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1. Common travel diseases

   Minus malaria and dengue
2. Guess that disease!
3. 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?
4. 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
5. Patient comes in with an ulcer on his foot. What else may they have? Splenomegaly, pancytopenia. Why?
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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