1. Tropical Health Update FLT LT LAURA HODSON

2. Acknowledgement Sqn Ldr Matt Adam Infectious Diseases Registrar

3. Scope Causes of Disease: Protozoa Viruses Bacteria Worms Prevention

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

5. Malaria Transmitted by bite of female Anopheles mosquito Four Species: P. Falciparum P. Vivax P. Ovale P. Malariae Incubation is 10-15 days Symptoms: Fever Flu-like symptoms Treatment: Antipyretics Analgesia Antimalarial Chemotherapy

6. 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

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

8. 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

9. 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)

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

11. 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 40-42 degree heat so radiofrequency or heat pads improve healing Infiltration of sodium stibogluconate or meglumine antimoniate into lesion is most common treatment

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

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

14. 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

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

16. Bacteria Faecal oral Spirochetes Rickettsias

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

18. Typhoid Transmission via contaminated food/water Incubation period 10-20 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

19. Bacteria - Spirochetes Leptospirosis Borrelia

20. Lyme disease

21. Worms/Helminths NematodeCestodeTrematode

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

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

24. 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

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

26. Any Questions?