Travel related infection Flashcards by Sophie C

Unfamiliar features of imported diseases (5)

Presenting features
Isolation requirements 
Diagnostic methods
Treatment/Management
Unexpected complications

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Give examples of how vulnerability with travellers increases away from home? (5)

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

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Name 4 infections that are common worldwide

influenza
community-acquired pneumonia
meningococcal disease
sexually transmitted diseases

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Climate or environment related health problems

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

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Give some examples of water related infections

Schistosomiasis
Leptospirosis
Liver flukes
Strongyloidiasis
Hookworms
Guinea worms

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Examples of Arthropod-borne infections

Malaria (mosquitos)
Dengue fever (mosquitos)
Rickettsial infections (ticks: typhus)
Leishmaniasis (sand flies: Kala-azar)

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Important Tropical Diseases include (7)

Malaria
Typhoid
Dengue Fever
Schistosomiasis
Rickettsiosis
Viral haemorrhagic fevers
Zika fever

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What is the vector for malaria

female Anopheles mosquito

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Malaria: 5 species - what one can be severe?

Plasmodium falciparum 
Plasmodium vivax 
Plasmodium ovale 
Plasmodium malariae
Plasmodium knowlesi

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Malaria - Clinical features - symptoms and signs

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

signs - splenomegaly
hepatomegaly
mild jaundice

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Complications of Malaria (6)

Cerebral malaria (encephalopathy)
Blackwater fever
Pulmonary oedema
Jaundice
Severe anaemia
Algid malaria

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Cerebral malaria (encephalopathy) often affects

non- immune visitors, children in endemic areas hypoglycaemia, convulsions, hypoxia

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Blackwater fever causes

severe intravascular haemolysis, high parasitaemia, profound anaemia, haemoglobinuria, acute renal failure

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Malaria - diagnosis

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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Severity assessment - 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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Treatment options for uncomplicated P. falciparum malaria (4)

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)

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Treatment options for complicated or severe P. falciparum malaria?

IV artesunate (unlicensed in UK)
IV quinine

PLUS plus oral doxycycline (or clindamycin)

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

what can you afford to eradicate liver hypnozoites

chloroquine 3 days
Riamet - 3 days
primaquine

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Typhoid (Enteric) Fever -organism names

Salmonella typhi

Salmonella paratyphi

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Typhoid Fever: Clinical features - week 1-4

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

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Typhoid fever incubation period

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Incubation period: 7 days - 4 week

Typhoid Fever: Diagnosis - clinical vs lab

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Clinical - not easy, evolution of features

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

Typhoid Fever: Treatment

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Oral Azithromycin

IV Ceftriaxone - (complicated)

Commonest human arbovirus infection

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Dengue

Transmission of Dengue

Aedes aegypti

Classical Dengue Fever (5)

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

the rashes of Dengue fever

Macular rash | Petichial rash

Dengue Diagnosis - clinical (4) laboratory

``` Clinical Thrombocytopenia Leucopenia Elevated transaminases Positive tourniquet test ``` PCR, serology

Dengue Management | prevention?

No specific therapeutic agents ``` avoid bites new vaccine (Dengvaxia), 2016; limited use ```

Dengue Management - complications (2) - how to treat?

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

Schistosomiasis is found in

fresh water and freshwater snails

Schistosomiasis types (3)

S. haematobium S. mansoni S. japonicum

Schistosomiasis - Clinical features

- Swimmers Itch - 1st few hours - Invasive stage - 24 hrs - Katayama Fever - Acute disease (6-8 weeks) - Chronic disease

Schistosomiasis - Clinical diagnosis

Antibody tests Ova in stools and urine Rectal snip

Schistosomiasis - treatment (2)

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

Tick typhus - what will show on the skin

Tick-bite eschar | Maculopapular rash

Rickettsiosis - types | most common in UK and give a few more examples

Tick typhus (R. conorii, R. africae) - Rocky Mountain Spotted Fever (R. rickettsii) - Epidemic typhus (R. prowazekii)

Rickettsiosis - CLINICAL features, diagnosis/management?

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

Viral Haemorrhagic Fevers- ones rare to the UK but serious include? (4)

Ebola Congo-Crimea haemorrhagic fever Lassa fever Marburg disease

Some features of the Zika virus

flavivirus - daytime-biting Aedes mosquitos - sexual contact, blood transfusions

Zika - clinical features (6)

no or mild symptoms - headache, rash, fever, malaise, conjunctivitis, joint pains (like dengue)

Zika - in pregnancy

microcephaly and other neurological problems

Zika infections can cause what condition?

Guillain-Barre syndrome

Zika has no antiviral therapy so what must you do instead?

Mosquito control measures | Vaccines in development

Examination signs - rash often caused by

typhoid, typhus, dengue

Examination signs - jaundice - what condition

- hepatitis, malaria, Yellow fever

Examination signs - lymph nodes

- leishmania, trypanosomiasis

Examination signs - liver - condition?

- malaria, typhoid, amoebic abscess

Examination signs - spleen - condition ?

visceral leishmaniasis, typhoid, malaria

Investigations for a returning traveller

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

Treatments for a returning traveller?

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

Travel related infection Flashcards

(51 cards)