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114 Cards in this Set
- Front
- Back
What is ciguatera
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a toxin sometimes found in large saltwater fish including grouper, red snapper, and sea bass.
eating fish that contain toxins produced by a marine microalgae called Gambierdiscus toxicus. |
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Gambierdiscus toxicus ingestion can cause
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Ciguatera
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Cure for Cigutera
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None
Symptoms usually go away in days or weeks but can last for years. People who have ciguatera can be treated for their symptoms. |
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chikungunya virus what is it
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RNA virus that belongs to the family Togaviridae, genus Alphavirus.
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Chikungunya mode of trasmission
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osquito of the Aedes spp., predominantly Aedes aegypti and Ae. albopictus.
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Chikungunya the main reservoirs of the virus
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Nonhuman and human primates are likely the main reservoirs of the virus with anthroponotic (human-to-vector-to-human) transmission occurring during outbreaks of the disease.
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What is anthroponotic disease, or anthroponosis
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is an infectious disease in which a disease causing agent carried by humans is transferred to other animals.
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what is zoonotic.
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isease transmitted from animals to humans or humans to animals (reverse zoonosis)
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give and example of a disease that is both zoonotic and anthroponotic forms
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Leishmaniasis
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What is the infectious agent of Cholera
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acute bacterial, intestinal infection caused by toxigenic Vibrio cholerae
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Cholera mode of trasmission
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bacterial organisms found in fresh and brackish water,
most commonly acquired from drinking water in which V. cholerae is found naturally or into which it has been introduced from the feces of an infected person. Other vehicles contaminated fish and shellfish, produce, or leftover cooked grains that have not been properly reheated. |
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True or False
Transmission from person to person, like health care workers during epidemics, is common |
false
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CLINICAL PRESENTATION
Cholera |
most often asymptomatic or results in a mild gastroenteritis.
evere cholera is characterized by acute, profuse watery diarrhea, described as “rice-water stools,” and often vomiting, leading to volume depletion. Signs and symptoms include tachycardia, loss of skin turgor, dry mucous membranes, hypotension, and thirst. Additional symptoms, including muscle cramps, are secondary to the resulting electrolyte imbalances. If untreated, volume depletion can rapidly lead to hypovolemic shock and death. |
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DIAGNOSIS
Cholera |
confirmed through culture of a stool specimen or rectal swab.
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TREATMENT
Cholera |
Rehydration is the cornerstone of therapy.
Antibiotics reduce fluid requirements and duration of illness. Antimicrobial therapy is indicated for severe cases, which can be treated with tetracycline, doxycycline, furazolidone, erythromycin, or ciprofloxacin. *When possible, antimicrobial susceptibility testing should inform treatment choices. |
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PREVENTIVE MEASURES FOR TRAVELERS Cholera
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Safe food and water precautions and frequent handwashing are critical in preventing cholera
No cholera vaccine is available in the United States. |
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Two oral vaccines are available outside the United States:
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Dukoral (Crucell, the Netherlands) and Shanchol (Shantha Biotechnics, India)/mORCVAX (Vabiotech, Vietnam).
*Shanchol and mORCVAX are similar vaccines produced by different manufacturers. |
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INFECTIOUS AGENT
Hep A |
(HAV) is an RNA virus classified as a picornavirus (pee-corn-o-virus).
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MODE OF TRANSMISSION
hep A |
direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested from sewage-contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling. HAV is shed in the feces of infected people.
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EPIDEMIOLOGY
Hep A |
Levels of endemicity are related to hygienic and sanitary conditions in the area
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What is one of themost common vaccine-preventable infections acquired during travel.
