Tropical Infections

Question 1

what should you look for upon examination of a returned traveller with fever?

Answer 1

rash 
hepato/splenomegaly 
lymphadenopathy 
insect bites 
wounds

Question 2

what should be done to control infection if a returned traveller presents with fever?

Answer 2

they should be isolated until the clinical picture is clear

Question 3

what is acute traveller’s diarrhoea defined as?

Answer 3

three loose stools in 24 hours

Question 4

what is the most common cause of acute traveller’s diarrhoea?

Answer 4

E.Coli

Question 5

what viruses should be considered in travelers returning from cruise ships?

Answer 5

norovirus

rotavirus

Question 6

what causes amoebic diarrhoes?

Answer 6

entamoeba histolytica

Question 7

what is dysentery and what may cause it?

Answer 7

bloody diarrhoea

E.Coli, amoebic colitis

Question 8

what is perfuse watery diarrhoea caused by?

Answer 8

cholera

Question 9

what investigations should be done if someone has acute traveller’s diarrhoea?

Answer 9

stool culture

stool wet prep

Question 10

what can be given to prevent worsening of acute travellers diarrhoea in someone who is still travelling?

Answer 10

a single dose of a fluoroquinolone

Question 11

what are the two types of enteric fever?

Answer 11

typhoid fever

paratyphoid fever

Question 12

who is most commonly affected by typhoid fever?

Answer 12

patients returning from india and south east asia

Question 13

what is the incubation period for enteric fever?

Answer 13

7-18 days

Question 14

name some symptoms of enteric fever

Answer 14

fever
headache
altered bowel movements
dry cough

Question 15

name some possible complications of enteric fever

Answer 15

GI bleeding
GI perforation
encephalopathy
bone infection

Question 16

what organisms cause enteric fever?

Answer 16

salmonella typhi

salmonella paratyphi

Question 17

what is the empirical treatment of enteric fever and when is this given?

Answer 17

IV ceftriaxone

when a patient is unstable with severe sepsis

Question 18

name three antibiotics that may be used to treat enteric fever

Answer 18

ciprofloxacin
azithromycin
ceftriaxone

Question 19

what are the three types of jaundice?

Answer 19

pre-hepatic (haemolytic)
hepatic
post-hepatic

Question 20

name two causes of pre hepatic jaundice

Answer 20

malaria

HUS

Question 21

name two causes of hepatic jaundice

Answer 21

enteric fever

hep A and E

Question 22

name two causes of post-hepatic jaundice

Answer 22

ascending cholangitis

helminths

Question 23

what investigations are done if a patient presents with fever and jaundice?

Answer 23

tests for malaria 
blood cultures 
FBC etc. 
USS abdomen 
serology for viruses

Question 24

what causes amoebiasis?

Answer 24

entamoeba histolytica

Question 25

how is amoebiasis spread?

Answer 25

via faeco-oral route

Question 26

how can an asymptomatic carrier of amoebiasis spread it?

Answer 26

cysts are chronically shed in stools spread is associated with poor hygiene

Question 27

what is another name for amoebiasis?

Answer 27

amoebic dysentery

Question 28

name some symptoms of amoebic dysentery

Answer 28

abdominal pain fever bloody diarrhoea abdominal tenderness

Question 29

what investigations are done if amoebic dysentery is suspected?

Answer 29

stool microscopy AXR (look for toxic megacolon) endoscopy + biopsy

Question 30

what organism causes amoebic liver abscesses?

Answer 30

entamoeba histolytica

Question 31

what is the incubation period for entamoeba histolytica to cause liver abscesses?

Answer 31

8-20 weeks

Question 32

are amoebic liver abscesses more common in men or women?

Answer 32

men

Question 33

describe the presentation of amoebic liver abscesses

Answer 33

subacute, over 2-4 weeks

Question 34

name some symptoms of amoebic liver abscesses

Answer 34

``` fever upper abdo pain dysentery hepatomegaly point tenderness over lower right ribs ```

Question 35

what investigations would be done if a patient has suspected amoebic liver abscess?

Answer 35

LFT's CXR (raised R hemi diaphragm) USS/CT serology

Question 36

what antibiotics are used to treat amoebic liver abscesses?

Answer 36

metronidazole | tinidazole

Question 37

what needs to be cleared from the gut lumen before treatment of amoebic liver abscess, and how is this done?

Answer 37

parasites paromomycin or diloxanide

Question 38

what causes giardiasis?

Answer 38

giardia intestinalis a protozoa

Question 39

where does giardiasis affect?

Answer 39

the duodenum and proximal jejunum

Question 40

how is giardiasis spread?

Answer 40

faeco-oral route most commonly in contaminated water

Question 41

name some symptoms of giardiasis

Answer 41

diarrhoea bloating abdominal cramps weight loss

Question 42

what investigations would be done if a patient has suspected giardiasis?

Answer 42

stool microscopy | OGD for biopsy (rare)

Question 43

how is giardiasis treated?

Answer 43

metronidazole | tinidazole

Question 44

what is helminth infection often associated with?

Answer 44

eosinophilia

Question 45

what is often used to diagnose helminth infection?

Answer 45

worm/eggs passed in stool

Question 46

name the three main types of helminths

Answer 46

nematodes trematodes cestodes

Question 47

what causes chagas disease?

Answer 47

trypanosoma cruzi, transmitted by the kissing bug

Question 48

what does chagas disease cause?

Answer 48

parasympathetic denervation of the colon and/or oesophagus