Tropical infections of GI tract Flashcards
(47 cards)
describe the history you would want to acquire in a returned traveller with a fever?
1) where have they been?
- rural/urban
- accommodation situation
2) when did they go & when did they get back?
3) what did they do when they went away?
- swimming, animal contact, walking in bushes, sex, work
4) when did they start becoming unwell?
5) did they have any insect bites - tick bites?
6) what are their symptoms?
+ is anyone else unwell?
7) vaccines, malaria prophylaxis, bite protection, condoms
what 5 things do you need to think about when someone presents with a fever who is a returned traveller?
- resp tract infections
= pneumonia/influenza - travellers’ diarrhoea
- malaria
- enteric fever
- arboviruses
= dengue, Chikungunya, zika
what would you do with somebody who presents with a fever who is a returned traveler?
= infection control
- isolate all returns travellers until clinical picture is clear
+ use PPE
what is acute traveller’s diarrhoea?
= 3 loos stools in 24hours
+ fever
what typically causes acute traveller’s diarrhoea?
= enterotoxigenic E. coli
But also;
= campylobacter, salmonella, shigella
what 2 viruses are common on cruise ships?
- norovirus
- rotavirus
what are possible causes of bloody diarrhoea (dysentry) and profuse watery diarrhoea?
Bloody diarrhoea
= E. coli 0157 + amoebic colitis
Profuse watery diarrhoea
= cholera
= toxin mediated disease often associated with outbreaks (refugee camps)
how would you investigate acute traveller’s diarrhoea?
1) stool culture
2) stool wet prep on recently passed stool for amoebic trophozoites
how would you treat someone with acute traveller’s diarrhoea?
- supportive
= fluid dehydration - bloody diarrhoea with systemic upset may warrant treatment
- in those travelling a FLUOROQUINOLONE (ciprofloxacin) single dose can stop worsening)
what are 2 types of enteric fever?
1) typhoid
2) paratyphoid
who is most likely to acquire an enteric fever?
= in those returning from Indian sub-continent and SE Asia (often those visiting family or friends)
describe the incubation period for enteric fever?
7-18days
what are symptoms of enteric fever?
- fever
- non-specific
= headache
= constipation or diarrhoea
= dry cough
- complications = GI bleeding = GI perforation = encephalopathy = bone and joint infection
what is enteric fever most commonly caused by?
= salmonella typhi or paratyphi
describe how you would deal with salmonella typhi or paratyphi?
- treat empirically if patient is unstable withIV ceftriaxone
- fever clearance time
= ciprofloxacin <4days
= azithromycin 4.4days
= ceftriaxone 6.2 days
what precautions should be taken in people with enteric fever?
Precautions
- water
- food
- hand hygiene
Vaccinations
- incomplete protection against s. typhi no protection against S. paratyphi
hospital
= isolate patients immediately if diagnosis is considered
what are 3 types of fever and jaundice?
1) pre-hepatic (haemolytic)
2) hepatic
3) post-hepatic
what could be the cause of pre-heptic fever & jaundice?
- malaria
- HUS as complication of diarrhoea illness = E. coli 0157, shigella
- sickle cell crisis triggered by infection
what could be some causes of hepatic causes of fever and jaundice?
- Hepatitis A and E – acute (occasionally Hepatitis B)
- Leptospirosis – Weils diseases (Icteric, haemorrhagic and renal failure)
- Malaria
- Enteric fever
- Rickettsia (scrub typhus, Rocky Mountain spotted fever etc)
- Viral haemorrhagic fever
what could be the cause of post-hepatic fever and jaundice?
- associated cholangitis and helminths
how would you investigate anyone with fever & jaundice?
- Malaria blood film and rapid antigen
- Blood film for red cell fragmentation
- FBC/UE/LFT/coagulation
- Blood cultures
- USS abdomen
- Serological testing for viruses
how would you manage anyone with fever & jaundice?
- isolation & infection control
- Supportive – may need dialysis if acute kidney injury
- If acute liver failure – hepatology/transplant unit
- Directed to pathogen isolated
- Discussion with infectious diseases
what is a common cause of amoebiasis?
= entamoeba histolytica, a protozoa
how is entamoeba histolytica, a cause of amoebiasis spread?
= faecal-oral spread, strong association with poor sanitation
