Travel Related Infection Flashcards
(65 cards)
1
Q
Factors that can make travellers vulnerable to infection
A
Temptation to take risks away from home - food - water - animals - sex Different epidemiology of some diseases - HIV, TB, Polio, diptheria Incomplete understanding of health hazards Stress of travel Refugees - deprevation - malnutrition - disease - injury
2
Q
Climate or environment related health problems
A
Sunburn Heat exhaustion/Heat stroke Fungal infections Bacterial skin infections Cold injury Altitude sickness
3
Q
Infections that are controllable by sanitation
A
Traveller's diarrhoea Hep A or E Typhoid Food poisoning Cholera
4
Q
Water related infections include
A
Schistosomiasis
Leptospirosis
Liver flukes
5
Q
What is malaria’s vector?
A
Female anopheles mosquito
6
Q
What is dengue fever vector?
A
Mosquitos
7
Q
What is leishmaniasis’s vector?
A
Sand flies
8
Q
Definition of malaria
A
Parasitic infection of red blood cells
9
Q
Malaria life cycle
A
- mosquito bite
- sporozoites injected into bloodstream which rapidly migrate to liver cells
- multiple in liver cells to merozoites
- these go to red cells and replicate and make them burst
- A cycle of replication is made
- Male and female gameotocytes replicate inside the mosquitos gut
10
Q
5 species of malaria
A
plasmodium falciparum (serious) plasmodium vivax plasmodium ovale plasmodium malariae plasmodium knowlesi
11
Q
Presentation of malaria
A
Fever and rigors Aching bones Abdominal pain Headache Dysuria Frequency Sore throat Cough Majority no signs until established disease - splenomegaly - hepatomegaly - jaundice
12
Q
Complications of malaria
A
Cerebral malaria (encephalopathy) Blackwater fever Pulmonary oedema Jaundice Severe anaemia Algid malaria
13
Q
Definition of algid malaria
A
Gram -ve septicaemia
14
Q
Investigations of malaria
A
Thick and thin blood films
Quantative buffy coat (QBC)
Rapid antigen tests
15
Q
Complicated malaria means one or more of…..
A
Impaired consciousness/seizures
Hypoglycaemia
Parasite count >_2%
haemoglobin
16
Q
Treatment of uncomplicated P. Falciparum malaria
A
Rimamet, euratesim and malarone for 3 days OR
Quinine 7 days plus oral doxycycline/clindamycin
17
Q
Treatment of complicated or severe P. falciparum malaria
A
IV quinine plus oral doxycycline/clindamycin
18
Q
Treatment of benign species of malaria
A
Cholorqine 3 days
Riamet 3 days
Add primaquine (14 days) in vivax + ovale to eradicate liver hypnozoites
19
Q
Malaria control measures
A
Mosquito breeding sites - drainage of standing water Larvacides Mosquitos killing sprays (DDT) Human behaviour - DDT - bed nets - mesh windows
20
Q
Causative organisms of typhoid (enteric) fever
A
Salmonella typhi
Salmonella paratyphi
21
Q
Causes of typhoid fever
A
Poor sanitation
Unclean drinking water
22
Q
How is typhoid fever transmitted?
A
Faecal-oral route
23
Q
Incubation time for typhoid fever
A
7 days - 4 weeks
24
Q
Presentation of typhoid fever
A
1st week - fever - headache - abdominal discomfort - constipation - dry cough - relative bradycardia - neutrophilia - confusion 2nd week - fever peaks 7-10 days - rose spots - diarrhoea begins - tachycardia - neutropenia 3rd week (complications) - intestinal bleeding - perforation - peritonism - metastatic infections 4th week (recovery) - 10-15% relapse
25
Investigations for typhoid fever
Blood culture
urine culture
stool culture
Bone marrow culture
26
Treatment of typhoid fever
uncomplicated, Asian acquired
- oral azithromycin
Complicated/concerning
- IV ceftriaxone
27
What is the commonest human arbovirus infection?
Dengue fever
28
Where is dengue fever found?
South of the equator - tropical conditions
29
Presentation of dengue fever
```
Sudden fever
Severe headache, retro-orbital pain
Severe myalgia and arthralgia
Macular/maculopapular rash
haemorrhagic
- petechiae, purpura
```
30
Investigations for dengue fever
```
Clinical
- thrombocytopenia
- leucopenia
- elevated transaminases
- positive tourniquet test
PCR
Serology
```
31
Treatment for dengue fever
No treatment
32
Complications of dengue fever
Dengue haemorrhagic fever (DHF)
| Dengue shock syndrome (DSS)
33
Treatment of complications of dengue fever
IV fluids
Fresh frozen plasma
Platelets
34
Prevention of dengue fever
```
Avoid bites
New vaccine (degvaxia)
```
35
Where is schistosomiasis found?
