Travel Related Infections

Question 1

What pathogens are transported by vectors

Answer 1

Rickettsia/spirochaete (bacteria)

Protozoa and helminth (parasites)

Question 2

Why is travel history important

Answer 2

Recognise imported diseases

Check for different strains of pathogen - greater chance of MDR bacteria abroad

Infection prevention

Question 3

What is a sign of a multicellular organism infection

Answer 3

Eosinophilia

Question 4

What are some possible ways for patients to be infected while abroad

Answer 4

Food/water

Insect/tick bite

Swimming

Sexual contact

Animal contact

Recreational activities

Question 5

What infection might you get from an animal bite

Answer 5

Rabies

Question 6

What infection might you get from rodents

Answer 6

Leptospirosis

Question 7

What infections might you get from a mosquito/insect bite

Answer 7

Malaria

Dengue

Question 8

What infection might you get from a tick bite

Answer 8

Rickettsia

Question 9

What infection might you get from dead/slaughtered animals

Answer 9

Anthrax

Ebola

Question 10

What infection might you get from farms

Answer 10

Q-fever

Question 11

What infection might you get from game parks

Answer 11

Rickettsia

Question 12

What infection might you get from fresh water

Answer 12

Schistosomiasis

Leptospirosis

Question 13

What infection might you get from caves

Answer 13

Histoplasmosis

Question 14

What infection might you get from unpasteurised dairy

Answer 14

Brucellosis

Question 15

What infection might you get from eating under/uncooked fish/meat

Answer 15

Salmonella

Question 16

Name some species which cause malaria

Answer 16

Plasmodium flaciparum

Plasmodium vivax

Plasmodium ovale

Plasmodium malariae

Plasmodium knowlesii

Question 17

What is the vector which carries malaria

Answer 17

Female anopheles mosquito

Question 18

What are the symptoms of malaria

Answer 18

Headache

Fever

Muscle pain and fatigue

Back pain

Chills and sweating

Dry cough

Splenomegaly

Nausea

Vomiting

Question 19

What investigations are done to test for malaria

Answer 19

3 Blood films

FBC

Urea and electrolyte

LFTs

Glucose

Coagulation

Head CT if neurological symptoms

CXR

Question 20

How do you treat malaria caused by P. falciparum

Answer 20

Artesunate

Question 21

How do you treat malaria caused by P. vivax, ovale or malariae

Answer 21

Choloroquine

Question 22

What do you give to kill any malarial parasites lying dormant in the liver

Answer 22

Primaquine

Question 23

What is the mechanism of infection of typhoid/parathyphoid fever

Answer 23

Faecal-oral from contaminated food/water

Question 24

What type of fever are typhoid and paratyphoid fever

Answer 24

Enteric fever

Question 25

What some of the causative organisms of enteric fever

Answer 25

Salmonella typhi Salmonella paratyphi A, B and C

Question 26

What type of bacteria are salmonella typhi and paratyphi

Answer 26

Enterobacteriaceae - aerobic Gram-negative bacillus

Question 27

What is the incubation period of malaria

Answer 27

Minimum 6 days P. falciparum - by 4 weeks F. vivax/ovale - up to 1 year+

Question 28

What is the incubation period of enteric fever

Answer 28

7 - 14 days

Question 29

What are the signs and symptoms of enteric fever

Answer 29

Fever Headache Abdominal discomfort Dry cough Relative bradycardia Paratyphoid - generally milder

Question 30

What are the complications of enteric fever

Answer 30

Intestinal haemorrhage Perforation and seeding Mortality if left untreated - 10%

Question 31

What investigations are performed to test for enteric fever

Answer 31

FBC - moderate anaemia and lymphopaenia in enteric fever LFTs - raised transaminase and bilirubin Blood (+ve in 40-80%) and faeces culture

Question 32

What is the treatment for enteric fever

Answer 32

Uncomplicated - azithromycin (PO) Complicated - IV ceftriaxone

Question 33

What other infections can salmonella cause and what are the symptoms

Answer 33

Non-typhoidal salmonella infections - 'food poisoning' Symptoms - diarrhoea, fever, vomiting, abdominal pain

Question 34

What are some potential causes of fever and rash

Answer 34

Measles, rubella, parvovirus (childhood viruses) Infectious mononucleosis (EBC/CMV) Acute HIV infection Rickettsia - spotted fever

Question 35

How is dengue tested for

Answer 35

Dengue PCR Dengue serology (IgM)

Question 36

Describe some feature of dengue fever

Answer 36

Commonest arbovirus 4 serotypes Common in sub and tropical regions 1st infection ranges from asymptomatic to non-specific febrile illness - supportive treatment only Re-infection with different serotype is harmful/deadly

Question 37

What are the possible consequences of re-infection with the same or different serotype of dengue

Answer 37

Consequence is antibody dependent enhancement causing: Dengue haemorrhagic fever Dengue shock syndrome

Question 38

What is the term for infection with a fly larvae

Answer 38

Myiasis

Question 39

Give some examples of fly larvae that can cause myiasis

Answer 39

Tumbu/mango fly Bot fly

Question 40

Name a type of viral haemorrhagic fever

Answer 40

Ebola

Question 41

What type of virus causes ebola and what are the symptoms

Answer 41

Filovirus Flu-like symptoms with vomiting, diarrhoea, headaches, confusion, rash, and internal/external bleeding at 5-7 days

Question 42

Name an arbovirus

Answer 42

Zika virus Dengue virus

Question 43

What tests and investigations should be performed on a patient with a suspected travel related infection

Answer 43

Malaria film x3 Blood culture x2 (prior to antibiotics) FBC U&E/LFT CXR Serology/PCR based on Hx/symptoms

Question 44

Name some features of severe malaria

Answer 44

Tachycardia Hypotension Arrhythmias Acute respiratory distress syndrome Diarrhoea Derranged LFTs Acute kidney injury High bilirubin Confusion and fits Cerebral malaria Thrombocytopenia DIC Metabolic acidosis Hypoglycaemia Secondary infection