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Hep A
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CLINICAL PRESENTATION
Hep A |
incubation period averages 28 days
HAV infection may be asymptomatic,Sx range in severity from a mild illness lasting 1–2 weeks to a severely disabling disease lasting several months. Clinical manifestations :abrupt onset of fever, malaise, anorexia, nausea, and abdominal discomfort, followed within a few days by jaundice. The likelihood of having symptoms with HAV infection is related to the age of the infected person. In children aged <6 years, most (70%) infections are asymptomatic; if illness does occur, its duration is usually <2 months. Ten percent of infected people have prolonged or relapsing symptoms over a 6- to 9-month period. The overall case-fatality ratio is 0.3%; however, the ratio is 1.8% among adults aged >50 years. |
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DIAGNOSIS
hep A |
Demonstration of IgM anti-HAV in the serum of acutely or recently ill patients establishes the diagnosis. IgM anti-HAV becomes detectable 5–10 days after exposure. A 4-fold or larger rise in specific antibodies in paired sera, detected by commercially available EIA, also establishes the diagnosis. If laboratory tests are not available, epidemiologic evidence may provide support for the diagnosis in a clinically compatible case. HAV RNA can be detected in blood and stools of most people during the acute phase of infection through nucleic acid amplification methods, but these generally are not used for diagnostic purposes.
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TREATMENT
Hep A |
No specific treatment is available for people with hepatitis A; therefore, treatment is supportive.
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PREVENTIVE
Hep A |
Monovalent Vaccines: Havrix/Vaqta
Combination Vaccine: Twinrix |
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What is the best vaccine for someone who is traveling for international adoption
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Hep A
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Hep A Travelers who are aged <12 months, are allergic to a vaccine component, or who otherwise elect not to receive vaccine can receive what and how will it protect them
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single dose of IG (0.02 mL/kg), which provides effective protection against HAV infection for up to 3 months
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Twinrix should not be administered to people with a history of hypersensitivity
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yeast
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None vaccine measure to prevent Hep A
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Boiling or cooking food and beverage items for ≥1 minute to 185°F (85°C) inactivates HAV.
Adequate chlorination of water, as recommended in the United States, will inactivate HAV. Follow Food and Warter precatuions |
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What is Nipah virus (NiV)
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infection is a newly emerging zoonosis that causes severe disease in both animals and humans.
Natural host of the virus are fruit bats of the Pteropodidae Family, |
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Sx, Prevention and Care Nipah Virus (NiV)
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range : asymptomatic infection to acute respiratory syndrome and fatal encephalitis.
There is no vaccine for either humans or animals. intensive supportive care. |
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According to International Health Regulations, national governments must report which of the following diseases to the World Health Organization (WHO) for maintenance of an infected area list?
A. Meningococcal meningitis B. Ebola hemorrhagic fever C. Yellow fever D. Human immunodeficiency virus |
C. Yellow fever
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2. A 25-year-old male is admitted to the hospital for unexplained high fever and diarrhea over the last week. He returned 4 months ago from a 1-month trip to India. He states that he took mefloquine weekly as prescribed (without missing any doses) prior to his trip, during his trip, and for 4 weeks after he returned. The most appropriate first diagnostic step is
A. a stool examination for ova and parasites B. a blood culture to rule out typhoid fever C. a blood smear for malaria parasites D. an amoebic serology |
C. a blood smear for malaria parasites
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what is the infectious agent for malaria
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1 of 4 protozoan species of the genus Plasmodium: Plasmodium falciparum, P. vivax, P. ovale, or P. malariae.
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Mode of transmission malaria
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female Anopheles mosquito.
Occasionally, transmission occurs by blood transfusion, organ transplantation, needle sharing, or congenitally from mother to fetus. |
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how many malaria infections per year
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350–500 million infections
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malaria how many deaths annually
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1million
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what is the most deadly strain of malaria
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Plasmodium falciparum
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rank the regions with the most incidences of malaria
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(66%) sub-Saharan Africa,
(14%) in Asia, (12%) in the Caribbean and Central and South America, 220 (3%) in Oceania, (1%) in North America (all from Mexico). |
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Travelers with the highest estimated relative risk for infection are those going to
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West Africa and Oceania
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what is the clinical presentation of malaria
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fever / influenzalike , chills, headache, myalgias, and malaise; can occur at intervals.
anemia and jaundice. In severe disease, seizures, mental confusion, kidney failure, acute respiratory disease syndrome (ARDS), coma, and death may occur. |
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When can malaria Sx develop
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As early as 7 days (usually ≥14 days) after initial exposure and as late as several months or more after departure.
