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travel related infection Flashcards

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1
Q

unfamiliar features of imported diseases

A 
presenting features
isolation requirements
diagnostic methods
treatment/management 
unexpected complications
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2
Q

vulnerability of travelers to infection

A

temptation to take risks away from home - food, water, animals, sex
different epidemiology of some diseases - HIV, TB, polio, diphtheria
incomplete understanding of health hazards
stress of travel
refugees - deprivation, malnutrition, disease, injury

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3
Q

common worldwide infections

A

influenza
community acquired pneumonia
meningococcal disease
STD

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4
Q

climate or environment related health problems

A 
sunburn 
heat exhaustion/heat stroke 
fungal infections 
bacterial skin infections 
cold injury
altitude sickness
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5
Q

how are infections controllable by public health measures

A

sanitation
immunisation
education

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6
Q

infections controllable by sanitation

A 
traveller's diarrhoea
typhoid 
hep A/E
giardiasis 
amoebiasis 
helminth infections 
viral gastroenteritis 
food poisoning 
shigella dysentery 
cholera
cryptosporidiosis
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7
Q

infections controllable by immunisation

A

poliomyelitis

diphtheria

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8
Q

infections controllable by education

A

HIV

STDs

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9
Q

water related infections

A

bathing in infected water

schistosomiasis 
leptospirosis 
liver flukes 
strongyloidiasis 
hookworks 
guinea worms
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10
Q

arthropod borne infections

A

mosquitos - malaria, dengue fever
mosquitoes - elephantiasis, filariasis
ticks - rickettsial infections, typhus
sand flies - leishmaniasis
tsetse fly - trypanosomiasis, sleeping sickness
black flies - river blindness, onchocerciasis

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11
Q

emerging infectious diseases

A 
COVID 19 - global pandemic 
zika - latin america, caribbean 
ebola - west africa 
MERS-CoV - middle east 
swine flu - worldwide
avian flu - china 
SARS: far east, worldwide
west nile virus - US
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12
Q

important tropical diseases

A 
malaria 
typhoid 
dengue fever 
schistosomiasis 
rickettsiosis 
viral haemorrhagic fevers
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13
Q

malaria epidemiology

A

most important imported disease
UK - 1400 cases p/a, 6 deaths p/a
worldwide - 207mln cases p/a, 627 000 deaths p/a

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14
Q

what cells does malaria effect

A

RBC

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15
Q

what areas of the world does malaria affect

A

tropics

subsaharan africa, northern parts of south africa, northern parts of south america, asia (indian subcontinent, SE Asia)

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16
Q

what is the vector for malaria

A

female anopheles mosquito

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17
Q

what are the 5 species of malaria

A

potentially severe: plasmodium falciparum

“benign”: P. vivax, P. ovale, P. malariae, P. knowlesi

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18
Q

symptoms of malaria

A 
fever 
rigors
aching bones
abdo pain 
headache 
dysuria 
frequency 
sore throat 
cough
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19
Q

signs of malaria

A

majority show none at the beginning
splenomegaly
hepatomegaly
mild jaundice

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20
Q

complications of malaria

A 
cerebral malaria (encephalopathy)
blackwater fever 
pulmonary oedema 
jaundice 
severe anaemia 
algid malaria
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21
Q

cerebral malaria

A

non-immune visitors
children in endemic areas

hypoglycaemia
convulsions
hypoxia

potentially fatal

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22
Q

blackwater fever

A 
severe intravascular haemolysis 
high parasitaemia 
profound anaemia 
hemoglobinuria 
acute renal failure
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23
Q

