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Riccò M, Zaniboni A, Satta E, Baldassarre A, Cerviere MP, Marchesi F, Peruzzi S. Management and Prevention of Traveler's Diarrhea: A Cross-Sectional Study on Knowledge, Attitudes, and Practices in Italian Occupational Physicians (2019 and 2022). Trop Med Infect Dis 2022; 7:370. [PMID: 36422921 PMCID: PMC9692574 DOI: 10.3390/tropicalmed7110370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 07/29/2023] Open
Abstract
Even though Italian Occupational Physicians (OP) are increasingly involved in the managing of overseas workers, their knowledge, attitudes, and practices (KAP) in travel medicine are mostly undefined. We, therefore, permed a KAP study specifically targeting the management of travelers' diarrhea (TD) by OP. A total of 371 professionals (43.4% males; mean age 40.8 ± 10.9 years) completed in 2 rounds (2019 and 2022) a specifically designed web questionnaire that inquired participating OP on their knowledge status (KS), risk perception, and management of TD through pre- and post-travel advice and interventions. Multivariable odds ratios (aOR) for predictors of a better knowledge status were calculated through regression analysis. Eventually, the majority of participants (53.4%) had participated in the management of cases of TD in the previous months, but only 26.4% were reportedly involved in pre-travel consultations. The overall knowledge status was unsatisfying (potential range: 0-100%, actual average of the sample 59.6% ± 14.6), with substantial uncertainties in the management of antimicrobial treatment. Interestingly, only a small subset of participants had previously prescribed antimicrobial prophylaxis or treatment (3.5% and 1.9%, respectively). Main effectors of a better knowledge status were: having a background qualification in Hygiene and Public Health (aOR 14.769, 95%CI 5.582 to 39.073), having previously managed any case of (aOR 3.107, 95%CI 1.484 to 6.506), and having higher concern on TD, reported by acknowledging high frequency (aOR 8.579, 95%CI 3.383 to 21.756) and severity (aOR 3.386; 95%CI 1.741 to 6.585) of this disorder. As the adherence of participating OP to official recommendations for TD management was unsatisfying, continuous Education on Travel Medicine should be improved by sharing up-to-date official recommendations on appropriate treatment options for TD.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Department of Public Health, AUSL-IRCCS di Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Alessandro Zaniboni
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Elia Satta
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, I-50134 Florence, Italy
| | | | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, I-43126 Parma, Italy
| | - Simona Peruzzi
- Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, AUSL-IRCCS di Reggio Emilia, I-42016 Guastalla, Italy
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Chilukuri PH, Orr M, Blakemore S, Hofto ME. Do We Know Where They Go? Obtaining Travel History in Pediatric Patients. South Med J 2021; 114:640-643. [PMID: 34599342 DOI: 10.14423/smj.0000000000001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine how often travel histories are obtained in pediatric patients. METHODS A retrospective medical record review was performed at a single tertiary care children's hospital for patients aged 2 months to 18 years who were admitted October 2015-December 2017 with International Classification of Diseases, 10th Revision codes for potential travel-related illnesses. Demographic information and travel history documentation were obtained, along with travel-related testing. From May to June 2018, prospective, single-blinded, direct observation of a convenience sample of pediatric residents was performed during the initial patient encounter to determine the frequency and quality of travel histories obtained regardless of documentation. RESULTS Of 249 charts reviewed, 27 (10.8%) patients had a travel history query documented. Patients with complex chronic conditions were significantly less likely to have a travel history documented (37% vs 67%; P = 0.005). Age, sex, length of stay, race, payer status, and critical care admission did not significantly differ between groups. Those with a travel history documented were more likely to have a documented exposure history (100% vs 52%; P < 0.001) and additional testing performed (56% vs 13%, P < 0.001). During this time, a simulation course with residents featuring travel-related diagnoses led to a significant increase in documented travel histories (5% prior versus 21% after, P = 0.03). A total of 37 patient encounters were observed; travel history was asked for 4 times (4/37, 10.8%). CONCLUSIONS Travel histories are rarely asked for in pediatric patients. Missed diagnoses may not only affect the patient but also have broader public health implications. Simulation is an effective tool to improve history-taking skills, yet more work is still needed.
