travel medicine

Terms in this set (44)

what vaccines should you get before any destination
hep a, hep b, typhoid
selected destination vaccines
yellow fever, meningocococcal, polio, japanese encephalitis virus, rabies
typhoid fever
salmonella typhi. causes febrile illness. spread via fecal oral transmission
whats more effective... bacterial or viral vaccines?
viral
what treatment is given for yellow fever?
no treatment
what is the most common cause of traveler's diarrhea?
enterotoxigenic e. coli
therapy for traveler's diarrhea
levofloxacin or cipro for 1-3 days
southeast asia, india, nepal anti travelers diarhea?
use azitrhomycin because so much quinolone reistances for 3 days
what parasites can you get through the skin
schistosomiasis, hookworm, strongyloides
when a traveler returns with a fever....
malaria until proven otherwise. if from malarious country. need to get a travel history
prophylaxis for malaria
atovaquone-proguainil, doxycycline, mefloquine.
in chloroquine sensitive areas can use chloroquinine
which prophylaxis malaria drug covers liver phase?
atovaquone-proguainil
what is most common disease in the carribean?
dengue most prevalent. same with south east asia.
sub-saharan africa travel.. most common disease?
malaria
dengue-rash
characteristic blanching rash. starts on day 5 after fever resolves.
also may have a sea of red with islands of normal skin
when are you more likely to developd engue hemorrhagic fever? dengue shcok syndrome?
more common with secondary dengue infections, or more common with dengue virus type 2
DHF
early on=no gross bleeding. positive tourniquet test suggests increased bleeding tendencey.
thrombocytopenia and petechiae
later - spontaenous bleeding form mucosal surfaces
DSS
leads to shock. due to inflammatory response, blood vessels get more permeable. leak plasma into the skin and cavities. leaking fluid? hemoglobin more concentrated. leads to acute respiratory distress syndrome - leaking in the lung, and get infiltrates in the lung. inflamamtion in the lung. need good icu unit
diagnosis of dengue
serum IgM - by day 6 should show up.

PCR for earlier than day 6. can detect the RNA. detectable when high levels of viremia occurs (virus in the blood).
treatment of dengue
nada. supportive care for DHF/DSS
gram stain of salmonella
gram negative bacilli
enteric fever
generic term for typhoid and parathyphoid fever
salmonella infects....
only humans. strict human pathogens. spread due to poor sanitation (fecal-oral).
highest incidence of salmonella
south central asia and southeast asia
pathogenesis enteric fever
eat salmonella and goes to small intestine, cross intestinal epithelial lining at Peyer's patches (lymphoid tissue in ileal mucosal). get engulfed by macrophages. macrophages travel to reticuloendothelial system --> spleen, liver, bone marrow.
replicate in peyer's patches, and slowly insidiously develop fever.
symptoms enteric fever
fever in most. insidious. get some abdominal pain, diarrhea, constipation, headache, anorexia, chills, myalgia.
not many physical findings.
relative bradycardia (relatively low heart rate with high fever... generally increase in temp correlates with an increase in heart rate) - not specific for typhoid.
rash not common - can get rose spots. during 2nd week.
coated tongue a possibility. big liver or spleen.
blood counts can be low because bacteria replicating in bone marrow.
diagnosis enteric fever
culture blood, bone marrow, and stool. bone marrow most sensitive.
chronic carrier state enteric fever
persistence of salmonella in stool for >1 year. can spread infection. carried in the gallbladder - gets infected during bacteremia. no symptoms otherwise.
most tick borne diseases are treated with
doxycycline
how is cikungunya fever transmitted
mosquito
how do you get leptospirosis
exposure to water contaminated with rat/animal urine main risk factor. have jaundice and also conjunctival suffusion (redness)
bats.... missouri... caves
histoplasma. common in midwest.
can also get from birds.
where are histoplasmosis usually found?
macrophages
acute histoplasmosis
acute pneumonia. fever, cough, self-limited
reactivation histoplasmosis
macrophages engulf these and go to different organs.
disseminated infection when growth of yeast no longer restricted in granuloma.
histoplasmosis treatment
amphotericin b
mississippi.... skin ulcers....
often blastomycosis.
found in mississippi, arkansas, kentucky, tennessee, wisconsin.
where is blastomycosis found
soil , decaying vegetation, decomposed wood. inhale mold form and converts to yeast form in lungs and get acute pneumonia.
acute blastomycosis
mimics community acquired bacterial pneumonia. does not respond to antibacterials.
treatment blastomycosis
amphotericin B or itraconazole
appearance of blasto
broad based buds.
dissemination of blasto
goes to the skin. can get warty looking lesions or ulcerative lesions.
southwest....
coccidioides
appearance of coccidioides
spherule forms in lungs - yeast form. inahled the mold in environment.
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