Fresh water and fresh water snails
36
Types of Schistosomiasis
S. Haematobium
S. mansoni
S. japonicum
37
Life cycle of schistosomiasis
1. Eggs in faeces and urine
2. Eggs hatch releasing miracidia
3. Miracidia penetrate snail tissue
4. Sporocysts in snail (successive generation)
5. Cercarial released by snail into water and free swimming
6. Penetrate skin
7. Cercarial lose tails during penetration and become schistosomulae
8. circulation
9. Migrate to portal circulation in liver and mature into adults
10. Paired adult worms migrate to
- mesenteric venules of bowels/rectum (layering eggs that circulate to the liver and shred in stools)
- venous plexus of the bladder
11. excreted out in faeces/urine (eggs)
38
Presentation of schistosomiasis
```
Swimmers itch in first few hours - clears after 24-48 hours
Invasive stage (after 24 hours)
- cough
- abdominal discomfort
- splenomegaly
- eosinophilia
Katayama fever (After 15-20 days)
- prostate
- fever
- urticaria
- lymphadenopathy
- splenomegaly
- diarrhoea
- eosinophilia
Acute disease (6-8 weeks)
- eggs deposited in bowel (dysentery) or bladder (haematuria)
```
39
Investigations for schistosomiasis
Clinical
Antibody tests
Ova in stools and urine
Rectal snip
40
Treatment for schistosomiasis
Praziquantel 2 doses 6 hours apart
| Prednisolone if severe
41
Presentation of Rickettsiosis/tick typhus
```
Tick bite eschar
Maculopapular rash
Abrupt onset swinging fever
Headache
Confusion
Endovasculitis
Rash (macular, petechial)
bleeding
```
42
Diagnosis of ricketsiosis/tick typhus
Clinical features
| Serology
43
Treatment of tick typhus/rickettsiosis
Tetracycline
44
Maximum incubation period of viral haemorrhagic fevers
3 weeks
45
Examples of viral haemorrhagic fever infections
Ebola
Lassa fever
Marburg disease
46
Treatment of viral haemorrhagic fevers
Supportive
47
Transmission of zika virus
daytime-biting aedes mosquito
sexual contact
blood transfusion
48
What is the Zika virus related to?
Dengue
Yellow fever
Jap B encephalitis
West nile virus
49
Presentation of zika virus
```
No or mild symptoms
- headache
- rash
- fever
- malaise
- conjunctivitis
- joint pains (like dengue)
In pregnancy
- microencephaly and other neurological problems
Guillian barre syndrome
```
50
Treatment of the zika virus
No treatment
51
Investigations of a returning traveller with a fever
```
FBC
Malaria films
LFTs
Stool microscopy/culture
Urinalysis + culture
Blood cultures
CXR
Specific tests for specific diseases as indicated
```
52
If a rash and fever on examination, what can this indicated in a returning traveller?
Typhoid
Typhus
Dengue
53
What can jaundice and fever on examination of a returning traveller indicate?
Leishmania
| Trypanosomiasis
54
What can liver signs and fever suggest in a returning traveler?
Malaria
Typhoid
Ameobic abscess
55
What can spleen signs and fever suggest in a returning traveler?
Visceral leishmaniasis
Typhoid
Malaria
56
Treatment of non falciparum acute malaria
Chloroquine
57
Most common non falciparum malaria
Plasmodium vivax
58
What is yellow fever spread by?
Aedes mosquito
59
Incubation of yellow fever
2 - 14 days
60
Presentation of yellow fever
Mild flu like illness lasting < 1 week
Sudden onset high fever, rigours, N + V, bradycardia
Brief remission
Then jaundice, haematemesis, oliguria
61
What may be seen in hepatocytes in yellow fever?
Councilman bodies (inclusion bodies)
62
Transmission of typhoid
Faecal oral (and contaminated food and water)
63
Presentation of typhoid
```
Headache
Fever
Arthrlagia
Relative bradycardia
Abdominal pain and distension
Rose spots (trunk in 40%) - more common in parathyroid
```
64
Complications of typhoid
```
Osteomyelitis
GI bleed / perforation
Meningitis
Cholecystitis
Chronic carriage (1% - more likely if adult females)
```
65
Treatment of amoebiasis
Metronidazole