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any febrile illness post travel - you should suspect
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malaria
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what is the gold standard for diagnosis of malaria
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Smear microscopy
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what are RDTs
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rapid diagnostic tests to diagnose where microscopy is not available. In the US only for labs and hospitals because you still need smear microscopy to determine the parasitemia.
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PCR testing for malraia is mostly for
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determining the offending parasite.
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what part of the world would a traveler be most like mis diagnosed with malaria
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sub-Saharan Africa
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if a traveler is skeptical about their diagnosis what should they do
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follow the treatment offered locally (except the use of halofantrine, which is not recommended; see below) but not to stop their chemoprophylaxis regimen.
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name the treatment meds for malaria
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THESE ARE ACTIVE IN THE BLOOD
chloroquine atovaquone-proguanil (Malarone®) artemether-lumefantrine (Coartem®) mefloquine (Lariam®) quinine quinidine doxycycline (used in combination with quinine) clindamycin (used in combination with quinine) artesunate (not licensed for use in the United States, but available through the CDC malaria hotline) |
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which drug will work on the dormant parasite liver forms (hypnozoites) and prevents relapses.
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primaquine
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Primaquine should not be taken by
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pregnant women or by people who are deficient in G6PD
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How to treat a patient with malaria depends on:
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The type (species) of the infecting parasite
The area where the infection was acquired and its drug-resistance status The clinical status of the patient Any accompanying illness or condition Pregnancy Drug allergies, or other medications taken by the patient |
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why is halofantrine not recommended for malaria treatment
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cardiac adverse events, including deaths, which have been documented after treatment. These adverse events have occurred in people with and without preexisting cardiac problems and both in the presence and absence of other antimalarial drugs
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when using the Atovaquone-proguanil (250mg/100mg) for treatment of malaria what is the dose for an adult
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4 adult tablets, orally as a single daily dose for 3 consecutive days NOT RECOMMEND IF YOU WERE USING IT FOR PROPHYLLAXIS
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What are the contraindications for using Atovaquone-proguanil for treatment of malaria
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severe renal impairment
NOT RECOMMEND IF YOU WERE USING IT FOR PROPHYLLAXIS peds under 5kg preggers and breastfeeding |
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Artemether-lumefantrine
One tablet contains 20 mg artemether and 120 mg lumefantrine What is the adult dose ? |
3-day treatment schedule with a total of 6 oral doses is
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What are the CIs for Artemether-lumefantrine
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mefloquine prophylaxis
peds under 5kg preggers and breastfeeding |
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how do you prevent malaria
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combination of mosquito avoidance measures and chemoprophylaxis.
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what group of people have the highest risk of getting malaria
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VFR first- and second-generation immigrants living in nonendemic countries who return to their countries of origin to visit friends and relatives
*acquired immunity is lost quickly |
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where is mefloquine resistant
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Thailand with Burma (Myanmar) and Cambodia, in the western provinces of Cambodia, in the eastern states of Burma on the border between Burma and China, along the borders of Laos and Burma, the adjacent parts of the Thailand-Cambodia border, and in southern Vietnam
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where is sulfadoxine-pyrimethamine resistant
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Amazon River Basin area of South America, much of Southeast Asia, other parts of Asia, and in large parts of Africa
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resistance of P. falciparum to chloroquine has been confirmed in all areas with P. falciparum malaria except
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Caribbean, Central America west of the Panama Canal, and some countries in the Middle East.
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what are the relapsing type of malaria
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P. vivax and P. ovale
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what causes the relapse malaria or the dormant type
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hypnozoites (dormant liver stages)
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which type of meds for malaria over seas are most likely to be counterfiet
TREATMENT OR PREVENTION |
prevention
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Atovaquone-Proguanil for prevention what is the useage
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2+daily+7
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most common adverse effects Atovaquone-Proguanil
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abdominal pain, nausea, vomiting, and headache
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CI for Atovaquone-Proguanil
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children weighing <5 kg (11 lb),
pregnant women, severe renal impairment *There is a theoretical interaction between proguanil and warfarin that can increase the effect of warfarin |
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Chloroquine and Hydroxychloroquine usage
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2 wks+weekly+4 weeks
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SE Chloroquine and Hydroxychloroquine
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gastrointestinal disturbance, headache, dizziness, blurred vision, insomnia, and pruritus,
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Chloroquine and related compounds have been reported to exacerbate
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psoriasis.
