My Flash Cards

Front 1

What is ciguatera

Back 1

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.

Front 2

Gambierdiscus toxicus ingestion can cause

Back 2

Ciguatera

Front 3

Cure for Cigutera

Back 3

None
Symptoms usually go away in days or weeks but can last for years. People who have ciguatera can be treated for their symptoms.

Front 4

chikungunya virus what is it

Back 4

RNA virus that belongs to the family Togaviridae, genus Alphavirus.

Front 5

Chikungunya mode of trasmission

Back 5

osquito of the Aedes spp., predominantly Aedes aegypti and Ae. albopictus.

Front 6

Chikungunya the main reservoirs of the virus

Back 6

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.

Front 7

What is anthroponotic disease, or anthroponosis

Back 7

is an infectious disease in which a disease causing agent carried by humans is transferred to other animals.

Front 8

what is zoonotic.

Back 8

isease transmitted from animals to humans or humans to animals (reverse zoonosis)

Front 9

give and example of a disease that is both zoonotic and anthroponotic forms

Back 9

Leishmaniasis

Front 10

What is the infectious agent of Cholera

Back 10

acute bacterial, intestinal infection caused by toxigenic Vibrio cholerae

Front 11

Cholera mode of trasmission

Back 11

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.

Front 12

True or False
Transmission from person to person, like health care workers during epidemics, is common

Back 12

false

Front 13

CLINICAL PRESENTATION
Cholera

Back 13

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.

Front 14

DIAGNOSIS
Cholera

Back 14

confirmed through culture of a stool specimen or rectal swab.

Front 15

TREATMENT
Cholera

Back 15

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.

Front 16

PREVENTIVE MEASURES FOR TRAVELERS Cholera

Back 16

Safe food and water precautions and frequent handwashing are critical in preventing cholera
No cholera vaccine is available in the United States.

Front 17

Two oral vaccines are available outside the United States:

Back 17

Dukoral (Crucell, the Netherlands) and Shanchol (Shantha Biotechnics, India)/mORCVAX (Vabiotech, Vietnam).
*Shanchol and mORCVAX are similar vaccines produced by different manufacturers.

Front 18

INFECTIOUS AGENT
Hep A

Back 18

(HAV) is an RNA virus classified as a picornavirus (pee-corn-o-virus).

Front 19

MODE OF TRANSMISSION
hep A

Back 19

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.

Front 20

EPIDEMIOLOGY
Hep A

Back 20

Levels of endemicity are related to hygienic and sanitary conditions in the area

Front 21

What is one of themost common vaccine-preventable infections acquired during travel.

Back 21

Hep A

Front 22

CLINICAL PRESENTATION
Hep A

Back 22

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.

Front 23

DIAGNOSIS
hep A

Back 23

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.

Front 24

TREATMENT
Hep A

Back 24

No specific treatment is available for people with hepatitis A; therefore, treatment is supportive.

Front 25

PREVENTIVE
Hep A

Back 25

Monovalent Vaccines: Havrix/Vaqta
Combination Vaccine: Twinrix

Front 26

What is the best vaccine for someone who is traveling for international adoption

Back 26

Hep A

Front 27

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

Back 27

single dose of IG (0.02 mL/kg), which provides effective protection against HAV infection for up to 3 months

Front 28

Twinrix should not be administered to people with a history of hypersensitivity

Back 28

yeast

Front 29

None vaccine measure to prevent Hep A

Back 29

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

Front 30

What is Nipah virus (NiV)

Back 30

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,

Front 31

Sx, Prevention and Care Nipah Virus (NiV)

Back 31

range : asymptomatic infection to acute respiratory syndrome and fatal encephalitis.
There is no vaccine for either humans or animals.
intensive supportive care.

Front 32

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

Back 32

C. Yellow fever

Front 33

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

Back 33

C. a blood smear for malaria parasites

Front 34

what is the infectious agent for malaria

Back 34

1 of 4 protozoan species of the genus Plasmodium: Plasmodium falciparum, P. vivax, P. ovale, or P. malariae.

Front 35

Mode of transmission malaria

Back 35

female Anopheles mosquito.
Occasionally, transmission occurs by blood transfusion, organ transplantation, needle sharing, or congenitally from mother to fetus.

Front 36

how many malaria infections per year

Back 36

350–500 million infections

Front 37

malaria how many deaths annually

Back 37

1million

Front 38

what is the most deadly strain of malaria

Back 38

Plasmodium falciparum

Front 39

rank the regions with the most incidences of malaria

Back 39

(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).

Front 40

Travelers with the highest estimated relative risk for infection are those going to

Back 40

West Africa and Oceania

Front 41

what is the clinical presentation of malaria

Back 41

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.

