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55 Cards in this Set
- Front
- Back
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Who are the 4 groups of people who seek travel medicine?
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Travelers to and from developing regions
Immigrants Rwefugees Military |
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What are the key parts of a travel medicine consult?
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Assess fitness for travel
Assess need for preventative measures Counsel about prevention Assess/care for returned traveller |
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List 5 things that are risk factors in traveller's illness?
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Food and water safety
Malaria Insect protection Peronal safety Vaccine preventable dz |
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When do 90% of traveller's diarrhea cases present?
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First 2 weeks of travel
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What are the etiologies of traveller's diarrhea, with percentages?
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Bacterial 85%
Parasitic 5-15% Viral <5% |
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What percentage of people travelling to developing world will get diarrhea?
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30-70% on a 2 week trip will get diarrhea
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What causes "food poisoning"
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Staph
Clostridium perfringens B. cereus (?) ETEC (caused by toxin mediated) |
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What causes longer duration diarrhea in travellers?
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ETEC
Campylobacter jejuni Salmonella Vibro |
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What causes prolonged diarrhea in travellers?
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Salmonella
Giardia Amoebae Cyclospora Cryptosporidia Tropical Sprue |
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What common traveller's diarrhea is becoming resistant to cipro?
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Campylobacter jejuni
(due to antibiotics in animal feed) |
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How to prevent traveler's diarrhea? (3 things)
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Educate traveler to avoid risks
Consider chemoprophylaxis Provide plan for self therapy (ORS, symptom relief, antimicrobial) |
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What antibiotics recommended for self-treating diarrhea?
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Quinolones/zpack for adults
Zithromax/Bactrim for kids |
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Where is quinolone resistant campylobacter seen in the world?
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SE Asia, Latin america
(use zithromax) |
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Name 3 antisecretory agents for diarrhea
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Racecadotril (Hidrasec)
Zaldaride Provir/SB-NSF/sp-303 (food supplement) |
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How does hidrasec work?
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Enkephaliase inhibitor (antisecretory agent) -- works to shut off the pump started by toxins in secretory diarrhea
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How does zaldaride work?
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Inhibits intestinal calmodulin
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What is rifaximin?
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A non-absorbable antibiotic, works best in small intiestine so doesn't kill flora in large intestine
Licensed as prophylactic abx |
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What is the dukoral vaccine?
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Cholera vaccine licensed in Canada
Also 85 percent effective vs. ETEC x 3 months |
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Name insect-born diseases travellers can get
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Yellow fever
Dengue Japanese encephalitis Filariasis Sleeping sickness typhyus Malaria Chikungunya fever Trypanosomiasis Rickettsial infections Others... |
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What percent of the world is at risk for getting malaria?
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40%
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How many people die yearly from malaria?
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2 million
(1 million children) |
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What does dengue cause?
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First infection -- dengue fever (breakbone fever)
Second infection -- risk dengue hemorrhagic fever |
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How is dengue spread?
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Mosquito (early afternoon biting type)
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Where can you catch dengue?
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Asia, latin america
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What is chikungunya fever?
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Similar to dengue
Found in Africa, Asia, Indian Ocean (recently...affecting french) Autochthonous transmission in italy, singapore |
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Sx of chikungunya fever?
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Nonspecific flu like
Mistaken for dengue Severe, persistent joint pains |
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Where can you catch trypanosomiasis?
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East African type found in tanzania, game parks/safari
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Name some rickettsial infections
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Rocky mountain spotted fever
Typhus Tick typhus Q fever |
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How to catch rickettsial disease in africa?
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Walk through brush, cattle areas
Cow ticks are rapid feeders, short exposure causes infection |
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How much DEET do you need?
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20-30% gives 3-4 hours protection
>50% little extra benefit Give no more than 30% in kids % tells you how long it will last |
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Name an alternative to DEET?
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Picaridin
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What anti insect chemical can you spray on your clothing?
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Permethrin
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What bugs are resistant to DEET and permethrin?
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Tsetse flies, which spread trypanosomiasis
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How to avoid tsetse flies?
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DEET/permetrin don't work
Avoid dark colors Long sleeves, long pants |
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Where can you get Plasmodium vivax?
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India, central america, SE Asia, S. America, Oceania
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Where can you get Plasmodia falciparum
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Africa, Haiti, New Guinea, SE Asia, S. America, Oceania
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What is the number 1 cause of ID death in africa?
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Plasmodium falciparum
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How to take Chloroquine?
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2 weeks pre-travel, 4 weeks post (takes 2 months to achieve steady state)
DOES NOT TREAT HYPNOZOITES - LATENT LIVER STAGE |
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What are the forms of chloroquine for malaria?
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Chloroqine phosphate (300mg base/500mg salt) q week
Hydroxychloroquine sulfate = plaquenil (310mg base/400mg salt) q week |
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What are the side effects of chloroquine?
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H/A, dizziness, confusion, nausea, tinnitus
In Blacks, pruritis, worsens psoriasis Lower's seizure threshold |
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What antimalarials lowers the seizure threshold?
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Chloroquine
Mefloquine |
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What is larium?
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Mefloquine
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What is mefloquine good for?
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Areas with chloroquine resistant plasmodium falciparum
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Dosing for mefloquine?
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250mg q week
2 weeks pre travel/4 weeks post |
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What are side effects of mefloquine?
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Anxiety, depression, lower's seizure threshold
Prolongs QT |
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Are beta blockers a contraindication to mefloquine?
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No
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What antimalarial prolongs the QT interval?
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Mefloquine
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Is chloroquine ok in pregnancy?
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Yes
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Is mefloquine safe in pregnancy?
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For last 2 trimesters (prob ok for first also)
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Can you give mefloquine to kids?
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Yes, >5kg
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When is doxy helpful in malaria?
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Effective for chloroquine and mefloquine resistant malaria (Thai, Myarmyar, Laos borders)
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How do you dose doxy for malaria?
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100mg QD, 2d pre travel, then 4 weeks post
Short half life -- missed doses are bad |
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Side effects of doxy?
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Photosensitivity (1-2%, independent of skin tone)
Yeast infections Esophageal ulcerations Nausea |
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Can you give doxy in pregnancy?
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No, and not to kids < 8
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What is malarone?
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Atovaquone/proguanil
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