student electives 2008
Download
Skip this Video
Download Presentation
Student Electives 2008

Loading in 2 Seconds...

play fullscreen
1 / 53

Student Electives 2008 - PowerPoint PPT Presentation


  • 111 Views
  • Uploaded on

Student Electives 2008. Dr Alisdair MacConnachie Consultant in Infectious Diseases Brownlee Centre. Plan. Bite avoidance Malaria Dengue fever HIV and use of PEP Water exposure and Bilharzia Rabies risk and vaccination. Bite Avoidance. Aedes. Anopheline. Physical Avoidance. Indoors

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Student Electives 2008' - glen


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
student electives 2008

Student Electives 2008

Dr Alisdair MacConnachie

Consultant in Infectious Diseases

Brownlee Centre

slide2
Plan
  • Bite avoidance
  • Malaria
  • Dengue fever
  • HIV and use of PEP
  • Water exposure and Bilharzia
  • Rabies risk and vaccination
bite avoidance
Bite Avoidance

Aedes

Anopheline

physical avoidance
Physical Avoidance
  • Indoors
      • AC; screens
  • Impregnated netting
      • Permethrin
      • “tucked in”
      • “mosquito free”
  • Clothing
      • Cover up (arms, legs, ankles, feet)
      • Spray/soak clothing
slide6
DEET

-

-

30% re apply every 3-4 Hrs

-

malaria
Malaria
  • 27-48% hospitalised returning travellers1
  • Most common cause fever in travellers from sub saharan Africa
  • 10% Geosentinal no report of fever
      • GI
      • Respiratory
      • Headaches
  • Diagnosis initially missed up to 59% cases2
      • Rx 7.6 days after admission
  • Doherty et al QJM 1995;88:277-81, O’Brien et al CID 2001;33:603-9, Antimori et al J Trav Med 2004;11:135-42
  • Kain et al CID 1998;27:142-9
slide10
INCUBATION

P.falciparum 7-14 dy

P.vivax 12-17dy

P.ovale 15-18dy

P.malaria 18-40dy (>1yr)

DIAGNOSIS

Antigen testing

Blood films (thick & thin)

PCR

malaria1
Malaria
  • Clinical Features
      • Fever, malaise, headache, myalgia, diarrhoea etc…………..
      • Anaemia
      • Jaundice
      • Renal impairment
  • Severe malaria
      • Parasitaemia >2%
      • Cerebral malaria
      • Severe anaemia
      • Renal failure
      • Shock
      • DIC
      • Acidosis
      • Pulmonary oedema
  • Treatment
      • Quinine + Doxycicline
      • Malarone
      • Artemesinins
chemoprophylaxis
Chemoprophylaxis
  • Must be used in conjunction with PPM
  • Suppress/prevent symptoms caused by blood stages
      • Continued post travel
  • Choices
      • Mefloquine
      • Doxycicline
      • Malarone (atovaquone/progaunil)
mefloquine larium
Mefloquine (Larium)
  • 250mg once weekly
      • With food
      • Same time & day
  • Start 1 week prior, throughout risk & 4 weeks after
      • 3 weekly doses prior for toxicity
  • Contraindications
      • Severe liver disease; epilepsy; psychiatric illness
  • Side effects
      • Nausea etc
      • Psychiatric illness (sleep disturbance to psychosis)
doxycicline
Doxycicline
  • 100mg daily
      • With food
  • Start 2-3 days prior, throughout risk & 4 weeks after
  • Contraindications
      • Pregnancy; children; porphyria
      • Drug interactions (OCP)
  • Side effects
      • Nausea etc
      • Photosensitivity
malarone
Malarone
  • 1 tablet daily
      • With food
  • Start 1-2 days prior, throughout risk & 1 week after
  • Contraindications
      • Drug interactions; pregnancy
  • Side effects
      • Nausea etc
      • Cost!
standby therapy
Standby Therapy
  • Allows prompt treatment
      • Remote from medical care
  • NOT substitute for medical attention
  • Regimes
      • Malarone 4 tabs daily for 3 days
      • Quinine/doxycicline
      • Riamet
  • Interactions & SEs
      • Medical evaluation
dengue fever
Dengue fever
  • 100 million cases/yr
  • Day biting
  • Incubation 5-14 days
clinical features
Clinical Features
  • “Breakbone Fever”
      • Headache
      • Fever
      • Retro-orbital pain
      • Arthralgia/myalgia
      • Rash
      • Cough
      • Sore throat
      • Nausea
      • Diarrhoea
  • Laboratory
      • Leucopenia
      • Thrombocytopenia
      • Transaminitis
dengue haemorrhagic fever
Dengue Haemorrhagic Fever
  • <1% infections
  • Definition
      • ↑vascular permeability
      • Thrombocytopenia
      • Fever
      • Bleeding
  • Less likely in travellers
adults and children estimated to be living with hiv 2005
Adults and children estimated to be living with HIV – 2005

Eastern Europe & Central Asia

1.5 million

[1.0 – 2.3 million]

Western &

Central Europe

720 000

[550 000 – 950 000]

North America

1.3 million

[770 000 – 2.1 million]