Front 42

When can malaria Sx develop

Back 42

As early as 7 days (usually ≥14 days) after initial exposure and as late as several months or more after departure.

Front 43

any febrile illness post travel - you should suspect

Back 43

malaria

Front 44

what is the gold standard for diagnosis of malaria

Back 44

Smear microscopy

Front 45

what are RDTs

Back 45

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.

Front 46

PCR testing for malraia is mostly for

Back 46

determining the offending parasite.

Front 47

what part of the world would a traveler be most like mis diagnosed with malaria

Back 47

sub-Saharan Africa

Front 48

if a traveler is skeptical about their diagnosis what should they do

Back 48

follow the treatment offered locally (except the use of halofantrine, which is not recommended; see below) but not to stop their chemoprophylaxis regimen.

Front 49

name the treatment meds for malaria

Back 49

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)

Front 50

which drug will work on the dormant parasite liver forms (hypnozoites) and prevents relapses.

Back 50

primaquine

Front 51

Primaquine should not be taken by

Back 51

pregnant women or by people who are deficient in G6PD

Front 52

How to treat a patient with malaria depends on:

Back 52

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

Front 53

why is halofantrine not recommended for malaria treatment

Back 53

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

Front 54

when using the Atovaquone-proguanil (250mg/100mg) for treatment of malaria what is the dose for an adult

Back 54

4 adult tablets, orally as a single daily dose for 3 consecutive days NOT RECOMMEND IF YOU WERE USING IT FOR PROPHYLLAXIS

Front 55

What are the contraindications for using Atovaquone-proguanil for treatment of malaria

Back 55

severe renal impairment
NOT RECOMMEND IF YOU WERE USING IT FOR PROPHYLLAXIS
peds under 5kg
preggers and breastfeeding

Front 56

Artemether-lumefantrine
One tablet contains 20 mg artemether and 120 mg lumefantrine
What is the adult dose ?

Back 56

3-day treatment schedule with a total of 6 oral doses is

Front 57

What are the CIs for Artemether-lumefantrine

Back 57

mefloquine prophylaxis
peds under 5kg
preggers and breastfeeding

Front 58

how do you prevent malaria

Back 58

combination of mosquito avoidance measures and chemoprophylaxis.

Front 59

what group of people have the highest risk of getting malaria

Back 59

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

Front 60

where is mefloquine resistant

Back 60

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

Front 61

where is sulfadoxine-pyrimethamine resistant

Back 61

Amazon River Basin area of South America, much of Southeast Asia, other parts of Asia, and in large parts of Africa

Front 62

resistance of P. falciparum to chloroquine has been confirmed in all areas with P. falciparum malaria except

Back 62

Caribbean, Central America west of the Panama Canal, and some countries in the Middle East.

Front 63

what are the relapsing type of malaria

Back 63

P. vivax and P. ovale

Front 64

what causes the relapse malaria or the dormant type

Back 64

hypnozoites (dormant liver stages)

Front 65

which type of meds for malaria over seas are most likely to be counterfiet
TREATMENT OR PREVENTION

Back 65

prevention

Front 66

Atovaquone-Proguanil for prevention what is the useage

Back 66

2+daily+7

Front 67

most common adverse effects Atovaquone-Proguanil

Back 67

abdominal pain, nausea, vomiting, and headache

Front 68

CI for Atovaquone-Proguanil

Back 68

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

Front 69

Chloroquine and Hydroxychloroquine usage

Back 69

2 wks+weekly+4 weeks

Front 70

SE Chloroquine and Hydroxychloroquine

Back 70

gastrointestinal disturbance, headache, dizziness, blurred vision, insomnia, and pruritus,

Front 71

Chloroquine and related compounds have been reported to exacerbate

Back 71

psoriasis.

Front 72

igh doses of chloroquine, such as those used to treat rheumatoid arthritis, have been associated with

Back 72

retinopathy

Front 73

Doxycycline usage

Back 73

2day+daily+28days

Front 74

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

Back 74

true

Front 75

SE doxy

Back 75

photosensitivity,
vaginal yeast infections.
Gastrointestinal side effects

Front 76

use these forms of doxy to reduce the GI side effects

Back 76

doxycycline monohydrate or the enteric-coated doxycycline hyclate, rather than the generic doxycycline hyclate, which is often less expensive.

Front 77

CI doxy

Back 77

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.

Front 78

Mefloquine usage

Back 78

2wks+wkly+4wks

Front 79

Rare but serious SE mefloquine

Back 79

psychoses or seizures) at prophylactic doses; these reactions are more frequent with the higher doses used for treatment.

