Travel Related Infection

Question 1

what is malaria transmitted by?

Answer 1

the female anopheles mosquito

Question 2

what organisms causes potentially severe forms of malaria?

Answer 2

plasmodium falciparum

Question 3

name some signs of malaria

Answer 3

> none
splenomegaly
mild jaundice
hepatomegaly

Question 4

name some symptoms of malaria

Answer 4

> fever
> rigors
> aching bones
> abdominal pain
> headache
> dysuria
> frequency
> sore throat

Question 5

what complications can arise from malaria?

Answer 5

> blackwater fever
> pulmonary oedema
> severe anaemia
> algid malaria (gram negative septicaemia)
> encephalopathy

Question 6

how is malaria diagnosed?

Answer 6

> thick and thin blood films
rapid antigen tests
quantative buffy coats

Question 7

when assessing the severity of malaria what presentation indicates it is complicated?

Answer 7

> hypoglycaemia
> impaired consciousness
> haemoglobinuria
> renal impairment
> pulmonary oedema
> shock
> spontaneous bleeding
> ?haem <8mg?
> parasite count 2% or more

Question 8

how do you treat uncomplicated p. falciparum malaria?

Answer 8

> riamet 3 days
euratesim 3 days
malarone 3 days
quinine 7 days + oral doxycycline

Question 9

how would you manage complicated severe p. falciparum?

Answer 9

> IV quinine + oral doxycycline

> IV artesunate

Question 10

how would you manage vivax/ovale/malariae/Knowles malaria?

Answer 10

> chloroquine 3 days

> riamet 3 days (+ primaquine in ovale/vivax)

Question 11

what methods of control exist to tackle malaria?

Answer 11

> draining standing water
larvicides
mosquito killing spray
behaviour (nets and mesh windows)

Question 12

what is responsible for causing typhoid fever?

Answer 12

> salmonella typhi and paratyphi

Question 13

what is the incubation period for typhoid fever?

Answer 13

7 days to 4 weeks

Question 14

how does typhoid fever present in the 1st week?

Answer 14

> fever
> confusion
> abdominal discomfort
> headache
> constipation
> dry cough
> relative bradycardia
> neutrophilia

Question 15

how does typhoid fever present in the 2nd week?

Answer 15

> fever peaks at 7-10 days
> rose spots
> diarrhoea begins
> tachycardia
> neutropenia

Question 16

what complications can occur in the 3rd week of typhoid fever?

Answer 16

> intestinal bleeding
perforation
peritonism
metastatic infections

Question 17

what percentage of patients relapse in typhoid fever?

Answer 17

10-15%

Question 18

how is typhoid fever diagnosed?

Answer 18

> clinically by evaluating features

> culture of urine, blood, stool and bone marrow

Question 19

how is typhoid fever managed?

Answer 19

> oral azithromycin in Asian uncomplicated TF

> IV ceftriaxone in complicated TF

Question 20

what transmits dengue fever?

Answer 20

aedes aegypti

Question 21

how does dengue fever present?

Answer 21

> sudden fever
> severe headache (retro orbital pain)
> myalgia
> arthralgia
> macular popular rash
> haemorrhagic signs (petechiae, purpura)

Question 22

how is dengue fever diagnosed?

Answer 22

> clinically:
   leukopenia
   thrombocytopenia
   elevated transaminase
   positive tourniquet test

> lab:
serology
PCR

Question 23

what are some complications of dengue fever?

Answer 23

> dengue haemorrhagic fever

> dengue shock syndrome

Question 24

how is complicated dengue fever treated?

Answer 24

> IV fluids
plasma
platelets

Question 25

how can dengue fever be prevented?

Answer 25

> avoiding bites | > vaccine (limited)

Question 26

how is schistosomiasis transmitted?

Answer 26

via fresh water snail, the parasite then penetrates the skin and travels to the portal vein

Question 27

name the parasites that cause schistosomiasis

Answer 27

> s. haematobium > s. mansoni > s. japonicum

Question 28

what are the symptoms of schistosomiasis in the first few hours?

Answer 28

swimmers itch that clears in 48 hours

Question 29

how does the invasive stage of schistosomiasis present?

Answer 29

> abdominal discomfort > cough > splenomegaly > eosonophillia

Question 30

describe the katayama fever stage in schistosomiasis

Answer 30

``` > 15-20 days > fever > urticaria > diarrhoea > lymphadenopathy > eosinophilia ```

Question 31

how does acute schistosomiasis disease present?

Answer 31

> 6-8 weeks > dysentery (with eggs in bowel) > haematuria

Question 32

how is schistosomiasis diagnosed?

Answer 32

> clinically > ova in stools > rectal strip > antibody test

Question 33

how is schistosomiasis treated?

Answer 33

> praziquantel | > prednisolone

Question 34

what information would you want from a returning traveller who has a fever?

Answer 34

> other symptoms > where they went to > precautions they took

Question 35

a returning traveller with a fever also presents with a rash. give 3 differential diagnoses

Answer 35

> typhoid fever > typhus > dengue

Question 36

a returning traveller with a fever also presents with jaundice. give 3 differential diagnoses

Answer 36

> yellow fever > malaria > hepatitis

Question 37

a returning traveller with a fever also presents with enlarged lymph nodes. give 2 differential diagnoses

Answer 37

> leishmania | > trypanosomiasis

Question 38

a returning traveller with a fever also presents with liver signs. give 3 differential diagnoses

Answer 38

> malaria > typhoid > amoebic abscess

Question 39

a returning traveller with a fever also presents with splenic signs. give 3 differential diagnoses

Answer 39

> typhoid > malaria > visceral leishmiasis

Question 40

what investigations would you want to carry out in a returning traveller with a fever?

Answer 40

``` > FBC > LFT's > malaria films > urinalysis and culture > stool microscopy and culture ```

Question 41

what are the clinical features of rickediosis (tick typhus)?

Answer 41

``` > abrupt onset swinging fever > headache > bleeding > confusion > endovasculitis > rash (petechial and macular) ```

Question 42

how is rickediosis treated?

Answer 42

tetracycline

Question 43

what infections can cause viral haemorrhagic fever?

Answer 43

> Ebola > lassa-fever > Marburg disease > congo-crimea haemorrhagic fever

Question 44

what is the max incubation time for viral haemorrhagic fever?

Answer 44

3 weeks

Question 45

how does zika present?

Answer 45

``` > fever > rash > headache > malaise > conjunctivitis > joint pain > microcephaly > gaulliane barre syndrome ```