Travel Medicine I

Undercooked food

Cholera, nontyphoidal salmonellosis, trichinosis, typhoid fever

Atovaquone-proquanil, meloquine HCL, or doxycycline

What drugs can be considered for malaria prophylaxis in chloroquine-resistant areas?

Primaquine or tafenoquine

What drugs can be used during short-term travel to areas with more than 90% P. Vivax?

DVT or COVID

What two conditions should you always consider when assessing a returning traveler for a fever?

Central/south America

Where is P. Vivax most common?

Animal contact

brucellosis, plague, anthrax, Q fever, rabies, tularemia

Sexual contact

chancroid, gonorrhea, hep B, HIV, syphilis, Zika

Untreated water

cholera, hepatitis A, nontypohoidal salmonellosis, typhoid fever

Bacterial infections

Acute bacterial meningitis, enteric fever, meningococcemia

Parasitic infection

African trypanosomiasis, plasmodium falciparum malaria

>21 days

An incubation period of this many days would be suspicious in a returning traveler for a more serious condition

Yes

Can meloquine HCL be used during pregnancy?

1-2 weeks, 4 weeks

Chloroquine or hydroxychloroquine should be initiated how many weeks before travel and continued for how long after travel?

Unpasterurized dairy products

Brucellosis, tuberculosis

One

CDC recommends consultation with travel med specialist at least ___ month before international travel

No

Can Atovaquone-proquanil be used during pregnancy?

Yes

Can Chloroquine be used during pregnancy?

No

Can Primaquine or tafenoquine be used during pregnancy?

No

Can doxycycline be used during pregnancy?

Yes

Can hydroxychloroquine be used during pregnancy?

Chloroquine

Consider the resistance to this in the area of travel when determining malarial prophylaxis

Malaria

Consider the strain of malaria present in area of travel when considering malarial prophylaxis

G6PD

Deficiency of what leads to higher risk of malaria?

EMERGENCY

Fever + Altered mental status =

Is not

Fever in a returning traveler (is/is not) frequently associated with a tropical/exotic illness

12 months

Generally, what length of time should travel history cover in months?

Years

In cases of TB, what length of time should travel history cover?

DEET/permethrin

Insect repellant for ticks

Viral infection

Japanese encephalitis, rabies, yellow fever, viral hemorrhagic fevers (ebola, marburg, lassa)

Freshwater activities

Leptospirosis, schistomoniasis

Chloroquine or hydroxychloroquine

Malaria prophylaxis in areas with chloroquine-sensitive malaria

Dengue, malaria

Mosquito contact

Dengue fever, malaria (mostly P. Vivax), zika

Most common tropical illnesses of central and south america

Dengue fever, enteric fever, malaria (MC non-P. Falciparum)

Most common tropical illnesses of south central asia

Dengue fever, malaria (mostly non-p. Falciparum)

Most common tropical illnesses of south east asia

Malria (mostly P. Falciparum), tick-borne rickettsiae, acute schistomoniasis, filiariasis

Most common tropical illnesses of sub-saharan Africa

Dengue fever, malaria, zika

Most common tropical illnesses of the caribbean

Destination, time of travel, travel style (hotel vs tents), activites while traveling (scuba, hiking, etc), medical history

Risk assessment prior to international travel

Usual adult/childhood immunizations, additional includes COVID, influenza, and hep A

Routine immunizations during pre-travel consultation

1-2 days before and 1 week after

Schedule for Primarquine

1-2 days before and 7 days after

Schedule for atovaquone-proguanil

1-2 days before and 4 weeks after

Schedule for doxycycline

2 weeks before and 4 weeks after

Schedule for mefloquine HCL

3 days of a loading dose and 1 week after last maintenance dose

Schedule for tafenoquine

Non-travel related illness

Sinus, ears, and teeth in a physical exam can point in the direction of a

Meningococcemia and viral hemorrhagic fever

These two conditions are uncommon but should be ruled out immediately if patient displays AMS

rickettsial disease, tularemia

Tick contact

Typhoid fever, yellow fever, Japanese encephalitis, rabies, cholera, meningococcus

Travel-specific vaccines

Sick contacts

meningococcal disease, TB, viral hemorrhagic fevers, COVID