what is algid malaria

A

development of gram -ve septicaemia in those w/ malaria

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24
Q

malaria diagnosis

A

thick and thin blood films - giemsa, field’s stain

quantitative buffy coat (QBC) - centrifugation, UV microscopy

rapid antigen tests - optiMal, ParaSight-F

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25
severity assessment
complicated malaria = one or more of: ``` impaired consciousness or seizures hypoglycaemia parasite count ≥2% haemoglobin ≤8mg/dL spontaneous bleeding/DIC haemoglobulinuria renal impairment or pH <7.3 pulmonary oedema or ARDS shock (algid malaria) - ? gram -ve bacteraemia ```
26
2 main drugs for malaria treatment
quinine | artemisinins
27
treatment options for uncomplicated P. falciparum malaria
riamet - 3 days eurartesim - 3 days malarone - 3 days quinine - 7 days plus oral doxycycline (or clindamycin)
28
side effects of quinine
``` nausea tinnitus deafness (cinchonism) rash hypoglycaemia ```
29
treatment options for complicated or severe P. falciparum malaria
IV artesunate IV quinine plus oral doxycycline (or clindamycin) switch to oral treatments when pt is stable and able to swallow
30
side effects of IV quinine
cardiac depression cerebral irritation N+V
31
treatment of P. vivax, P. ovale, P. malariae, P. knowlesi
chlorquine - 3 days riamet - 3 days add primaquine (14 days) in vivax and ovale to eradicate liver hypnozonites
32
malaria control programmes
mosquito breeding sites - drainage of standing water larvacides into the water - paris green, temphos, biological mosquito killing sprays - DDT, malathion, dieldrin human behaviour - bed nets, mesh windows
33
typhoid fever causative organisms
salmonella typhi | salmonella paratyphi
34
epidemiology of typhoid fever
global - 27mln infections p/a >200 000 deaths p/a UK - 500 cases p/a
35
how is typhoid fever spread
poor sanitation | unclean drinking water
36
clinical features of typhoid fever - week 1
``` fever headache abdo discomfort constipation dry cough relative bradycardia neutrophilia confusion ```
37
timeline for typhoid fever
incubation period - 7days-4wks | disease becomes apparent over next 4 wks
38
clinical features of typhoid fever - week 2
``` fever peaks at 7-10 days rose spots diarrhoea tachycardia neutropenia ```
39
clinical features of typhoid fever - week 3 (complications)
intestinal bleeding perforation peritonism metastatic infections
40
what % of typhoid fever pts relapse
10-15%
41
diagnosis of typhoid fever
not easy based on evolution of clinical features laborator: culture blood, urine and stool, sometimes culture bone marrow
42
treatment of typhoid fever
oral azithromycin - drug of choice for asian-acquired, uncomplicated enteric fever IV ceftriaxone - if complicated or concerned re absorption
43
dengue
viral infection commonest human arbovirus infection 100mln cases p/a 25 000 deaths p/a disease of the tropics
44
transmission of dengue
aedes aegypti mosquito
45
clinical presentation of dengue fever
``` sudden fever severe headache, retro-orbital pain severe myalgia and arthralgia macular/maculopapular rash haemorrhagic signs: petechiae, purpura, +ve tourniquet test ```
46
dengue diagnosis
clinical: thrombocytopenia, leucopenia, elevated transaminases, +ve tourniquet test lab: PCR, serology
47
dengue management
no specific therapeutic agents
48
complications of dengue
dengue haemorrhagic fever (DHF) dengue shock syndrome (DSS) rx: IV fluids, fresh frozen plasma, platelets
49
prevention of dengue
avoid bits | new vaccine - limited use
50
schistosomiasis transmission
fresh water freshwater snails parasitic infection
51
schistosomiasis causative organisms
S. haematobium S. mansoni S. japonicum
52
schistosomiasis clinical features
``` swimmers itch (1st few hrs, clears in 24-28hrs) invasive stage (after 24hrs) katayama fever (15-20 days) acute disease (6-8wks) chronic disease ```
53
schistosomiasis invasive stage
cough abo discomfort splenomegaly eosinophilia
54
schistosomiasis katayama fever
``` prostate fever urticaria lymphadenopathy splenomegaly diarrhoea eosinophilia ```
55
schistosomiasis acute disease
eggs deposited in bowel - dysentery | eggs deposited in bladder - haematuria
56
diagnosis of schistosomiasis
clinical diagnosis antibody tests ova in stools and urine rectal snip
57
treatment of schistosomiasis
praziquantel 20mg/kg 2 doses 6 hrs apart prednisolone if severe
58
rickettsiosis
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) others ```
59
commonest form of rickettsiosis imported to the UK
tick typhus | from southern africa, mediterranean, arabian gulf
60
clinical features of rickettsiosis
``` abrupt onset swinging fever headache confusion endovasculitis rash - macular, petechial bleeding ```
61
diagnosis of rickettsiosis
clinical features | serology
62
management of rickettsiosis
tetracycline
63
viral haemorrhagic fevers examples
ebola congo-crimea haemorrhagic fever lassa fever marburg disease serious infections but rare in UK
64
management of viral haemorrhagic fevers
maximum incubation period 3 wks rule out common severe infections isolation - high security infection unit supportive treatment
65
Zika
flavirus related to dengue, yellow fever, Jap B encephalitis, west nile viruses pacific outbreak 2013-14 latin america pandemic - 2015-16
66
how is zika virus transmitted
daytime biting Aedes mosquitoes sexual contact blood transfusion
67
clinical features of Zika
``` no or mild symptoms headache rash fever malaise conjunctivitis joint pains ``` like dengue
68
what can Zika infection in pregnancy result in
microcephaly | other neurological problems
69
what syndrome can Zika lead to
Guillain-Barre
70
management of Zika
no antiviral therapy mosquito control measures vaccines in development
71
most common cause of fever in a returning traveller
malaria
72
history for fever in a returning traveller
``` is it tropical travel hx precautions taken risks symptoms incubation periods ```
73
signs to look for in examination in fever in a returning traveller
rash - typhoid, typhus, dengue jaundice - hepatitis, malaria, yellow fever lymph nodes - leishmania, trypanosomiasis liver - malaria, typhoid, amoebic abscess spleen - visceral leishmaniasis, typhoid, malaria
74
investigations for fever in a returning traveller
``` FBC malaria films LFTs stool microscopy and culture urine analysis and culture blood cultures CXR specific tests as indicated ```
75
treatment for fever in a returning traveller
isolation (? PPE) supportive measures (resuscitation) empirical treatment if patient unwell (antimicrobial therapy based on likely diagnosis, aim to treat life threatening conditions e.g typhoid, septicaemia) specific treatment once diagnosis established

Y2 infection (15 decks)

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