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igh doses of chloroquine, such as those used to treat rheumatoid arthritis, have been associated with
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retinopathy
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Doxycycline usage
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2day+daily+28days
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People on a long-term regimen of minocycline who need malaria prophylaxis should stop taking minocycline 1–2 days before travel and start doxycycline instead.
TRUE OR FALSE |
true
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SE doxy
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photosensitivity,
vaginal yeast infections. Gastrointestinal side effects |
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use these forms of doxy to reduce the GI side effects
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doxycycline monohydrate or the enteric-coated doxycycline hyclate, rather than the generic doxycycline hyclate, which is often less expensive.
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CI doxy
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allergy to tetracyclines,
during pregnancy, aged <8 years. Vaccination with the oral typhoid vaccine Ty21a should be delayed for ≥24 hours after taking a dose of doxycycline. |
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Mefloquine usage
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2wks+wkly+4wks
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Rare but serious SE mefloquine
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psychoses or seizures) at prophylactic doses; these reactions are more frequent with the higher doses used for treatment.
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Common SE Mefloquine
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gastrointestinal disturbance, headache, insomnia, abnormal dreams, visual disturbances, depression, anxiety disorder, and dizziness
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Mefloquine CI
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hypersensitivity to mefloquine (such as quinine or quinidine)
depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures. cardiac conduction abnormalities. |
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Any traveler receiving a prescription for mefloquine must also receive
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FDA medication guide,
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Primaquine uses
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2 distinct uses for malaria prevention: primary prophylaxis in areas with primarily P. vivax and presumptive antirelapse therapy (terminal prophylaxis).
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Primaquine for prophylaxis usage
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2day+daily+7day
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Primary prophylaxis with primaquine obviates the need for
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presumptive antirelapse therapy.
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Primaquine for antirelapse therapy
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administered for 14 days after the traveler has left a malarious area. When chloroquine, doxycycline, or mefloquine is used for primary prophylaxis, primaquine is usually taken during the last 2 weeks of postexposure prophylaxis. When atovaquone-proguanil is used for prophylaxis, primaquine may be taken during the final 7 days of atovaquone-proguanil, and then for an additional 7 days. Primaquine should be given concurrently with the primary prophylaxis medication.
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most common adverse event primaquine
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people with normal glucose-6-phosphate dehydrogenase (G6PD) levels is gastrointestinal upset if primaquine is taken on an empty stomach. This problem is minimized or eliminated if primaquine is taken with food. In G6PD-deficient people, primaquine can cause hemolysis that can be fatal. Before primaquine is used, G6PD deficiency MUST be ruled out by appropriate laboratory testing.
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Travel to Areas with Limited Malaria Transmission what is the recommendation
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mosquito avoidance measures only, and no chemoprophylaxis
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Travel to Areas with Mainly P. vivax Malaria recommendation
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mosquito avoidance measures, primaquine is a good choice for primary prophylaxis for travelers who are not G6PD deficient. Its use for this indication is considered off-label in the United States.
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Travel to Areas with Chloroquine-Sensitive Malaria recommendation
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mosquito avoidance measures,
chloroquine, atovaquone-proguanil, doxycycline, mefloquine, and in some instances, primaquine for travelers who are not G6PD-deficient. |
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Travel to Areas with Chloroquine-Resistant Malaria recommendation
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mosquito avoidance measures, chemoprophylaxis options are atovaquone-proguanil, doxycycline, and mefloquine.
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Travel to Areas with Mefloquine-Resistant Malaria recommendation
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mosquito avoidance measures, chemoprophylaxis options are either atovaquone-proguanil or doxycycline.
