Microbio -18- Traveler's health #2
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| Associated with flue like syndrome that may progress into pneumonia, respiratory failure and sometimes death. believed to have originated in the Guandgdon province in china | SARS
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| What type of virus is SARS | Coronavirus
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| How is SARS spread | spread by close person to person contact through droplets when an infected person sneezes or coughs
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| What are the clinical features of a SARS infection | begins 2-7 days after exposure w/
headache, fatigue, muscle ahces and pain, malaise, decreased appetite, diarrhea and respiratory symptoms of dry cough, SOB,
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| what can be visualized in most patients radiographically at 7-10 days who are infected with SARS | evidence of pneumonia on Chest X-ray
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| How can you DX SARS infection | confirm DX with PCR some ELISA tests are under production
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| What do you need for a positive SARS dx test finding | confirmed positive PCR test in 2 different clinical specimens or same clinical speciment collected 2 or more days in the course of the illness
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| What is the tx protocol for a patient with SARS | No specific tx is available but patient should be isolated and undergo aggresive tx at a hospital with mechanical ventilation and CCU care
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| what are the 4 lines of defense against SARS | contain, safeguard, isolate, screen
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| How is Dengue Fever spread | mosquito
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| What type of virus causes Dengue Fever and Dengue hemorrhagic fever | falvivirus
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| What is the difference betwee dengue fever and dengue hemorrhagic fever | they are antigenically distinct virus serotypes of flavivirus
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| Where is Dengue Fever endemic to | endemic to primarily tropical and sub tropical areas
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| What type of mosquito spreads dengue fever | Aedes mosquito
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| Fever in this disease may reach as high as 41c with chills, headache, retro-orbital pain, lumbar backache, extreme aching in the legs and joints, hypotension and relative bradycardia, Cervical, epitrochlear, and inguinal lymph nodes are usually enlarged | Dengue Fever
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| What is the layman term for dengue fever | breakbone fever
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| What dermatological sign may accompany infection with dengue fever | maculopapular or macular confluent rash over face, thorax, and flexor surfaces rahs begins on day 3 and lasts for 2-3 days
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| What is the more severe form of Dengue Fever and what are the additional clinical s/sx it presents with | Dengue Hemorrhagic fever which presents with small amounts of bleeding from the nose or gums to melena, menorrhagia, hematemesis, conjunctival injection, sore throat, cough
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| What often presages development of DHF | abdominal pain with change in mental status, hypothermia, and a drop in platelets
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| how is recovery from DF or DHF generally marked | generally is a complete recovery
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| how do you dx dengue fever | patient has traveled to or lives in an endemic area. Develops sudden fever, headache, myalgias, and adenopathy
need to rule out malaria and leptospirosis
PCR and serology can help
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| What may you see on a CBC with a patient who has DF or DHF | CBC may show leukopenia by 2nd day of fever
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| What is the tx for dengue fever | just symptomatic care because it is a virus
patient should be kept under mosquito nets to avoid transmission to mosquitos and spreading disease
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| Mosquito borne flavivirus related to St. Louis encephalitis virus found in africa, europe and asia but has now become endemic to the US | WNV west nile virus
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| What is the only domestic animal that has shown infection with WNV. So what is the reservoir for infection then | horse, generally wild birds and animals are the reservoir of infection for WNV with mosquitos acting as the vector of transmission into humans
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| How long do sx of WNV last | last 3-6 days
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| What are the general s/sx of WNV | fever, rash, headache, menegitis, encephalitis, coma and possibly death
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| What is the fatality rate of WNV | around 10%
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| What are the neurological presentations of WNV infection | ataxia, extrapyramidal signs, optic neuritis, cranial nerve abnormalities, and seizures
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| What is the most conclusive DX method for WNV infection | detecting WNV specific IgM antibody in the CSF using MAC-ELISA
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| What is the tx for WNV | supportive care, hospitalization, IV fluids, respiratory support, and prevention of secondary infections
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| What used to be a major endemic killer in the US until we cleaned up the water supply and now is a travelers disease caused by vibrio | Cholera
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| Gram Negative highly motile curved rods with a single polar flagellum that can cause diarrhea | Vibrio Cholera
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| How is Cholera Transmitted | fecal oral routes historically passed through contaminated water sources
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| Why don't you always get infected when exposed to cholera | cholera is sensitive to acid and most die in the stomach
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| How does cholera cause the problems it does | attaches to small bowel and secrete potent cholera enterotoxin which causes massive secretion of electrolytes and water into the intestinal lumen
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| S/sx of infection with this disease is classically described as RICE WATER STOOL | Cholera
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| What is the incubation period for Cholera, and how long does it last | incubates in 6-48 hours and lasts for 2-7 days
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| What is the major concern with infection from cholera | electrolyte loss and dehydration can lead to hypovolemic shock, metabolic acidosis, and uremia resulting from acute tubular necrosis
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| How do you dx cholera | stool culture and serotyping.
