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Tagoe JA, Addo SO, Mosore MT, Bentil RE, Agbodzi B, Behene E, Ladzekpo D, Addae CA, Nimo-Painstil S, Fox AT, Bimi L, Dafeamekpor C, Richards AL, Letizia AG, Diclaro JW, Dadzie SK. First Molecular Identification of Rickettsia aeschlimannii and Rickettsia africae in Ticks from Ghana. Am J Trop Med Hyg 2024; 110:491-496. [PMID: 38295420 PMCID: PMC10919190 DOI: 10.4269/ajtmh.22-0753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/17/2023] [Indexed: 02/02/2024] Open
Abstract
The threats from vector-borne pathogens transmitted by ticks place people (including deployed troops) at increased risk for infection, frequently contributing to undifferentiated febrile illness syndromes. Wild and domesticated animals are critical to the transmission cycle of many tick-borne diseases. Livestock can be infected by ticks, and serve as hosts to tick-borne diseases such as rickettsiosis. Thus, it is necessary to identify the tick species and determine their potential to transmit pathogens. A total of 1,493 adult ticks from three genera-Amblyomma, Hyalomma, and Rhipicephalus-were identified using available morphological keys and were pooled (n = 541) by sex and species. Rickettsia species were detected in 308 of 541 (56.9%) pools by genus-specific quantitative polymerase chain reaction assay (Rick17b). Furthermore, sequencing of the outer membrane protein A and B genes (ompA and ompB) of random samples of Rickettsia-positive samples led to the identification of Rickettsia aeschlimannii and Rickettsia africae with most R. africae DNA (80.2%) detected in pools of Amblyomma variegatum. We report the first molecular detection and identification of the rickettsial pathogens R. africae and R. aeschlimannii in ticks from Ghana. Our findings suggest there is a need to use control measures to prevent infections from occurring among human populations in endemic areas in Ghana. This study underscores the importance of determining which vector-borne pathogens are in circulation in Ghana. Further clinical and prevalence studies are needed to understand more comprehensively the clinical impact of these rickettsial pathogens contributing to human disease and morbidity in Ghana.
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Affiliation(s)
- Janice A. Tagoe
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Seth O. Addo
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mba-tihssommah Mosore
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ronald E. Bentil
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Bright Agbodzi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Eric Behene
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Danielle Ladzekpo
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Charlotte A. Addae
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Anne T. Fox
- U.S Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | - Langbong Bimi
- Department of Animal Biology and Conservation Science, University of Ghana, Accra, Ghana
| | | | - Allen L. Richards
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, Maryland
| | - Andrew G. Letizia
- Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, Maryland
| | | | - Samuel K. Dadzie
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
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Rockowitz S, Wagner K, Cooper R, Stevens L, Davies K, Woodhams J, Kanja W, Flowe HD. A Systematic Review of Criminal Justice Initiatives to Strengthen the Criminal Investigation and Prosecution of Sexual Violence in East Africa. TRAUMA, VIOLENCE & ABUSE 2024; 25:813-827. [PMID: 37057398 PMCID: PMC10666499 DOI: 10.1177/15248380231165694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sexual violence (SV) is a widespread public health and human rights problem, with countries in East Africa having higher rates than the global average. Prosecutions of SV in East Africa are rare, and survivors face many challenges accessing medico-legal justice and services. Developing initiatives that support survivors in navigating the criminal justice system is vital, yet there is limited research on efforts to improve the criminal justice system's management and treatment of survivors. We conducted a scoping review of research on initiatives to strengthen responses toward investigating and prosecuting cases. We identified 25 academic articles and reports through a search of electronic databases and gray literature that address these initiatives in East Africa. The results reveal that seven types of initiatives have been studied: one-stop centers (OSCs), multisectoral referral networks, gender desks, community interventions, mobile applications, and specialized police and prosecution units. Upon review, we found that barriers to success include a lack of resources and facilities, a lack of trained health care, police, and judicial personnel to perform services, weak medico-legal partnerships, and stigma and impunity restricting the uptake and fair distribution of services. Overall, limited systematic evidence on the effectiveness and adaptability of initiatives exists, showing that SV interventions in East Africa remain an under-researched and under-resourced area, and need greater scientific rigor to inform practice and coordinated advocacy. This review is a call to action for policy makers and service providers working in East Africa-and for international bodies working toward achieving Sustainable Development Goals 5-to improve criminal justice initiatives.
