone marrow

27
Q

What is the treatment for typhoid fever?

A

Oral azithromycin
IV ceftriaxone if complicated

Note: increasing ciprofloxacin resistance

28
Q

What is the vector for Dengue fever?

A

Aedes aegypti (yellow fever mosquito)

29
Q

What are the clinical features for Dengue fever?

A 
Sudden fever
Headache
Severe myalgia, arthralgia
Rash
Haemorrhagic signs
30
Q

What is the diagnosis for Dengue fever?

A

Thrombocytopenia
Leucopenia
Elevated transaminases
PCR, serology

31
Q

What is the management for Dengue fever?

A

Conservative measures: IV fluids, frozen plasma, platelets

32
Q

What are the complications of Dengue fever?

A

Dengue haemorrhage fever

Dengue shock syndrome

33
Q

What is schistosomiasis caused by?

A

A parasitic worm that lives in freshwater, the larvae grow inside freshwater snails

34
Q

What are the clinical features and progression of schistosomiasis?

A

Swimmers itch
Invasive stage - cough, abdo discomfort, splenomegaly
Katayma fever - fever, diarrhoea, eosinophilia
Acute disease- eggs deposited in bowel (dysentery) or bladder
Chronic disease

35
Q

How is schistosomiasis diagnosed?

A

clinical
antibody tests
ova in stools and urine

36
Q

What is the treatment for schistosomiasis?

A

Praziquantel

Prednisolone if severe

37
Q

What is the vector for Rickettsiosis?

What is the bacteria responsible for it?

A

Ticks

•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)
38
Q

What are the clinical features of Rickettsiosis?

A

Abrupt fever, rash, headache, confusion, bleeding

39
Q

What is the diagnosis for Rickettsiosis?

What is the management?

A

Dx= Clinical features, serology

Tx= Tetracycline, doxycycline

40
Q

What are examples of viral haemorrhagic fevers?

A

Ebola
Congo-Crimea haemorrhage fever
Lassa fever
Marburg disease

max incubation = 3 weeks

41
Q

What is the course to follow for viral haemorrhage fevers?

A

Rule out severe infections
Isolation
Supportive treatment

42
Q

How is Zika virus transmitted?

A
  • Transmitted by daytime-biting Aedes mosquitos

- Also transmitted by sexual contact, blood transfusion

43
Q

What are the symptoms of Zika virus?

What are the complications?

A

No or mild symptoms - headache, rash, fever, malaise, joint pains

In pregnancy, can cause microcephaly and other neurological symptoms

Can cause Guillain Barre syndrome

Note, Prevention: mosquito control measures

44
Q

What is the approach to a fever in returning traveller?

A 
Travel history
Precautions taken
Risks
Symptoms
Incubation periods
45
Q

What investigations can be done if traveller illness suspected?

A
  • FBC
  • malaria films
  • liver function tests
  • stool microscopy & culture
  • urine analysis & culture
  • blood culture(s)
  • CXR
46
Q

What is the measures if travellers illness suspected?

A

Isolation + personal protective equipment
Supportive measures
Empirical Tx- Antimicrobial
Specific Tx once diagnosed

47
Q

Look at the following signs on examination and the indicated disease

(rash, jaundice, lymph nodes, liver, spleen)

A
  • rash - typhoid, typhus, dengue
  • jaundice - hepatitis, malaria, Yellow fever
  • lymph nodes - leishmania, trypanosomiasis
  • liver - malaria, typhoid, amoebic abscess
  • spleen – visceral leishmaniasis, typhoid, malaria

Infection (12 decks)

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