Flashcards in Travel medicine Deck (57)
Appearance of red cells in P falciparum and P vivax?
Falciparum: normal size cells, loads of ring forms, crescent shaped gametocytes
Vivax: large RBC, fewer infected, fine, eosinophilic dots
Thick film is to concentrate the parasites
Thin film is for species identification
In cerebral malaria, what are the LP and imaging findings?
Normal opening pressure
No evidence cerebral oedema on imaging usually
Lab findings in malaria?
If anaemia ALWAYS have thrombocytopaenia
What malaria prophylaxis in T2 and T2 pregnancy?
What should you use as malaria resistance when not sure about resistance patterns?
What do you have to give in P Vivax or P Ovale to prevent relapse?
Chloroquine should always be followed by course of Primaquine (check G6PD def first) to eradicate hypnozoites
A 14 day course can cause haemolytic anaemia
Dominant liver stages
Treatment for bad malaria?
What elements of supportive care?
IV Artesunate- assume chloroquine resistant P falciparum
Ensure no hypo
Transfuse if haematocrit drops below 20%
Treat seizures with benzos
When can take tabs should have full course of artemisinin combination
-artemether + lumefantrine
-atovaquone + proguanil
-quinine sulphate + doxy
If non life threatening antemether-lumefantrine ok
At what point in the life cycle does fever happen in malaria?
Schizont rupture (RBC)
P falciparum incubation period
So fever under 1 week after ariving in endemic area unlikely malaria
Vivax can come on weeks to months post return
What is the use of the immunochromatographic test in malaria? ICT
Rapid test not dependent on expertise for P falciparum and vivax
Good negative predictive value
Stays positive post treatment
What is the mutation that gives resistance to mefloquine and chloroquine?
SE asia there is lots of resistance to what malaria agent?
Mefloquine- so need to give doxy or atovaquone - proguanil
Contraindications to mefloquine use?
Cardiac conduction defects
How long do you have to continue agents after coming back (prophylaxis?)
AP: 1 day before 7 days post return
D:1 day before 4 weeks post
M: 2 weeks before travel 4 weeks post
Typhoid fever classic presentation
Fever, abdominal pain and CONSTIPATION
Rose spots on trunk
Febrile and brady in the returned traveller, think...
Complications of typhoid- what time frame and when are they?
3rd or 4th week
Bone and joint
Endocarditis and pericarditis
Splenic or liver abscess
Endovascular infection- especially old aneurysms, plaques, grafts
Diagnosis for Typhoid?
See leukopaenie and anaemia, low eosinophils, low plt
Mild CK rise
Treatment for typhoid?
NOT cipro- lots of resistance now
Azith if there is drug resistance
Dex if severe and neuropsych
take ages 5-7 days to stop fever
What is the risk of chronic typhoid carriage?
LIKE TYPHOID MARY!!!!
Higher frequency if biliary abnormality or concurrent bladder infection with Schistosoma
Incubation period of S Typhi?
Usually about 2 weeks, but can be longer weeks to a month or two
Classic dengue presentation?
MSK pain "breakbone fever"
Rash- macular rash with "islands of white"
WITHIN 14 DAYS of even brief trip to tropics or subtropics
Incubation 3-7 days
remember that defervesce for 1-2 days after the vomiting and diarrhoea and lymphadenopathy stage. Then get more fever, morbilliform rash, skin peels off, possible dengue shock. DONT SEND TOO EARLY HOME
How do you make a dengue diagnosis?
Often of exclusion, hard to do
Flavivirus PCR or ELISA to NS1 (whilst febrile)
High IgM with paired samples
Increase in IgG by 4 fold over 2 weeks if already present at diagnosis
See leukopaenia, thrombocytopaenia, neutropaenia
Hypoalbuminaemia and proteinuria
Arbovirus IgM specific
If plt under 100 or transaminases more than 3-5-->warning severe
What is the feared complication of dengue?
Dengue haemorrhagic fever
-haemorrhage spontaneously or with tournequet
-plt unde 100
-fever 2-7 days
-evidence of PLASMA LEAK based on pleural effusions and changes in haematocrit
What is the treatment for dengue
What are the range of presentations of entamoeba histolytica?
Asymptomatic infection to acute dysentery to toxic megacolon and perforation
Extraintestinal disease: liver, lung, brain abscess
Diagnosis of entamoeba histolytica?
3 fresh specimens stool for cysts and trophozoites
99% with liver abscess with have positive serology
Treatment for entamoeba histolytica?
paromomycin or diloxanide furoate (prevents continued luminal infection)
What is the management of acute hep A?
Give IMMUNE GLOBULIN
Vaccinate those at risk
Cruise ship gastro, think what?
What's the deal with campylobacter jejuni from Thailand?
Lots of cipro resistance
When do you need to give meningococcal prophylaxis?
Direct contact with respiratory secretions.
If sitting beside infected patient for longer than 8 hours.
What viral family is Ebola from?
There are 5 subspecies- the recent one was Zaire
Ebola incubation period
Present with fever, weakness, diarrhoea
Join onto cells via GP1 and 2
Ebola diagnostic test
Ebola PCR positive 1 day before symptoms
Fluid and electrolytes
Watch for bacterial superinfections
Single dose praziquantel
Itchy rash within a few days of swimming in fresh water
4-8 weeks post infection have acute self limiting febrile illness and marked eosinophilia
Months to years later can get diarrhoea, abdo pain, or haematuria or painful ejaculation as there is an inflammatory response in the bowel or bladder
Chronic infection can give you colitis, portal hypertension (most common cause of varices), chronic liver disease, SCC bladder, urolithiasis
Eosinophils up in half.
Serology is sensitive but takes months to go up
Urine micro from 10 am to 2pm
Semen analysis, stool micro, rectal biopsy
Ascariasis - what does it look like?
GROSS MASSIVE WORMS IN THE GUT!!!
Most common human helminthic infection.
Africa, SE asia
Worms gut-->portal vein-->lungs-->cough and swallow
Diagnosed on stool microscopy
Rabies: what is the clinical picture?
Fever headache malaise prodrome
Encephalitis with hydrophobia
Delirium and agitation
Ascending flaccid paralysis
How is Chikungunya spread?
Alphavirus- aedes aegypti mosquito that also spread dengue
What does Chikungunya look like clinically?
In someone back from India, Malaysia, Caribbean, indian ocean islands and after 1-14 days develop fevers, arthralgias, rash, myalgia
Pointer is often painful JOINTS ++++-->chronic arthritis in 5-60%
How do you diagnose Chikungunya?
When do you have higher risk of death with malaria?
Parasitaemia over 5%
Extremes of age
Delayed time to treatment
Giardia- what are the stools like?
Slimy not explosive
Treatment is metronidazole or tinidazole
Fever plus rash in the returned traveller?
Meningococcus, gonococcus, syphilis
HIV, EBV, CMV
Malaria less likely
Fever and lymphadenopathy?
Name two helminths
Name five protozoa
What do you think if severe malaria and haemodynamically compromised?
Suspect sepsis overlying
Malaria alone does not often do this
WHat does japanese enceph look like and how to diagnose?
Diagnose with CSF IgE- PCR useless
dystonic features, parkinsons movements
max number of times you can get dengue?
4- each time only temporary resistance against the other three strains but lifelong against the one you have had
Most specific deficit in early dengue in lab?
leukopaenia (not low plt)
LFTs in dengue?
Dengue inc period