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Affiliation(s)
- Pranaya H Chilukuri
- From the Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, and Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Mary Orr
- From the Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, and Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Shaundra Blakemore
- From the Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, and Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Meghan E Hofto
- From the Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, and Department of Pediatrics, University of Alabama at Birmingham, Birmingham
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Ricco M, Gualerzi G, Ranzieri S. Personal beliefs and misconceptions, not evidence guide general practitioners in the managing of travelers' diarrhea: Results from a pilot study (North-Western Italy, 2019). Infect Dis Now 2020; 51:266-272. [PMID: 33160008 DOI: 10.1016/j.medmal.2020.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/27/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The present study aims to characterize knowledge, attitudes and practices in a sample of general practitioners (GPs) on management of travelers' diarrhea (TD). METHODS A total of 158 GPs (44.3% males; mean age 40.2±12.4 years) completed a web questionnaire on antibiotic prophylaxis (AP) and/or an antibiotic treatment (AT) in TD cases. Participants were inquired on knowledge status (KS), risk perception and effectively applied recommendations for AP/AT through a specifically designed questionnaire. Multivariate odds ratios (OR) for predictors of AP/AT were calculated through regression analysis. RESULTS All in all, while 15 (9.5%) participants recommended AP for TD, 61 of them (39.4%) recommended AT. KS was largely unsatisfying as participants extensively ignored the most recent AP/AT recommendations. Acknowledgment of TD as a severe disorder was predictive for recommendation of AP (OR 37.843, 95%CI 4.752-301.4). As for AT, it was relatively elevated in GPs≥10 years (OR 2.653, 95%CI 1.169-6.019), but more rarely reported in participants with higher KS (OR 0.056, 95%CI 0.021-0.153). CONCLUSIONS Adherence of GPs to official recommendations for TD management was unsatisfying, particularly in older participants. Continuous Education of GPs should be improved by sharing up-to-date official recommendations on AT/AP for TD.
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Affiliation(s)
- Matteo Ricco
- IRCCS-AUSL di Reggio Emilia; Service for Health and Safety in the Workplace, Department of Public Health, Via Amendola n.2, 42122 Reggio Emilia (RE), Italy.
| | - Giovanni Gualerzi
- Department of Medicine and Surgery; School of Medicine, University of Parma, Via Gramsci n.14, Parma (PR), Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, School of Occupational Medicine, University of Parma, Via Gramsci n.14, Parma (PR), Italy
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Blakemore S, Hofto ME, Shah N, Gaither SL, Chilukuri P, Tofil NM. Travel Histories in Children: How Well Do Interns and Medical Students Do? South Med J 2020; 113:432-437. [PMID: 32885262 DOI: 10.14423/smj.0000000000001143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the knowledge of obtaining travel histories in medical students and interns. METHODS Medical students and interns participated in a high-fidelity pediatric simulation with two cases (malaria or typhoid fever) that hinged on travel history. After the simulation, appropriate methods of obtaining travel histories were discussed. Participants completed surveys regarding their previous education and comfort with obtaining travel histories. If and how a travel history was obtained was derived from simulation observation. RESULTS From June 2016 to July 2017, 145 medical trainees participated in 24 simulation sessions; 45% reported no prior training in obtaining travel histories. Participants asked for a travel history in all but 2 simulations; however, in 9 of 24 simulations (38%), they required prompting by either a simulation confederate or laboratory results. Participants were more comfortable diagnosing/treating conditions acquired from US domestic travel than from international travel (32.9% vs 22.4%, P < 0.001). Previous education in obtaining travel histories and past international travel did not significantly influence the level of comfort that participants felt with travel histories. CONCLUSIONS This study highlights the lack of knowledge regarding the importance of travel histories as part of basic history taking. Medical students and interns had low levels of comfort in obtaining adequate travel histories and diagnosing conditions acquired from international travel.