East Asia

680 000

[420 000 – 1.1 million]

North Africa & Middle East

440 000

[250 000 – 720 000]

Caribbean

330 000

[240 000 – 420 000]

South & South-East Asia

7.6 million

[5.1 – 11.7 million]

Latin America

1.6 million

[1.2 – 2.4 million]

Sub-Saharan Africa

24.5 million

[21.6 – 27.4 million]

Oceania

78 000

[48 000 – 170 000]

Total: 38.6 (33.4–46.0) million

routes of transmission
Routes of transmission
  • Sharing injecting equipment
  • Unprotected penetrative sexual contact
  • Oral sex
  • Mother to baby
  • Blood products
  • Needle stick injury
hiv is not passed on through social contact
HIV is not passed on through social contact

Such as :

  • Hugging
  • Kissing
  • Shaking hands
  • Sharing cups or cutlery
  • Sitting on the same toilet seat
what are the risks
What Are The Risks?
  • Malawi seroprevalence 1 in 12
  • Needlestick 1 in 300
  • Receptive vaginal intercourse 1 in 500
  • Insertive vaginal intercourse 1 in 1000
  • Receptive anal intercourse 1 in 33
  • Insertive anal intercourse 1 in 1667
post exposure prophylaxis
Post Exposure Prophylaxis
  • First Aid
      • Encourage bleeding
      • Wash with soap & water
      • Wash mucosal surfaces
  • Antiretroviral PEP
      • Reduced risk by up to 100 fold
      • Most effective within 1 hour
post exposure prophylaxis1
Post Exposure Prophylaxis
  • Combivir 1 tab b.d
      • AZT & Lamivudine (3TC)
      • Headache, nausea
      • Anaemia
  • Kaletra 2 tab b.d
      • Lopinovir/ritonavir
      • Nausea, diarrhoea
      • Drug interactions +++
  • Continued for 28 days (testing at 3 months)
hiv risk
HIV Risk
  • Know your risks
  • Do not put yourself at unnecessary risk
  • Prompt first aid and PEP
  • Get home
schistosomiasis bilharzia
Schistosomiasis (Bilharzia)
  • Helminth: Trematode (flatworm)
  • 3 major species:
    • S. haematobium
    • S. mansoni
    • S. japonicum
schistosomiasis
Schistosomiasis
  • Second most prevalent tropical disease after malaria.
  • 500-600 million people worldwide at risk
  • 200 million infected worldwide: 120 million symptomatic and 20 million have severe disease
  • 80% of those infected are in sub-Saharan-Africa: annual mortality in sub-Saharan Africa is estimated to exceed 150,000 (WHO)
schistosomiasis exposure risk
Schistosomiasis Exposure Risk

Freshwater (saltwater is safe)

  • Swimming
  • Paddling
  • Splashing
  • Washing
  • Showers
  • Drinking
infection
Infection
  • Infection is usually asymptomatic, especially in residents of endemic areas
  • Symptomatic infection:

- “Swimmers itch” soon after infection

- Katayama fever at least 6 weeks after infection - immunological reaction to soluble egg antigen, as the worms begin to lay eggs.

slide36
S. mansoni

S. haematobium

S. japonicum

schistosomiasis risk reduction
SchistosomiasisRisk Reduction

Avoid water contact

No evidence for efficacy of:

  • Brisk towelling after water contact
  • DEET before water contact
  • Waterproof sun cream

…but it might be worth a try!

schistosomiasis diagnosis
SchistosomiasisDiagnosis

At least 8 weeks after last exposure

  • Katayama fever (3%)

Asymptomatic screening:

  • Serology
  • Stools x 3
  • Urine – 24 hour collection
schistosomiasis treatment
SchistosomiasisTreatment
  • Praziquantel 40mg/kg on one day
  • Side effects very rarely reported
  • 80% effective (reduction in egg counts, endemic areas)
  • Serology remains positive
rabies risk
Rabies Risk

Infected saliva –warm blooded animal

  • Bite
  • Lick
  • Scratch
rabies prevention
Rabies Prevention
  • Avoid contact
  • Pre-exposure vaccination: 0, 7, 21 or 28 days
rabies wound management
RabiesWound Management
  • Wash by flushing under running tap for 10 minutes then wash with soap or water
  • Do not scrub, rub or squeeze
  • Apply disinfectant: 40-70% alcohol, tincture or aqueous povidine iodine, cetrimide
  • Do not suture, if possible
rabies post exposure prophylaxis
RabiesPost Exposure Prophylaxis

Following pre-exposure vaccinations:

  • 2 doses of rabies vaccine on days 0 and 3

No pre-exposure vaccination:

  • HRIG (human rabies immunoglobulin) 20iu/kg

plus

  • 5 doses vaccine on days 0, 3, 7, 14, 28
rabies why have pre travel vaccination
Rabies - Why have pre-travel vaccination?
  • Less likely to die of rabies
  • Less stressful
  • HRIG world shortage
  • Fewer post exposure vaccinations
slide53
“Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it sorely on these accounts.  Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one's lifetime.” 

Mark Twain

ad