Front 80

Common SE Mefloquine

Back 80

gastrointestinal disturbance, headache, insomnia, abnormal dreams, visual disturbances, depression, anxiety disorder, and dizziness

Front 81

Mefloquine CI

Back 81

hypersensitivity to mefloquine (such as quinine or quinidine)
depression,
generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures.
cardiac conduction abnormalities.

Front 82

Any traveler receiving a prescription for mefloquine must also receive

Back 82

FDA medication guide,

Front 83

Primaquine uses

Back 83

2 distinct uses for malaria prevention: primary prophylaxis in areas with primarily P. vivax and presumptive antirelapse therapy (terminal prophylaxis).

Front 84

Primaquine for prophylaxis usage

Back 84

2day+daily+7day

Front 85

Primary prophylaxis with primaquine obviates the need for

Back 85

presumptive antirelapse therapy.

Front 86

Primaquine for antirelapse therapy

Back 86

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.

Front 87

most common adverse event primaquine

Back 87

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.

Front 88

Travel to Areas with Limited Malaria Transmission what is the recommendation

Back 88

mosquito avoidance measures only, and no chemoprophylaxis

Front 89

Travel to Areas with Mainly P. vivax Malaria recommendation

Back 89

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.

Front 90

Travel to Areas with Chloroquine-Sensitive Malaria recommendation

Back 90

mosquito avoidance measures,
chloroquine,
atovaquone-proguanil,
doxycycline, mefloquine,
and in some instances, primaquine for travelers who are not G6PD-deficient.

Front 91

Travel to Areas with Chloroquine-Resistant Malaria recommendation

Back 91

mosquito avoidance measures, chemoprophylaxis options are atovaquone-proguanil, doxycycline, and mefloquine.

Front 92

Travel to Areas with Mefloquine-Resistant Malaria recommendation

Back 92

mosquito avoidance measures, chemoprophylaxis options are either atovaquone-proguanil or doxycycline.

Front 93

meds for malaria for children what is availalbe

Back 93

Chloroquine and mefloquine = all ages and weights
Primaquine for areas of P. vivax
Doxy >8ys
Atovaquone-proguanil 5kg or more

Front 94

pregnant women - because no prophylaixs is 100% should be

Back 94

told to change plans

Front 95

pregnancy is not a contraindication for malaria prophylaxis with

Back 95

chloroquine phosphate or hydroxychloroquine sulfate
or mefloquine

Front 96

lactating women on malaria med will pass it to the baby - true or false

Back 96

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.

Front 97

which malaria med is not recommended for women lactating to babay weighing less than 5 kg

Back 97

atovaquone-proguanil prophylaxis

*Note it can be used for treatment where the benifit outweighs the risk P. falciparum

Front 98

if Mefloquine has to be stopped due to SE what can be started

Back 98

Doxy or atovaquone-proguanil

Front 99

if Doxy has to be stopped due to SE what can be started

Back 99

atovaquone-proguanil

Front 100

if Atovaquone-proguanil has to be stopped due to SE what can be started

Back 100

Doxycycline or Primaquine

Front 101

if Chloroquine has to be stopped due to SE what can be started

Back 101

Doxy or atovaquone-proguanil

Front 102

if Primaquine has to be stopped due to SE what can be started

Back 102

Doxy or atovaquone-proguanil

Front 103

Overdose of antimalarial drugs, particularly chloroquine, can be fatal.
true or false

Back 103

true

Front 104

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

Back 104

true

Front 105

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.

Back 105

true

Front 106

what is paragonimiasis and how do you get it

Back 106

food-borne parasitic infection caused by the lung fluke,

person eats raw or undercooked infected crab or crayfish.

Front 107

what is strongyloidiasis and how do you get it

Back 107

human parasitic disease caused by the nematode (roundworm)

soil-transmitted helminth

Front 108

soil-transmitted helminths

Back 108

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.

Front 109

filariasis

Back 109

bite of infected Aedes, Culex, Anopheles, and Mansonia mosquito species.

Front 110

Cavitary lung lesions are seen in
patients with tuberculosis and which
of the following infections?
(A) strongyloidiasis
(B) paragonimiasis
(C) ascariasis
(D) filariasis

Back 110

(B) paragonimiasis

Front 111

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.

Back 111

(A) They usually do not multiply in the host.

Front 112

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

Back 112

(A) leprosy

Front 113

The most frequently identified
pathogen in tropical pyomyositis is:
(A) a Gram-negative organism
(B) Staphylococcus aureus
(C) Streptococcus pyogenes
(D) the pneumococcus

Back 113

(B) Staphylococcus aureus

Front 114

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

Back 114

(A) intravenous artesunate