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Affiliation(s)
- Shaundra Blakemore
- From the Department of Pediatrics, the Pediatric Research Office, and the School of Medicine, University of Alabama at Birmingham
| | - Meghan E Hofto
- From the Department of Pediatrics, the Pediatric Research Office, and the School of Medicine, University of Alabama at Birmingham
| | - Nipam Shah
- From the Department of Pediatrics, the Pediatric Research Office, and the School of Medicine, University of Alabama at Birmingham
| | - Stacy L Gaither
- From the Department of Pediatrics, the Pediatric Research Office, and the School of Medicine, University of Alabama at Birmingham
| | - Pranaya Chilukuri
- From the Department of Pediatrics, the Pediatric Research Office, and the School of Medicine, University of Alabama at Birmingham
| | - Nancy M Tofil
- From the Department of Pediatrics, the Pediatric Research Office, and the School of Medicine, University of Alabama at Birmingham
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Travel Medicine Curricula across Canadian Pharmacy Programs and Alignment with Scope of Practice. PHARMACY 2020; 8:pharmacy8020102. [PMID: 32549192 PMCID: PMC7355656 DOI: 10.3390/pharmacy8020102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
Limited research exists on pharmacy students’ training in travel medicine, and how this aligns with scope of practice. This research aimed to detail travel medicine education across pharmacy programs in Canada and map this against the scope of practice for pharmacists in each university’s jurisdiction. A survey based on the International Society of Travel Medicine’s Body of Knowledge was developed and distributed to all Canadian undergraduate pharmacy schools to identify topic areas taught, teaching modalities utilized, and knowledge assessment performed. Educational data was collected and analyzed descriptively, and compared to pharmacists’ scope of practice in the province in which each university is located. Training provided to students varied significantly across universities and topic areas, with topics amenable to self-care (e.g., traveller’s diarrhea and insect bite prevention) or also encountered outside of the travel context (e.g., sexually transmitted infections) taught more regularly than travel-specific topics (e.g., dengue and altitude illness). No apparent relationship was observed between a program’s curriculum and their provincial scope of practice. For example, training in vaccine-preventable diseases did not necessarily align with scope related to vaccine administration. Alignment of education to current and future scope will best equip new practitioners to provide care to travelling patients.
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Affiliation(s)
- Doug Fink
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Robert Serafino Wani
- Department of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Victoria Johnston
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Leblebicioglu H, Ozaras R, Fletcher TE, Beeching NJ. Crimean-Congo haemorrhagic fever in travellers: A systematic review. Travel Med Infect Dis 2016; 14:73-80. [PMID: 26970396 PMCID: PMC7110636 DOI: 10.1016/j.tmaid.2016.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/17/2016] [Accepted: 03/01/2016] [Indexed: 01/03/2023]
Abstract
Background The recent Ebola epidemic has increased public awareness of the risk of travel associated viral haemorrhagic fever (VHF). International preparedness to manage imported cases Ebola virus infection was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging tick-borne VHF centred in the Eurasian region, affecting a large geographical area and with human-to-human transmission reported, especially in the healthcare setting. Objectives To systematically review the characteristics of travel associated Crimean-Congo haemorrhagic fever. Methods A systematic review of travel-associated cases of CCHF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) and ProMED databases were searched for reports published between January 1960 and January 2016. Three independent reviewers selected and reviewed studies and extracted data. Results 21 cases of travel associated CCHF were identified, of which 12 died (3 outcome unknown) and 4 secondary (nosocomial) infections were reported. Risk occupations or activities for CCHF infection were reported in 8/12 cases when data were available. Travel from Asia to Asia occurred in 9 cases, Africa to Africa occurred in 5 cases, Africa to Europe in 3 cases, Asia to Europe in 2 cases and Europe to Europe in 2 cases. Conclusion CCHF related to travel is rare, is generally associated with at risk activities/occupation and is frequently fatal. Key to early diagnosis and prevention of nosocomial transmission is an understanding of CCHF risk factors and the geographical distribution of CCHF. International travel to CCHF endemic areas is increasing and clinicians and laboratory personnel managing returning travellers should maintain a high index of suspicion.
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Affiliation(s)
- Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
| | - Tom E Fletcher
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey; Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom
| | - Nick J Beeching
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom; NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, United Kingdom
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Obtaining a reliable travel history from III returned travellers. Travel Med Infect Dis 2015; 13:342-3. [PMID: 26005161 DOI: 10.1016/j.tmaid.2015.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 11/23/2022]
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Halbert J, Shingadia D, Zuckerman JN. Fever in the returning child traveller: approach to diagnosis and management. Arch Dis Child 2014; 99:938-43. [PMID: 24667950 DOI: 10.1136/archdischild-2012-303196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
During the last half century there has been an exponential increase in international travel including to more exotic and long-haul destinations. The assessment of febrile returning child travellers presents diagnostic challenges and is often performed poorly. A detailed travel and medical history, clinical examination and appropriate first-line investigations are essential. While the majority of children will have a common self-limiting or easily treatable infection, it is important to consider other causes, including imported infections, which may be life-threatening or highly contagious. In this article, we provide guidance on the initial assessment and management of such children with a focus on some of the more important imported infections, including malaria, dengue, typhoid fever, travellers' diarrhoea, respiratory infections, tuberculosis, schistosomiasis and rickettsial diseases.
