Common travel diseasesMinus malaria and dengue

Guess that

disease!

Patient presents with abdominal pain and a fever.

Patient is a sheep farmer. O/E – hepatomegaly, jaundice. Remembering Murphy’s punch test

wrong, you decide to punch the liver. Why is this a horrendous idea?

Patient complains of fever. . As well as these little things. Diarrhoea – blood, mucus. Urination is now painful and is a strange

colour. Recently been swimming in malawi. Diagnosis – eggs in urine or faeces Mangement – praziquantel, molluscides

Patient comes in with an ulcer on his foot.

What else may they have? Splenomegaly, pancytopenia. Why?

Epidemiology Affects 3-5 million per year, 100,000-130,000 deaths,

mainly developing world Symptoms

Asymptomatic, severe diarrhoea with rice water stools (watery flecks of mucus), no blood, vomiting, abdominal cramping

Pathogenesis Attaches and colonises small intestine – releases a toxin

which leads to increased chloride secretion and decreased sodium absorption

Prevention Antibiotic prophylaxis, vaccine (only some strains)

Treatment Fluid management, antimicrobidal therapy, zinc

supplemenation Disease

Cholera

Epidemiology Africa, South America, Asia 16-33 mill per year, 216,000 deaths

Symptoms Encephalitic – hydrophobia, aerophobia, pharyndeal spasms, hyperactivity Paralytic – quadriparesis, sphincter involvement, cerebral involvement late Non-classical – neuropathic pain, motor/sensory deficits, choreiform

movements, cranial nerve palsies etc.. Pathogenesis

Virus deposited in wound, travels form the periphery to the dorsal root ganglia then to the brain.

Prefentially localise in the brain stem, thalamus, basal ganglia, spinal cord, then from neural pathways to other organs

Prevention Don’t get bitten, pre-exposure prohphylaxis, post-exposure prophylaxis

Treatment With one exception, no patient who has been exposed and has not been

vaccinated has survived. Incubation period ranges several days to a year

Disease Rabies

Epidemiology Equatorial Africa, northern parts of South America

Symptoms Subclinical Abortive, nonspecific febrile illness without jaundice Fever, jaundice, renal failure, hemorrhage

Pathogenesis Single stranded RNA virus, transferred via mosquito. Replication begins at site of innoculation spreads through lymphatics –

monocytes, macrophages preferred. Liver – Councilman bodies, apoptosis – midzone of liver Renal – eosinophilic degeneration, fatty change of renal tubular

epithelium without inflammation Late phase – circulatory shock – cytokine dysregulation Symptoms 3-6 days after bite

Prevention Vaccination (not < 9 months), don’t get bitten

Treatment No specific anti-viral. Symptomatic treatment.

Disease Yellow fever

Epidemiology Mexico, Nepal, Indian, Pakistan, South-East Asia,

Latin America, Middle East, Central Africa Symptoms

Abdominal cramps, frequent diarrhoea with loose, watery bowel motions, possible vomiting

Pathogenesis Shigella, campylobater, Ecoli, salmonella infection Usually mild, lasts 2 to 3 days. Rare for over 5 days.

Prevention If you can’t peel it, boil it or cook it don’t eat it.

Treatment Hydration, antimotility agents, antibiotic, hospital

Disease Traveller’s diarrhoea

Epidemiology Especially – Nepal, Mongolia, Vietnam, parts of

Africa and Asia Symptoms

Fever, neck stiffness, altered mental status, rash Pathogenesis

Sepsis – meininges is first, infected fluid then passes into the spinal cord causing the other systems

Prevention Antimicrobial prophylaxis,

Treatment Appropriate antibiotic, shock management,

glucocorticoids, sepsis treatment Disease

Meningococcal infection

Epidemiology Africa, South America, Asia 16-33 mill per year, 216,000 deaths

Symptoms Abdominal pain, fever, chills, constitutional symptoms,

hepatosplenomegaly Pathogenesis

Salmonella typhi (only human reservoir) In small intestines access submucoa via M-cell, or direct

penetration into the epithelial cel Proliferate – hyertrophy, immune response, later on necrosis. Able

to spread via blood and lymphatics Eventually resides in monocyte or tissue macrophages in liver,

spleen, bone marrow Prevention

Vaccine Treatment

Fluid management, antimicrobidal therapy Disease

Typhoid

Epidemiology Asia 50,000 cases per year

Symptoms Acute encephalitis (headache, fever, confusion ,drowsiness,

fatigue) Fever, diarrhoea, rigors, headahce, vomitng, weakness,

mental status changes, neurological defects Pathogenesis

Enzootic cycle, mosquitos, pigs, wading birds That is all I got…

Prevention Vaccine

Treatment Control ICP, maintenance of cerebral perfusion seizure

control, no good anti-viral agent Disease

Japanese B encephalitis