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| What is the standard tx for cholera | giving fluid replacement, oral glucose-electrolyte solution is effective at replacing stool loses and may be only solution available in endemic areas
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| If you catch Vibrio Cholera infection early and give oral antimicrobial what can you expect | reduces stool volume by 50% and stops diarrhea within 48 h. pay attention to what antimicrobial is effective based on V. Cholerae in the community
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| What can happen to some patients after they have stopped having s/sx of the disease | some patients may become chronic biliary tract carriers
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| How can you prevent cholera | proper disposal of human excrement, purify water supplies, Drinking water should be boiled chlorinated and vegetables and fish cooked thoroughly.
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| Is there a vaccing for Cholera | yes for 01 serogroup it is only effective for 4-6 mos.
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| most important trematode infection only trematode that invades through the skin all other invade via ingestion | Schistosomiasis
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| What is important in the water for shisto life cycle | fresh water snail that plays host
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| What is an imporatnt way to control shisto | kill the snail host
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| what is the most common way of getting shisto | wading in waters or swimming in lakes that are infested with the snails
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| what are the clinical s/sx of shisto infection | shistosome dermatitis- macular papular rash where the cercariease penetrate skin
Can also get vesicles where they penetrate "swimmers ithch"
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| What are the s/sx of acute Schistosomiasis | occurs with onset of egg laying
-fever
-chills
-nausea
-abdominal pain
-malaise
-myalgia
-urticarial rashes
-marked eosinophilia resembling serum sickness
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| What is chronic Schistosomiasis s/sx | result of host response to eggs retained in tissues
-bloody diarrhea
-fibrosis
-fistulas
-chronic cystitis
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| how would you dx Schistosomiasis | eggs are sought in stool
patient has traveled to endemic area
mucosa can be biopsied for eggs if clinical picture suggest Schistosomiasis but no eggs are found otherwise
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| What is the tx for Schistosomiasis | single day oral tx w/ praziquantel
evaluate patient at 3 and 6 mo after treatment to make sure no living eggs remain
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| what is the best practice in regards to Schistosomiasis | avoidance of contact with contaminated water is key
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| how is Lymphatic Filariasis spread | mosquito bites infected human then spreads it to unifected person
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| Where do adult Lymphatic Filariasis worms live | live in lymphatic vessels
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| What is the second leading cause of permanent long term disability in the world after leprosy | Lymphatic Filariasis
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| is Lymphatic Filariasis generally fatal | no, but can cause permanent disablility
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| What are the s/sx of Lymphatic Filariasis | fever
inguinal or axillary lymphadenotpathy
testicular and or iguinal pain
skin exfoliation
limb or genital swelling
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| what are acute manifestations of Lymphatic Filariasis referred to as | adenolymphangitis (ADL)
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| what can repeated episodes of inflammation and lymphedema lead to w/ adenolymphangitis (ADL | can lead to lymphatic damage, chronic swelling, and elephantiasis of legs arms, scrotum vulva and breasts
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| What is the best way to dx lymphatic filariasis | blood test especially since infection doesn't always result in clinical symptoms
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| When did you use to have to get blood samples to test for lymphatic filariasis | had to get blood between 10pm and 2am when microfiliria are most likely to be in peripheral blood stream "night blood films"
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| what is the key to tx lymphatic filariasis | first reduce levels of microfilaria so it can't be spread to other people by giving albendazole plus mectizan or albendazole plus DEC
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| Why is DEC not advised in africa for tx of lymphatic filariasis | can have complications if there are other co infections at time of tx like onchocerciasis
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| Since DEC is not advised for tx in africa of lymphatic filariasis what would you prescribe | mectizan
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| What is the tx for lymphoedema resulting from lymphatic filariasis infections | proper hygiene of infected limb
wash it twice daily with soap
raise affected limb at night
massage and exercise limb
wear comfortable shoes
this can reduce elephantiasis
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| humans get this infection like many other by drinking infected water larvae are released and then penetrate the bowel where the mature into adult worms. Live for about 1yr then move to surface of the skin and form a papule that vesiculates | . Guinea Worm (Dracunculiasis)
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| why don't natives of areas endemic to . Guinea Worm (Dracunculiasis) need serologic tests or other help to dx infection | they know the clinical presentation so well they know who is infected
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| what is tx protocol for . Guinea Worm (Dracunculiasis) | cleanse local lesion and apply antibiotics to prevent superinfection by bacteria
progressive extraxtion of worm over several days
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| what can be done to prevent . Guinea Worm (Dracunculiasis) infections | filter water through cheese cloth or boiling it can prevent infection
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