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PHCY804: Insectborne Illnesses (yellow fever (YF) (signs and symptoms…
PHCY804: Insectborne Illnesses
malaria
drugs for PPX
mefloquine
CIs: seizure hx, psych disorder hx
dosage: 250mg weekly for 4 weeks
AEs: depression, vivid dreams
BBW: avoid use in pts with psychiatric disorders (may cause neuropsychiatric s/sx that can persist after discontinuation)
significant resistance in Southeast Asia
doxycycline
dosage: 1 tab QD for 28d; start 1 to 2 weeks prior to exposure and continue throughout stay and for 4 weeks after returning
AEs; photosensitivity, vaginal yeast infections
CIs: pregnancy, pts <8YO, antacid use, retinoid use;
chloroquine
dosage: 500mg weekly for 4wks
CIs: visual field defects, psoriasis hx, Tagamet use, antacid use
reserved for pts traveling to Central America
tafenoquine (Krintafel)
dosage: 200 mg once daily x 3 days prior to travel to exposure and continue 200 mg once weekly throughout stay
CIs: pregnancy
reserved for malaria PPX in pts ≥ 18YO
atovaquone-proguanil (Malarone)
CIs: severe renal impairment (CrCl <30 mL/min)
dosing: 250 mg/100 mg QD; start 1 to 2 days prior to exposure and continue throughout stay and for 7 days after returning
can be used in all areas of the world where malaria PPX is indicated
etiology and epidemiology
Sub-Saharan Africa and Oceania have the highest risk of malaria infection
~200 million cases of malaria occur each year, and ~450,000 die from the disease
factors that affect local transmission
mosquito density in area
weather conditions
prevalence of infection
caused by the
Anopheles
mosquito (nighttime biter)
yellow fever (YF)
vaccination info
adverse reactions
Acute Neurotropic Disease (YEL-AND)
affects CNS
onset within 30 days
s/sx: headache, fever, confusion ,stiff neck, seizures
most pts are able to recover
Acute Viscerotropic Disease (YEL-AVD)
affects vital organs (similar to YF disease)
onset within 10 days
s/sx: fatigue, fever, headache, muscle pain
50% mortality
more likely to occur after a pt's first YF vaccination than after subsequent doses
contraindications
hypersensitivity reactions to egg products
immunosuppresion
recent chemotherapy
hx of myasthenia gravis
symptomatic HIV infection or CD4+ T-lymphocytes less than 200/mm^3
documented on ICVP 10 days after shot
etiology and epidemiology
usually asymptomatic infection occurs
caused by the
Aedes
mosquito (daytime biter)
common in central Africa and South America
signs and symptoms
sudden onset of fever
chills
severe headache
back pain
N&V
fatigue
treatment of YF
there is no medicine to treat or cure YF infection
rest, drink fluids, and use pain relievers to reduce fever and aching
avoid
aspirin and NSAIDs, which may increase the risk of bleeding
Zika virus
etiology and epidemiology
caused by the
Aedes
mosquito (daytime biter)
virus survives longer in semen (men should wait at least 3 months before trying to concieve)
symptoms can last for several days to a week
methods of transmission
the bite of an infected mosquito
from a pregnant woman to her developing fetus
sex with a person who is infected with Zika
treatment of Zika virus
there is no medicine to treat or cure Zika infection
rest, drink fluids, and use pain relievers to reduce fever and aching
avoid
aspirin and NSAIDs, which may increase the risk of bleeding
Dengue
signs and symptoms
headache
fever
N&V
minor bleeding
pain in the eyes
rash
diarrhea
altered mental status
etiology and epidemiology
leading cause of illness and death in the tropics and subtropics (found in South America, India, and Africa)
caused by the
Aedes
mosquito (daytime biter)
no dengue vaccine available in the US!
~400 million people are infected each year
Japanese encephalitis (JE)
etiology and epidemiology
caused by the
Culex
mosquito (nighttime biter)
1:1,000,000 chance of getting JE while travelling
higher risk in rural areas, swamps, rice and pig farms
1/3 recover; 1/3 are permanently disabled after infection; 1/3 die
high risk areas: Southeast Asia, Western Pacific islands
non-pharmacological prevention methods
wear long sleeve clothing
use bed netting for JE and malaria protection
insect repellants
DEET (30-50%)
picaridin
permethrin
clothing should be treated 1-2 days in advance of travel to allow them to dry
not for skin!
use air conditioning, if available
Chikungunya
etiology and epidemiology
caused by the
Aedes
mosquito (daytime biter)
found for the first time in the Americas on islands in the Caribbean in 2013
risk factors: newborns, pts ≥65yo, HTN, diabetes, heart disease
signs and symptoms
joint pain and swelling
fever
headache
rash
muscle pain
treatment of Chikungunya
there is no medicine to treat or cure Chikungunya
rest, drink fluids, and use pain relievers to reduce fever and aching
avoid
aspirin and NSAIDs, which may increase the risk of bleeding