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82 Cards in this Set
- Front
- Back
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What four things does the travel medicine consultation consist of?
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1. assess fitness for travel
2. assess need for preventive measures 3. counsel about illness prevention 4. assessment and care of the returned travelor |
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What 7 things can cause travelers diarrhea?
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protozoan
helminths hep a cholera typhoid brucella TB |
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Catch phrase dr mclellan loves to say?
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boil it, cook it, peel it, or forget it
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Symptoms of typical travelers diarrhea?
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watery stools
cramp urgency self limited low grade fever nausea |
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90% of cases of travelers diarrhea present when?
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within the first 2 weeks of travel
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What is the likely etiology of travelers diarrhea?
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bacterial 85%
parasitic 5-15% viral <5% |
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Three main things for the prevention of travelers diarrhea?
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1. educate traveler to avoid risks
2. consider chemoprophylaxis in some situations - short trip with important itinerary - traveler at special risk 3. provide plan for self therapy - hydration (ORS) - symptom relief (loperimide) - antimicrobial |
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When do you give antibiotics when dealing with travelers diarrhea?
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When severe
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When rehydrating a patient with travelers diarrhea what should you take into consideration?
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avoid caffeine
a bit of sugar and salt (no gatorade) |
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What is the safest medication to use for symptom relief of travelers diarrhea?
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Imodium-loperimide
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Which antibiotics should be used in severe travelers diarrhea for adults or kids?
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adults: quinolones or azithromycin
kids: TMP/SMX |
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Which agents has shown Quinolone resistance to agents of travelers diarrhea?
Where is it found? What do you then treat it with? |
campylobacter jejuni
S. E. Asia and latin america azithromycin Salmonella resistance has been described, going up |
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Name three medications used as anti-secretory agents?
Why is this type beneficial? |
1. Racecadotril (hidrasec) enkephalinase inhibitor (available in Europe)
2. Zaldaride-inhibition of intestinal calmodulin 3. Provir--derivative of sap from Croton lechleri tree (available as non-regulated food supplement) Does not paralyze the bowel |
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Name a nonabsorbable antibiotic?
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Rifaximin- licensed to treat for ETEC
- may be better as a prophylactic and now licensed for that indication |
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Two examples of probiotics?
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Lactobacillus GG
Saccharomyces boulardii |
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What vaccine is out there for diarrheal?
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Dukoral vaccine - licensed in canada
-killed vaccine against cholera -85% effective against diarrhea due to ETEC- 3 months |
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5 diseases carried by insects that we talk about in this lecture?
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Malaria
Dengue Chikungunya fever Trypanosomiasis es Tanzania Rickettsial infections |
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What is the most common cause of infectious disease death?
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malaria
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Which people are more likely to get dengue fever vs dengue hemorrhagic fever?
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dengue fever: travelers
DHF: locals of endemic areas |
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What type of mosquito transmits dengue?
There is an increasing incidence where? |
aedes aegypti
daytime biter Asia and latin America |
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How does Chikunguna Fever present?
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nonspecific flu like
sever joint pain mistaken for dengue |
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Where is Chickungunya Fever found?
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Historically: Africa and Asia
Recent: Indian Ocean area (Comoros, Mauritius, Reunion and Seychelles Recent autochthonous transmission in Italy, Singapore |
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Where do people tend to get infected with East African Trypanosomiasis?
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game parks and safaris
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What is sentinel for epidemic activity in the area?
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tourist cases
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What four disease are caused by Rickettsial infections?
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Rocky mountain spotted fever
typhus (call types) tick typhus Q fever |
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Travelers usually get which type of typhus?
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tick typhus
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Which species of rickettsia is found in the Mediterranean?
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R. conori
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Which species of rickettsia is found in the Africa?
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R. africae
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Describe how the ticks act with rickettsial diseases?
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rapid fedders
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What type of exposure is needed for a ricketssial infection usually?
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walking through brush, cattle areas
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Which % if DEET should you wear?
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20-30%
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Concentration of DEET correlates with what?
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length of protections, not immediate efficacy
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What is an alternative to DEET?
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Picaridin
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What chemical can be used for clothes for insect protection?
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Permethrin
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What is the vector for Trypanosomiasis?
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Tsetse flies
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How does one protect themselves from the Tsetse fly?
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they are relatively resistant to DEET and permethrin
the fly prefers dark colors wear long slongs and long pants |
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What places in the world is P. vivax found?
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india, central america
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What places in the world is P. falciparum found?
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Africa, Haiti, New Guinea
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What places in the world are both P. vivax and P. falciparum present?
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SE. Asia
Oceania S. America |
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Name the 6 prophylaxis used for malaria
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1. Chloroquine
2. Mefloquine (Larium) 3. Doxycycline 4. Atovaquone/proguanil (Malarone) 5. Primaquine 6. Chloroquine/proquanil |
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Which prophylaxis are started 2 weeks pre travel?
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Chloroquine
Mefloquine (Larium) |
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Which prophylaxis do you continue taking 4 weeks post travel?
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Chloroquine
Mefloquine (Larium) Doxycycline |
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Which prophylaxis can you start 2 days pre travel?
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Doxycycline
Atovaquone/proguanil (Malarone) |
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Which prophylaxis is the most expensive?
