2. Common travel diseases Minus malaria and dengue

3. Guess that disease!

4.  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

5.  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

6.  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

7.  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

8.  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

9.  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

10.  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