Lecture 9.1 - Travel related infections

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Questions and Answers

What percentage of protective efficacy is associated with the Vi-PS vaccine against Salmonella infections?

50%

90%

80%

70% (correct)

Which bacterium is commonly transmitted through unpasteurised dairy products?

Brucella species (correct)

Salmonella typhi

Escherichia coli

Clostridium difficile

What is the primary method of diagnosis for Brucella species infection?

Stool culture

PCR

Bone marrow aspirate

Blood culture (correct)

What is a common symptom of enteric fever caused by Salmonella?

Diarrhea or constipation Signup and view all the answers

What type of vaccine is Ty21a, used to prevent Salmonella infections?

Live attenuated oral vaccine Signup and view all the answers

Who is typically given antibiotics for Salmonella gastroenteritis?

Immunocompromised individuals Signup and view all the answers

Which of the following infections can remain dormant in the body for years after initial infection?

Malaria Signup and view all the answers

Which of the following is a characteristic finding of Viral Haemorrhagic Fever (VHF)?

Thrombocytopenia Signup and view all the answers

What is the primary mode of transmission of Hepatitis A?

Faecal-oral route Signup and view all the answers

Which of the following vaccines is available for a travel-related illness?

Hepatitis A Signup and view all the answers

What is the typical incubation period of Acute HIV infection?

2-4 weeks Signup and view all the answers

Which of the following is a symptom of Hepatitis A?

Feeling tired and generally unwell Signup and view all the answers

Which of the following STDs can be transmitted through sexual contact with an infected person?

HIV Signup and view all the answers

What is the primary mode of transmission of Malaria?

Mosquito bites Signup and view all the answers

Which of the following is a complication of Viral Haemorrhagic Fever (VHF)?

Bleeding disorder Signup and view all the answers

What is the typical incubation period of Malaria?

Variable, depending on the type of malaria Signup and view all the answers

What is the typical duration of incubation period for P. malariae?

18-40 days Signup and view all the answers

Which of the following is NOT a symptom of severe malaria?

Diarrhea Signup and view all the answers

What is the primary treatment for P. vivax, ovale, and malariae?

Chloroquine with primaquine Signup and view all the answers

Which of the following travel-related vaccinations is recommended for Africa, South America, Central America, and Trinidad in the Caribbean?

Yellow fever Signup and view all the answers

What is the purpose of primaquine in the treatment of P. vivax, ovale, and malariae?

To eliminate dormant hypnozoites in the liver Signup and view all the answers

Which of the following STDs is NOT typically associated with new sexual partners?

Rabies Signup and view all the answers

What is the primary investigation for diagnosing malaria?

Blood film x3 Signup and view all the answers

Which of the following is a complication of severe malaria?

Aseptic meningitis Signup and view all the answers

Study Notes

Country/countries visited, accommodations, and activities
Food and water consumption
Exposure to insects, arthropods, and animals

International travel increased by 50% over the past decade
Long-distance travel, especially to Asia and Africa, has increased
Travel frequency is increasing for people with comorbid conditions, business travelers, and those visiting friends and relatives
Travel-related health problems reported in 22-64% of travelers to developing countries
Most post-travel infections become apparent soon after travel, but incubation periods vary
The 3 most common presenting symptoms are fever, diarrhea, and rash

Travel Location and Duration of Stay

The longer the stay in a developing country, the greater the risk of travel-related illness
Short stays are considered < 2-3 weeks, while long stays are > 1 month
The destination may include or exclude certain illnesses that follow geographic patterns and seasons

Travel itinerary and duration of travel
Exposure history (accommodation, food, activities, sexual partners)
Timing of onset of illness in relation to international travel (incubation period)
Severity of illness
Past medical history and medications
History of pre-travel consultation

Source of Infection

Type of accommodations
Insect precautions taken (e.g., repellent, bed nets)
Source of drinking water
Ingestion of raw meat or seafood, unpasteurized dairy products
Insect or arthropod bites
Freshwater exposure (e.g., swimming, rafting)
Animal bites and scratches
Body fluid exposure (e.g., tattoos, sexual activity)
Medical care while overseas (e.g., injections, transfusions)

Precautions

Understand the danger of infection to others
PPE, isolation, and care when handling samples for laboratory tests
Take appropriate history, perform diagnostic tests, and provide supportive and specific treatment

Accommodation and Travel

Crowded living conditions, group travel, and exposure to ill persons
Risk of Meningococcal disease, Influenza, MERS-CoV, SARS-CoV, Tuberculosis, and Viral Haemorrhagic fever (VHF)

Exposure - Arthropods

Mosquitoes: Risk of Malaria, Dengue, Yellow fever, Japanese Encephalitis, West Nile virus, and Chikungunya

Incubation Period and Causes of GI Problems

East African trypanosomiasis: Incubation period > 21 days
Malaria: Incubation period > 21 days
Acute HIV: Incubation period > 21 days
Acute systemic Schistosomiasis (Katayama fever): Incubation period > 21 days

Characteristic Findings

Physical: Vital signs, skin findings, joint, respiratory, gastrointestinal, and neurological symptoms
Laboratory/Diagnostic investigations: Eosinophilia, leukopenia, thrombocytopenia, LFTs, identification of organism, identification of immune response, chest X-ray, and CT scan

Illnesses Associated with Fever Presenting in the First 2 Weeks After Travel

Systemic febrile illness: Malaria, Dengue, Typhoid fever, Rickettsial diseases, East African trypanosomiasis, Acute HIV infection, and Leptospirosis
Fever with central nervous system symptoms: Meningococcal meningitis, Malaria, Arboviral encephalitis, and East African trypanosomiasis
Fever with respiratory symptoms: Influenza, Bacterial pneumonia, Legionella pneumonia, Q fever, and MERS
Fever and skin rash: Dengue, Chikungunya, Zika, Measles, Varicella, and Spotted fever or typhus group rickettsiosis

Exposure - Food and Water

Hepatitis A: Spread by faecal-oral route, symptoms include fatigue, joint pain, fever, and rash
Enteric fever (Typhoid and Paratyphoid): Caused by Salmonella typhi and S. paratyphi
Bacterial gastroenteritis: Caused by E. coli, symptoms include diarrhea, stomach cramps, and fever

Yellow fever: Recommended for travel to Africa, South America, Central America, and Trinidad in the Caribbean
Hepatitis A: Recommended for travel to low-to-middle-income countries
Typhoid: Recommended for travel to Asia, Africa, Latin America, the Caribbean, and Oceania
Meningitis: Recommended for travel to Saudi Arabia (hajj)
Japanese encephalitis: Recommended for travel to South East Asia and Western Pacific
Rabies: Recommended for travel to Asia and Africa

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Test your knowledge on travel-related infections, their causes, and prevention measures. Learn about the factors to consider when traveling and how to stay safe from infectious diseases.