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Affiliation(s)
- J Halbert
- Department of Paediatrics, Lister Hospital, Stevenage, Hertfordshire, UK
| | - D Shingadia
- Department of Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Jane N Zuckerman
- Academic Centre For Travel Medicine & Vaccines, WHO Collaborating Centre for Reference, Research and Training in Travel Medicine, University College London Medical School, London, UK
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Lewis JM, Goodwin L, Beadsworth MBJ. The returning traveller with diarrhoea. Br J Hosp Med (Lond) 2014; 75:C133-6. [DOI: 10.12968/hmed.2014.75.9.c133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- JM Lewis
- Specialist Trainee in Infectious Diseases
| | - L Goodwin
- Specialist Trainee in Infectious Diseases
| | - MBJ Beadsworth
- Consultant in Infectious Diseases in the Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool L7 8XP
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Piotte E, Bellanger AP, Piton G, Millon L, Marguet P. Pre-travel consultation: evaluation of primary care physician practice in the Franche-Comté region. J Travel Med 2013; 20:221-7. [PMID: 23809071 DOI: 10.1111/jtm.12030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/05/2012] [Accepted: 11/09/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary care physicians (PCP) are first in line to provide adequate pre-travel medical advice. Little data are available on the content of pre-travel PCP consultations in France. We undertook an observational survey to assess the level of specific knowledge among PCPs on health advice, vaccinations, and malaria prophylaxis. METHODS Standardized questionnaires were sent to a random sample of 400 PCPs practicing in the Franche-Comté regions (eastern France) who were asked to complete and return it on a voluntary and anonymous basis. The questionnaire requested sociodemographic details, practice-related characteristics, and proposed three clinical situations with multiple choice questions (MCQ). To identify factors associated with a higher level of specific knowledge in travel medicine, results were studied by uni- and multivariate analyses. An overall score was calculated based on the MCQ answers and a motivation score was calculated based on parameters such as frequency and developments in pre-travel consulting at the practice, PCPs' personal experience as travelers, and the formal agreement of PCPs to administer yellow fever vaccination. RESULTS The response rate was 37.5%, with 150 questionnaires returned completed and suitable for analysis. After multivariate logistic regression, the three variables associated with a higher score were: proximity of a vaccination center (p = 0.001), motivation score (p = 0.004), and absence of request for expert advice on malaria prophylaxis (p = 0.007). CONCLUSIONS PCPs play an important role in travel medicine. This study showed that their high level of knowledge in travel medicine was mostly linked to their motivation to practice in this specialized discipline.
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Affiliation(s)
- Emeline Piotte
- Emergency Department, Regional Hospital of Pontarlier, Pontarlier, France
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Taylor CA, Blau DM, Diangelo CR, Shieh WJ, Zaki SR, Arguin PM. Malaria diagnosed by autopsy in a young traveler returning from Uganda: limitations of surveillance. J Travel Med 2013; 20:47-9. [PMID: 23279231 PMCID: PMC4674784 DOI: 10.1111/j.1708-8305.2012.00672.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 11/26/2022]
Abstract
Fatal infectious disease acquired during international travel is less likely to be captured through existing surveillance when diagnosis is delayed or missed, especially as autopsy rates decline. Death of a young girl owing to malaria demonstrates needs for increased examination of travel-related deaths through postmortem investigation, autopsy, and expanded surveillance.
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Affiliation(s)
- Christopher A Taylor
- Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Wang X, Zhang X, Zong Z. A Case of loiasis in a patient returning to China diagnosed by nested PCR using DNA extracted from tissue. J Travel Med 2012; 19:314-6. [PMID: 22943273 DOI: 10.1111/j.1708-8305.2012.00635.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 02/05/2023]
Abstract
Recognition and diagnosis of loiasis is problematic in areas where this infection is not endemic but may be imported. A previously healthy Chinese male returned from Equatorial Guinea presenting with migratory masses. He was diagnosed with loiasis following detection of Loa loa by nested polymerase chain reaction using DNA extracted from tissue.
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Affiliation(s)
- Xiaohui Wang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
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