Travelling Flashcards
(24 cards)
What organism causes malaria?
Plasmodium: Falciparum: Common Vivax: Benign tertian malaria Ovale: Malariae: Rare, benign quartan malaria
How does malaria cause infection?
1st anopheles mosquito infects person
Plasmodium travels to liver
Gets into blood causing haemolysis, RBC sequestration and cytokine release
2nd mosquito sucks blood and acts as another vector to infect more
What are the risk factors for malaria?
African/SE asian countries Pregnancy Elderly Travellers Foreign aid workers
What are protective factors for malaria?
G6PD deficiency
Sickle-cell trait
What are the Sx of malaria?
Fever paroxysms PHASE 1: Shivering PHASE 2: ↑↑Fever, flushing, dry skin, N&V, headache PHASE 3: Cold sweats Hepatosplenomegaly Abdo pain Jaundice Myalgia
How is malaria investigated?
Blood Films x3: SERIAL thick & thin films stained w/Giemsa
-ve >2films over 48hours to exclude
Schizonts = Falciparum
Bloods: FBC (↓Hb, ↓Plt), Clotting, ↓Glucose, U+E (AKI - ↓Na, ↑Urea ↑↑Creat), deranged LFTs Cultures
ABG: Lactic acidosis
Urinalysis: ↑Protein casts, Blood
How is non-falciparum malaria managed?
1) PO Chloroquine
2) PO Quinine
3) Primaquine
What is given as prophylaxis for malaria in travellers?
Chloroquine +/- Proguanil
What are the complications of malaria?
Drug resistance
Complicated Falciparum infection
DIC
Blackwater fever
How does complicated Falciparum infection present?
Prodrome: Headache, malaise/myalgia, anorexia Fever Dyspnoea, ARDS Jaundice, AKI, Nephrotic syndrome 5 worrying signs: -↓GCS -Convulsions -Co-existing chronic illness -Acidosis -Renal failure (ATN)
How is complicated Falciparum infection treated?
ICU
IV Artesunate
What is blackwater fever?
Severe form of malaria resulting in massive intravascular haemolysis = haemoglobinuria (dark urine)
What are the Sx of E.Coli GE?
Travellers
Watery stools
Abdominal cramps
Nausea
What are the Sx of Giardiasis GE?
Prolonged diarrhoea (NO blood) Abdo pain
What are the Sx of Cholera?
Profuse, watery diarrhoea
Severe dehydration = ↓weight
What are the Sx of Shigella GE?
Bloody diarrhoea
Vomiting
Abdo pain
What are the Sx of Amoebiasis?
Gradual onset bloody diarrhoea
Abdo pain & tenderness
Lasts for several weeks
What are the Sx of campylobacter GE?
Flu-like prodrome
Crampy abdo pain
Fever
Diarrhoea (may be bloody)
What causes Typhoid and what are the Sx?
Salmonella Typhi FEVER Arthralgia Headache Constipation Abdo pain Macpap rose spots on trunk
How is GE investigated?
Stool MC&S
Bloods: FBC, U&E, Culture
When is stool MC&S indicated?
Blood/mucous in stools Foreign travel Septicaemia ImmunoC Diarrhoea not improved in 7d Diagnosis uncertain
How is GE treated?
ORS: 50ml/kg over 4hours + maintenance fluids
Cholera: Tetracycline
Salmon/Shigella: Cipro
Campylo: Clarithromycin
How is pyrexia of unknown origin defined?
Fever >38.3 for >3weeks with no identifiable cause after 3days of hospital admission/tests
What are the common causes of pyrexia of unknown origin?
Infection
Malignancy
CT disorder
