Archive for July 12, 2013

Rickettsioses and the international traveler.

Clin Infect Dis 2004 Nov 15; 39(10) :1493-9.

Jensenius M, Fournier PE, Raoult D

Department of Internal Medicine, Aker University Hospital, Oslo, Norway. mogens.jensenius@ioks.uio.no

Abstract

The rickettsioses–zoonotic bacterial infections transmitted to humans by arthropods–were for many years considered to be oddities in travel medicine. During the previous 2 decades, however, reports of >450 travel-associated cases have been published worldwide, the vast majority being murine typhus caused by Rickettsia typhi, Mediterranean spotted fever caused by Rickettsia conorii, African tick bite fever caused by Rickettsia africae, and scrub typhus caused by Orientia tsutsugamushi. Most patients present with a benign febrile illness accompanied by headache, myalgia, and cutaneous eruptions, but severe complications and fatalities are occasionally seen. Current microbiological tests include culture, polymerase chain reaction, and serological analysis, of which only the latter method is widely available. Tetracyclines are the drugs of first choice and should be prescribed whenever a case of rickettsiosis is suspected. Preventive measures rely on minimizing the risk of arthropod bites when traveling in areas of endemicity.

PDF

http://cid.oxfordjournals.org/content/39/10/1493.full.pdf+html

July 12, 2013 at 3:07 pm

Fever in returned travelers: results from the GeoSentinel Surveillance Network.

Clin Infect Dis 2007 Jun 15; 44(12) :1560-8.

Wilson ME, Weld LH, Boggild A, et al.

Mount Auburn Hospital, Cambridge, MA, USA. mary_wilson@harvard.edu

Abstract

BACKGROUND

Fever is a marker of potentially serious illness in returned travelers. Information about causes of fever, organized by geographic area and traveler characteristics, can facilitate timely, appropriate treatment and preventive measures.

METHODS

Using a large, multicenter database, we assessed how frequently fever is cited as a chief reason for seeking medical care among ill returned travelers. We defined the causes of fever by place of exposure and traveler characteristics.

RESULTS

Of 24,920 returned travelers seen at a GeoSentinel clinic from March 1997 through March 2006, 6957 (28%) cited fever as a chief reason for seeking care. Of patients with fever, 26% were hospitalized (compared with 3% who did not have fever); 35% had a febrile systemic illness, 15% had a febrile diarrheal disease, and 14% had fever and a respiratory illness. Malaria was the most common specific etiologic diagnosis, found in 21% of ill returned travelers with fever. Causes of fever varied by region visited and by time of presentation after travel. Ill travelers who returned from sub-Saharan Africa, south-central Asia, and Latin America whose reason for travel was visiting friends and relatives were more likely to experience fever than any other group. More than 17% of travelers with fever had a vaccine-preventable infection or falciparum malaria, which is preventable with chemoprophylaxis. Malaria accounted for 33% of the 12 deaths among febrile travelers.

CONCLUSIONS

Fever is common in ill returned travelers and often results in hospitalization. The time of presentation after travel provides important clues toward establishing a diagnosis. Preventing and promptly treating malaria, providing appropriate vaccines, and identifying ways to reach travelers whose purpose for travel is visiting friends and relatives in advance of travel can reduce the burden of travel-related illness.

PDF

http://cid.oxfordjournals.org/content/44/12/1560.full.pdf+html

July 12, 2013 at 3:05 pm

Spectrum of disease and relation to place of exposure among ill returned travelers.

N Engl J Med. 2006 Jan 12;354(2):119-30.

Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, Keystone JS, Pandey P, Cetron MS; GeoSentinel Surveillance Network.

Source

Division of Geographic Medicine, University of Alabama at Birmingham, Birmingham, USA. freedman@uab.edu

Erratum in

N Engl J Med. 2006 Aug 31;355(9):967.

http://www.nejm.org/doi/full/10.1056/NEJMx060042

Abstract

BACKGROUND:

Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s.

METHODS:

Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world.

RESULTS:

Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea.

CONCLUSIONS:

When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences.

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa051331

July 12, 2013 at 3:03 pm

Patterns of illness in travelers visiting Mexico and Central America: the GeoSentinel experience.

Clin Infect Dis. 2011 Sep;53(6):523-31.

Flores-Figueroa J, Okhuysen PC, von Sonnenburg F, DuPont HL, Libman MD, Keystone JS, Hale DC, Burchard G, Han PV, Wilder-Smith A, Freedman DO; GeoSentinel Surveillance Network.

Collaborators (91)

Source

Center for Infectious Diseases, School of Public Health, Houston, Texas, USA. jose.flores.figueroa@uth.tmc.edu

Abstract

BACKGROUND:

Mexico and Central America are important travel destinations for North American and European travelers. There is limited information on regional differences in travel related morbidity.

METHODS:

We describe the morbidity among 4779 ill travelers returned from Mexico and Central America who were evaluated at GeoSentinel network clinics during December 1996 to February 2010.

RESULTS:

The most frequent presenting syndromes included acute and chronic diarrhea, dermatologic diseases, febrile systemic illness, and respiratory disease. A higher proportion of ill travelers from the United States had acute diarrhea, compared with their Canadian and European counterparts (odds ratio, 1.9; P < .0001). During the 2009 H1N1 influenza outbreak from March 2009 through February 2010, the proportionate morbidity (PM) associated with respiratory illnesses in ill travelers increased among those returned from Mexico, compared with prior years (196.0 cases per 1000 ill returned travelers vs 53.7 cases per 1000 ill returned travelers; P < .0001); the PM remained constant in the rest of Central America (57.3 cases per 1000 ill returned travelers). We identified 50 travelers returned from Mexico and Central America who developed influenza, including infection due to 2009 H1N1 strains and influenza-like illness. The overall risk of malaria was low; only 4 cases of malaria were acquired in Mexico (PM, 2.2 cases per 1000 ill returned travelers) in 13 years, compared with 18 from Honduras (PM, 79.6 cases per 1000 ill returned travelers) and 14 from Guatemala (PM, 34.4 cases per 1000 ill returned travelers) during the same period. Plasmodium vivax malaria was the most frequent malaria diagnosis.

CONCLUSIONS:

Travel medicine practitioners advising and treating travelers visiting these regions should dedicate special attention to vaccine-preventable illnesses and should consider the uncommon occurrence of acute hepatitis A, leptospirosis, neurocysticercosis, acute Chagas disease, onchocerciasis, mucocutaneous leishmaniasis, neurocysticercosis, HIV, malaria, and brucellosis.

PDF

http://cid.oxfordjournals.org/content/53/6/523.full.pdf+html

July 12, 2013 at 3:01 pm


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