Tropical Health Update FLT LT LAURA HODSON

Acknowledgement Sqn Ldr Matt Adam Infectious Diseases Registrar

Scope Causes of Disease: Protozoa Viruses Bacteria Worms Prevention

Protozoa Single celled ‘complex’ organisms Malaria Amoebic Dysentery African Trypanosomiasis Leishmaniasis Giardiasis Toxoplasmosis Trichomoniasis

Malaria Transmitted by bite of female Anopheles mosquito Four Species: P. Falciparum P. Vivax P. Ovale P. Malariae Incubation is days Symptoms: Fever Flu-like symptoms Treatment: Antipyretics Analgesia Antimalarial Chemotherapy

Amoebic Dysentery Third leading parasitic cause of death Occurs via the faeco-oral route Symptoms: Only 10% are symptomatic Bloody diarrhoea Abdominal pain Treatment: Metronidazole 800mg TDS for 5/7 Diloxanide furoate 500mg TDS for 10/7

African trypanosomiasis – Sleeping sickness Caused by Trypanosoma brucei: T.b. gambiense – Central & West Africa T.b. rhodesiense – East Africa Transmitted by the bite of tsetse flies T.b. gambiense is a chronic disease T.b. rhodesiense is an acute disease

African trypanosomiasis Symptoms Non specific symptoms – fever, myalgia, malaise CNS – headaches, forgetfulness, psychosis, seizures Painful chancre (T.b. rhodesiense) Rash (T.b. rhodesiense) Multiorgan failure Meningoencephalitis within 1-3 months

African trypanosomiasis Treatment (T.b. gambiense) Early - Pentamidine 4mg/kg IM od for 7/7 Late - Eflornithine 100mg/kg IV q6h for 14/7 Treatment (T.b. rhodesiense) Early - Suramin 5mg/kg IV (1), 20mg/kg (3,10,17,24,31) Late - Melarsoprol 3.6mg/kg TDS x3 (7-10/7 between cycles)

Leishmaniasis Transmitted by nocturnal bite of female sandfly Two types: Visceral leishmaniasis Cutaneous leishmaniasis

Cutaneous Leishmaniasis Clinical Features: Nodule develops at bite site Grows and crusts over Develops into painless ulcer Heals over months/years Tissue paper scar remains Leishmania are killed at degree heat so radiofrequency or heat pads improve healing Infiltration of sodium stibogluconate or meglumine antimoniate into lesion is most common treatment

Viruses Ebola Lassa Yellow Fever Dengue Zika virus Chikungunya HIV Hepatitis A, B, C, D, E Rabies Polio

Dengue fever Transmitted by day biting Aedes mosquitoes Begins 5-8 days after bite Usually lasts 4-7 days Symptomatic management only

Zika Virus Related to dengue Transmitted by day biting Aedes mosquitoes Symptoms mild and self limiting: Fever Conjuntivitis Joint pain Headache Rash Myalgia Usually lasts 2-7 days Symptomatic management only Linked to birth defects

Ebola Viral Haemorrhagic Fever Spread by contact with body fluids Incubation 2-21 days Management: Isolation PPE Supportive care

Bacteria Faecal oral Spirochetes Rickettsias

Bacteria – faecal oral  Salmonella  Food poisoning vs Typhoid/paratyphoid  Shigella  Cholera  E coli  Campylobacter  Staphylococcus  Listeria  Brucella

Typhoid Transmission via contaminated food/water Incubation period days Early antibiotic treatment decreases mortality Untreated illness lasts 4 weeks: Week 1- Malaise, headache, fever Week 2 – Toxic, apathetic, rose spots, distended abdomen Week 3 – Delirium, weak pulse, diarrhoea, neuro complications Week 4 – Start to improve

Bacteria - Spirochetes Leptospirosis Borrelia

Lyme disease

Worms/Helminths NematodeCestodeTrematode

Nematodes Examples are: Whipworm Pinworm Hookworm Threadworm Roundworm Treatment Albendazole 400mg

Cestodes (tapeworms) Acquired by eating raw or undercooked meat Symptoms: Often asymptomatic Abdominal pain/distention Nausea Visible worms in stool Treatment Praziquantel 10mg/kg

Trematodes (Flukes) Schistosomiasis (bilharzia) is second only to malaria Transmission occurs when exposed to parasitic worms found in fresh water infested with snail hosts Symptoms: Swimmers itch Fatigue Fever Abdominal pain Diarrhoea Treatment Praziquantel 40mg/kg

Look after yourself Preparation: Sexual Heath Education & Training Vaccination Mental Health Acclimatisation Security During: Bite prevention Chemoprophylaxis Hygiene Sun protection Hydration

Any Questions?