travel related infections

Question 1

what are public health measures to control infection ?

Answer 1

sanitation
immunisation
education

Question 2

what are examples of water-related infections ?

Answer 2

schistosomiasis 
leptospirosis 
liver flukes
strongyloidiasis 
hookworms 
guinea worms

Question 3

what are examples of arthropod-borne infections ?

Answer 3

malaria - malaria 
dengue fever - malaria
rickettsial infection - ticks
leishmaniasis - sand flies
trypanosomiasis - tsetse flies
filariasis - mosquitoes (elephantiasis)
onchocerciasis - black flies (river blindness)

Question 4

what malaria species is the potentially severe infective type ?

Answer 4

plasmodium falciparum

Question 5

what are symptoms of malaria ?

Answer 5

fever
rigor 
aching bones
abdo pain
headache
dysuria
frequency
sore throat
cough

Question 6

what are signs of malaria ?

Answer 6

splenomegaly
hepatomegaly
mild jaundice

Question 7

what are complications of malaria ?

Answer 7

cerebral malaria - convulsions, hypoxia
blackwater fever - intravascular haemolysis, profound anaemia, haemoglobinuria, acute renal failure 
pulmonary oedema
jaundice
severe anaemia
algid malaria - gram -ve septicaemia

Question 8

how do you diagnose malaria ?

Answer 8

thick and thin blood films - Giesma, Field’s stain
quantitative Buffy coat - UV microscopy
rapid antigen test

Question 9

what features would indicate a complicated malaria ?

Answer 9

impaired consciousness or seizures
hypoglycaemia
parasite count >2%
haemoglobin <8mg/dl
DIC
haemoglobinuria
renal impairment pH <7.3
pulmonary oedema
shock

Question 10

how do you treat uncomplicated malaria ?

Answer 10

quinine 7 days, plus oral doxycycline or clindamycin

riamet, euratesim, malarone

Question 11

how do treat complicated malaria ?

Answer 11

IV quinine plus oral doxycycline or clindamycin

Question 12

what are side effects of quinine ?

Answer 12

nausea 
tinnitus
deafness
rash
hypoglycaemia

IV - cardiac depression, cerebral irritation, nausea + vomiting

Question 13

what are some malaria control programmes ?

Answer 13

mosquito breeding site drainage
larvacides
mosquito killing spray DDT
human behaviour - mesh

Question 14

what is the causative organism of typhoid (enteric) fever ?

Answer 14

salmonella typhi

salmonella paratyphi

Question 15

what is the clinical progression of typhoid fever ?

Answer 15

incubation 1-4 weeks

1st week- fever, headache, abdo discomfort, constipation, bradycardia, neutrophilia, confusion
2nd week - fever peaks, rose spots, diarrhoea, tachycardia, neutropenia
3rd week - intestinal bleeding, perforation, peritonism, metastatic infection
week 4 recovery

Question 16

how do you diagnose typhoid fever ?

Answer 16

clinical

lab - culture urine and stool, marrow

Question 17

how do you treat typhoid fever ?

Answer 17

oral azithromycin

IV ceftriaxone - increasing resistance

Question 18

what is the commonest arbovirus worldwide ?

Answer 18

Dengue fever

Question 19

what is the classical presentation of dengue fever ?

Answer 19

sudden fever
severe headache, retro-orbital pain
severe myalgia, arthralgia
macular/macropapular rash
haemorrhagic signs - petechiae, purport, positive tourniquet test

Question 20

how do you diagnose dengue fever ?

Answer 20

clinical - thrombocytopenia, leucopenia, elevated transaminases, +ve tourniquet
lab - PCR, serology

Question 21

how do you manage dengue fever ?

Answer 21

no specific therapeutic agents
dengue haemorrhage fever and dengue shock syndrome - fluids, FFP, platelets
prevent bites and get vaccine

Question 22

what are the causative organisms of schistosomiasis ?

Answer 22

S. haematobium
S. mansoni
S. japonicium

Question 23

what are the stages and clinical features of schistosomiasis ?

Answer 23

swimmers itch 1st few hours - clears 24-48hrs
invasive stage >24 hours - cough, abdo discomfort, splenomegaly, eosinophilia
katakana fever 15-20 days - prostrate, fever, urticaria, lymphadenopathy, splenomegaly, diarrhoea, eosinophilia
acute disease 6-8 weeks - eggs in bowel and bladder, dysentery/heamaturia

Question 24

how is schistosomiasis diagnosed ?

Answer 24

clinical
antibody test
ova in stools and urine
rectal snip

Question 25

how do you treat schistosomiasis ?

Answer 25

praziquantel 20mg/kg, two doses 6 hours apart | prednisolone if severe

Question 26

what is rickettsiosis ?

Answer 26

tick typhus | R. conorii, R.africae

Question 27

what are clinical features of rickettsiosis ?

Answer 27

``` abrupt onset swinging fever headache confusion endovasculitis rash - macular, petechial bleeding ```

Question 28

what are examples of viral haemorrhage fevers ?

Answer 28

ebola congo-crimea haemorrhagic fever lassa fever Marburg disease maximum incubation is 3 weeks

Question 29

how do you manage viral haemorrhagic fevers ?

Answer 29

rule out common severe infection isolation supportive treatment

Question 30

what is Zika virus ?

Answer 30

flavivirus transmitted by mosquito, sexual contact, blood transfusion related to dengue, yellow, Jam B

Question 31

what are clinical features of Zika virus ?

Answer 31

``` no or mild symptoms headache rash fever malaise conjunctivitis joint pain Guillain-Barre syndrome ``` can cause microcephaly in pregnancy

Question 32

what diseases give you rash ?

Answer 32

typhoid typhus dengue

Question 33

what diseases give you jaundice ?

Answer 33

hepatitis malaria yellow fever

Question 34

what diseases affect the lymph nodes ?

Answer 34

leishmaniasis | trypanosomiasis

Question 35

what diseases affect the liver ?

Answer 35

malaria typhoid amoebic abscess

Question 36

what diseases affect the spleen ?

Answer 36

visceral leishmaniasis typhoid malaria