Undifferentiated febrile illnesses in South Sudan: a case series from Operation TRENTON from June to August 2017

Optimising remote health care delivery in Antarctica: a review of the current capabilities utilised in the British Antarctic Territory

Injury in Antarctica can have a significant impact when considering transfer timelines of several weeks. Medical support to the British Antarctic Territory (BAT) is provided by deployed healthcare professionals and the utilisation of "reach-back" with telemedicine. This is paired with robust training and familiarisation with a system of modularised deployed equipment.This paper examines the current telemedicine strategy, infrastructure modularisation, and influence from military practice by the British Antarctic Survey Medical Unit (BASMU) for medical care at extreme reach. Current telemedicine practices and utilisation, as well as modular equipment capabilities across the BAT were reviewed to provide an outline of care delivery.Requests varied from expert advice to remote supervision of clinical procedures. Integration of commercially available solutions enabled real-time display of patient physiology. The deployment of modular resources has improved equipment availability and greater standardisation between sites. The sending of case notes and digital x-rays has been generally sufficient but, when greater supervision was required, limited data transfer bandwidth was a challenge.An ongoing review of deployed equipment capabilities may also enhance the ease with which remote support can be offered but an uplift in telemedicine capability will likely require infrastructure upgrades to maintain data transfer from 8000 miles away.

Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years

OBJECTIVES

Military deployments to the tropics are associated with specific infection risks. To add to the available epidemiological information, infectious disease risks in German military personnel returning from predominantly tropical deployments were assessed.

METHODS

Since 2006, German soldiers returning from predominantly tropical deployments have been offered the opportunity of returnee screenings at the Department of Tropical Medicine and Infectious Diseases of the Bundeswehr Hospital Hamburg. Case files and diagnostic results recorded between 2006 and 2018 were retrospectively assessed to identify deployment-associated infectious disease risks.

RESULTS

Along with high enteric colonisation rates with apathogenic protozoa and resistant Enterobacteriaceae, direct or indirect proof of infections among the 764 assessed cases comprised Plasmodium spp (n=37), Giardia duodenalis (n=21), Schistosoma spp (n=14), Yersinia enterocolitica (n=5), Strongyloides stercoralis (n=3), Campylobacter jejuni (n=1), Leishmania spp (n=1) and Salmonella enterica (n=1), as well as latent infections with Mycobacterium tuberculosis complex (n=8). The infections were mainly imported from the African region and Eastern Mediterranean region and high proportions of cases lacked typical symptoms. Reported side effect rates of antimalarial chemoprophylaxis for mefloquine (n=121), atovaquone/proguanil (n=49) and doxycycline (n=6) were 36.3%, 19.3% and 11.8%, respectively, while non-compliance rates were 12.9%, 13.0% and 5.9%, respectively.

CONCLUSIONS

Considerable rates of infections with sometimes atypical or absent symptoms confirm a need for returnee screenings after tropical deployments. High reported side effect rates for mefloquine support its replacement by atovaquone/proguanil or doxycycline for antimalarial chemoprophylaxis.