Diphtheria: another risk of travel

Fever in the returned traveler

The most important cause of fever in the returned traveler is malaria. All febrile patients in which malaria is epidemiologically possible require urgent evaluation for P. falciparum malaria, which can be rapidly fatal in the nonimmune patient. Early diagnosis and therapy can prevent severe morbidity and mortality. Other less common causes of undifferentiated fever include acute schistosomiasis, the enteric fevers, rickettsial diseases, leptospirosis, and dengue fever. Early empiric therapy for suspected leptospirosis and the rickettsial infections is encouraged to decrease morbidity and mortality. About a quarter of febrile patients do not have an etiologic agent determined for their illness but recover without sequelae. Patients with fever and hemorrhagic manifestations within 3 weeks of their return need to be isolated for the remote possibility of a highly transmissible agent. Although the febrile traveler is always a challenge, the real world differential diagnosis is limited and a systematic approach via the history, physical examination, and selected laboratory tests is usually sufficient to confirm the diagnosis or eliminate potentially serious infections.

Clinical microbiology of coryneform bacteria

Coryneform bacteria are aerobically growing, asporogenous, non-partially-acid-fast, gram-positive rods of irregular morphology. Within the last few years, there has been a massive increase in the number of publications related to all aspects of their clinical microbiology. Clinical microbiologists are often confronted with making identifications within this heterogeneous group as well as with considerations of the clinical significance of such isolates. This review provides comprehensive information on the identification of coryneform bacteria and outlines recent changes in taxonomy. The following genera are covered: Corynebacterium, Turicella, Arthrobacter, Brevibacterium, Dermabacter. Propionibacterium, Rothia, Exiguobacterium, Oerskovia, Cellulomonas, Sanguibacter, Microbacterium, Aureobacterium, "Corynebacterium aquaticum," Arcanobacterium, and Actinomyces. Case reports claiming disease associations of coryneform bacteria are critically reviewed. Minimal microbiological requirements for publications on disease associations of coryneform bacteria are proposed.

Assessment of an Adult Population's Knowledge Regarding Vaccine-Preventable Diseases

Background: The purpose of this study was to determine adult patients' knowledge about their history of age-appropriate routine vaccinations and vaccine preventable diseases. Methods: This was a prospective descriptive study using a self-administered questionnaire. During a 9-month period, all patients older than 18 years of age answered a questionnaire at the time of their first visit to a health department travelers' clinic. Questions included knowledge of vaccines that they might have received (against tetanus, diphtheria, polio, measles, rubella, influenza, and pneumococcus); knowledge of illnesses that they might have had (measles and rubella); incidence of visits to a regular physician; and incidence of chronic illness. Results: Two hundred and twenty patients answered the questionnaire. Eighty-two percent had a regular physician whom they had visited within 5 years. Respondents reported their age-appropriate vaccination history as follows: Td-69%; polio-48%; measles-41%; rubella-38%; influenza-68%; and pneumococcal-13%. For any vaccine, approximately one-third of respondents did not know their status. Age, gender, or a regular source of medical care did not influence the results. Conclusions: Adult patients frequently did not receive, or do not know whether they received, recommended immunizations. Until physicians giving primary medical care improve patient education about vaccination status and develop a better system for having patients keep records of their routine vaccinations, travel clinics will have to function, in part, as primary health care providers.