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Atovaquone/proguanil (Malarone)
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Which prophylaxis is out there that is not very effective but still used by some?
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Chloroquine/proquanil
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Which prophylaxis is usefull for areas with chloroquine resistance AND for areas with mefloquine resistance (Thai-Myar-Myar-Laos Borders)
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Doxycycline and Atovaquone/proguanil (Malarone)
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Which prophylaxis's do you take weekly?
Which do you take daily? |
Weekly: Chloroquine
Mefloquine Daily: Doxycycline Atovoquone/proguanil (malarone) Primaquine |
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Which prophylaxis is most useful in areas with Cholorquine resistant P. falciparum?
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Mefloquine (Larium)
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Which two prophylaxis lower the seizure threshhold?
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Cholorquine
Mefloquine |
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Which two prophylaxis can be used in pregnancy?
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Chloroquine : all of pregnancy
Mefloquine: last 2 trimesters of pregnancy |
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If a patient has a history of significant psych problems, seizures, and arrythmias which prophylaxis should be avoided?
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Mefloquine
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Which prophylaxis causes side effects of photosensitivity, yeast infections, and esophageal ulcerations?
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Doxycycline
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Which prophylaxis is known as terminal for Plasmodia spp. with hypnozoite stage?
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Primaquine
True causal prophylaxis - all live stages |
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What do you need to test for if considering prescribing Primaquine?
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hemolysis for G6PD deficiency
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How would one take prophylaxis of Primaquine?
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Every day dose
Start 2 days pre travel and continue 1 week post travel |
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Name two self testing kits for malaria?
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Parasight F
ICT Malaria PF |
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When is self treatment of malaria ok?
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only in situations where medical care not immediately available (24 hours)
NOT a substitute for getting medical care |
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Which four medications are used for self treatment of malaria?
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Fansidar (pyrimethamine/sulfadoxine)
Malarone Mefloquine maybe Coartem (ACT) available overseas |
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List ten vaccine preventable diseases that are live vaccines?
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mealses
mumps rubella polio yellow fever typhoid varicella Tuberculosis (BCG) small pos nasal flu |
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Which vaccines should you update?
There are 4 primary ones... |
DPT, Td or Tdap, MMR, Varicella
Polio - OPV or IPV x 1 adult booster Pneumovax: asthma or anyone that smokes Influenza |
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Who are a contraindications with the Yellow Fever vaccine
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Pregnant people
infancy <6 months old--encephalitis People with thymus disorder Increase in side effects with age |
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What is the first most common vaccine preventable disease of travelers?
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Flu
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What is the second most common vaccine preventable disease of travelers?
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Hep A
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What type of protection does the Serum Immune globulin of Hep A provide you?
Who should this usually be given to along with the vaccine? |
For the immediate traveler (<4wk)
Short term protection (<6months) can be given with vaccine Immunocomprimised |
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What are the two Hepatitis A vaccines?
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Vaqta
Havrix |
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How young can you be to get the Hep A vaccine?
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>1 year old
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How is the dosing set up for Hep A vaccine?
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1st dose protect for 6 months
2nd dose protects maybe for lifetime |
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How is Hepatitis B transmitted?
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Sex, blood products, needles, health care providers
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The risk for Hepatitis B depends on?
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area and behavior
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What is the third most common vaccine preventable disease in travelers?
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Hep B
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What two types of Hep B vaccines are out there?
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Recombivax HB
Engerix B |
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What is the schedule for Hep B vaccine?
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3 does series
0, 1, 6 months accelerated schedules possible |
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Which Hepatitis B vaccine is approved for a 2 dose schedule?
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Recombivax
2 dose schedule for 11-15 year olds |
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What three Typhoid vaccines are out there?
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Capsular polysaccharide (Typhum Vi)
-- >2 years of age, single injections, 2-3 years protections Oral live attentuated (Vivotef Berna) --- >6 years of age, 5 years protection, less convenient, 4 capsules taken every other day Heat phenol inactivated vaccine (series of 2) --lots of side effects but cheaper, > 6 months age, 3 years protection |
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When is Typhoid vaccine recommended?
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for "adventurous eaters" and long term stays
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How long before a person travelers should they receive a Typhoid vaccine?
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2-4 weeks
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When does meningitis occur most in the "meningitis belt" in Africa?
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dry season (dec-june)
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Where in the world is it required to have a meningitis vaccine?
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Saudi Arabia for Hajj and Umla
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What two meningitis vaccines are available?
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Capsular polysaccharide (MPSV4- Menimmune)
---variable duration (3-5 yrs) ---poorly immunogenic <2 years old Conjugate (MCV4-Menactra) ---much longer durection ---licensed in US for 2-55 y/o ---used in Europe/Canada in >2months |
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What two vaccines are available for Japanese Encephalitis?
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Biken vaccine: inactivated
Series of 3: day 0, 7, 14-30 effective at 10 days High rate of side effects that can occur up to 10d or more after vaccine very expensive No longer in production! but still available for kids Japanese Encephalitis Virus vaccine IC 51: IXIARO new vaccine only approved for adults 2 doses 1 months apart better side effect profile |
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Risk of Japanese Encephalitis tends to be?
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seasonal
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How can you protect yourself from Japanese Encephalitis?
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insect protection
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