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meds for malaria for children what is availalbe
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Chloroquine and mefloquine = all ages and weights
Primaquine for areas of P. vivax Doxy >8ys Atovaquone-proguanil 5kg or more |
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pregnant women - because no prophylaixs is 100% should be
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told to change plans
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pregnancy is not a contraindication for malaria prophylaxis with
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chloroquine phosphate or hydroxychloroquine sulfate
or mefloquine |
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lactating women on malaria med will pass it to the baby - true or false
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true BUT in such small amount it will not give the baby any protection.
IF using primiquine mother and infant should be tested for G6PD deficiency before primaquine is given to a woman who is breastfeeding. |
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which malaria med is not recommended for women lactating to babay weighing less than 5 kg
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atovaquone-proguanil prophylaxis
*Note it can be used for treatment where the benifit outweighs the risk P. falciparum |
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if Mefloquine has to be stopped due to SE what can be started
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Doxy or atovaquone-proguanil
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if Doxy has to be stopped due to SE what can be started
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atovaquone-proguanil
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if Atovaquone-proguanil has to be stopped due to SE what can be started
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Doxycycline or Primaquine
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if Chloroquine has to be stopped due to SE what can be started
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Doxy or atovaquone-proguanil
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if Primaquine has to be stopped due to SE what can be started
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Doxy or atovaquone-proguanil
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Overdose of antimalarial drugs, particularly chloroquine, can be fatal.
true or false |
true
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Chemoprophylaxis can be started earlier if there are particular concerns about tolerating one of the medications. For example, mefloquine can be started 3–4 weeks in advance to allow potential adverse events to occur before travel.
true or false |
true
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In comparison with drugs with short half-lives, which are taken daily, drugs with longer halflives, which are taken weekly, offer the advantage of a wider margin of error if the traveler is late with a dose. For example, if a traveler is 1–2 days late with a weekly drug, prophylactic blood levels can remain adequate; if the traveler is 1–2 days late with a daily drug, protective blood levels are less likely to be maintained.
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true
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what is paragonimiasis and how do you get it
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food-borne parasitic infection caused by the lung fluke,
person eats raw or undercooked infected crab or crayfish. |
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what is strongyloidiasis and how do you get it
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human parasitic disease caused by the nematode (roundworm)
soil-transmitted helminth |
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soil-transmitted helminths
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hookworm, and whipworm are known as soil-transmitted helminths (parasitic worms).
hands or fingers that have contaminated dirt on them are put in the mouth or by consuming vegetables or fruits that have not been carefully cooked, washed or peeled. |
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filariasis
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bite of infected Aedes, Culex, Anopheles, and Mansonia mosquito species.
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Cavitary lung lesions are seen in
patients with tuberculosis and which of the following infections? (A) strongyloidiasis (B) paragonimiasis (C) ascariasis (D) filariasis |
(B) paragonimiasis
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Which of the following is characteristic of
helminths that infect human beings? (A) They usually do not multiply in the host. (B) They rarely provoke an eosinophilia. (C) They cause severe disease after infection with only a few parasites. (D) They typically cause lifelong infections. |
(A) They usually do not multiply in the host.
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Orbicularis oculi paresis with
lagophthalmos and an insensitive cornea frequently leads to blindness in patients with: (A) leprosy (B) vitamin A deficiency (C) diabetes (D) trachoma |
(A) leprosy
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The most frequently identified
pathogen in tropical pyomyositis is: (A) a Gram-negative organism (B) Staphylococcus aureus (C) Streptococcus pyogenes (D) the pneumococcus |
(B) Staphylococcus aureus
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A 40-year-old patient returns from a trip
to Thailand with a four-day history of fever and a one-day history of hallucinations and bloody diarrhea. The temperature is 39°C; the rest of the physical examination is normal. A thick blood film reveals that 6% of erythrocytes are parasitized with Plasmodium falciparum. Appropriate initial management includes; (A) intravenous artesunate (B) oral mefloquine (C) oral chloroquine and pyrimethaminesulfadoxine (D) oral quinine and doxycycline |
(A) intravenous artesunate
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