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Common travel diseases

Common travel diseases. Minus malaria and dengue. Guess that disease!. 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

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Common travel diseases

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  1. Common travel diseases Minus malaria and dengue

  2. Guess that disease!

  3. 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

  4. 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

  5. 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

  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 • 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

  8. 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

  9. 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

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