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Rockowitz S, Flowe H, Bradbury-Jones C. A Scoping Review on Sexual and Gender-Based Violence Medicolegal Service Provision in East Africa. TRAUMA, VIOLENCE & ABUSE 2023; 24:3579-3592. [PMID: 36384339 PMCID: PMC10594834 DOI: 10.1177/15248380221134292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sexual and gender-based violence (SGBV) is a leading cause of physical, emotional, and psychosocial problems around the world, with many countries in East Africa having rates above the global average. Despite the high prevalence in the region, service provision for post-SGBV care is often poorly funded, difficult to access, or simply nonexistent. This review reports the findings of a scoping review of literature from East Africa. The goals of this research were to evaluate existing service provision practices throughout the region, understand how provider bias may affect service provision, and compare existing practices to national policies and internationally agreed human rights treaties. This review identified 54 academic papers and reports through a search of electronic databases and grey literature sources, and four main themes emerged: (1) current models of service provision are inadequate to address the medical and psychosocial needs of survivors; (2) countries are not providing sufficient funding for services; (3) further research is needed into how to incorporate SGBV care into existing health systems and align with international human rights treaties; and (4) there is limited research in many countries in East Africa. The findings are likely to be of use to policy makers, nongovernmental organizations, and service providers working in the medical, legal, and justice systems.
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Schawaller M, Wiemer D, Hagen RM, Frickmann H. Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years. BMJ Mil Health 2023; 169:146-151. [PMID: 33257519 DOI: 10.1136/bmjmilitary-2020-001575] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Marius Schawaller
- Department of Tropical Medicine and Infectious Diseases, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - D Wiemer
- Department of Tropical Medicine and Infectious Diseases, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - R M Hagen
- Department of Microbiology and Hospital Hygiene, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - H Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsmedizin Rostock, Rostock, Germany
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Kojima N, Ross J, Tymchuk C. Evaluation of Safety of Medical Trainees on Global Health Rotations. Am J Trop Med Hyg 2023; 108:227-230. [PMID: 36509048 PMCID: PMC9833064 DOI: 10.4269/ajtmh.22-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022] Open
Abstract
We conducted a survey on the health and safety of medical trainees who participated in a short-term international clinical elective at a large academic training institution. We distributed an anonymous 28-question online survey via e-mail to the 142 participants available who, together, completed 185 international clinical electives. Of the 142 participants sent an anonymous survey, we received 68 responses (response rate, 48%). Of the respondents, 41 (61%) reported experiencing some form of illness. Of those, two respondents (5%) reported seeking care from a medical physician. The most commonly reported adverse health events were diarrhea (n = 32, 48.5%); fever (n = 13, 19.4%); a cough, cold, or flu-like illness (n = 9, 13.4%); and vomiting (n = 7, 13.6%). There were no reported needlestick injuries or motor vehicle accidents, and none of the reported adverse health events led to hospitalization or early termination of the elective. Four participants (5.9%) reported concerns of personal property and two (2.9%) were victims of a robbery. Two participants (2.9%) reported concerns of physical safety; however, no one reported being a victim of physical assault. Although the majority of respondents reported experiencing some form of illness, the vast majority were minor and self-limited in nature. Further studies are needed to assess problems related to mental health on international rotations and whether interventions could be used to decrease the rates of illness among participants of short-term international clinical electives.
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Affiliation(s)
- Noah Kojima
- Department of Medicine, University of California Los Angeles, Los Angeles, California;,Address correspondence to Noah Kojima, Department of Medicine at UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095. E-mail:
| | - Jesse Ross
- Department of Medicine, Columbia University, New York, New York
| | - Christopher Tymchuk
- Department of Medicine, University of California Los Angeles, Los Angeles, California
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Manor DU, Grossman DT, Vainer J, Schwartz PE. A nationwide study of imported Plasmodium ovale and mixed infections in Israel 2008-2020. J Travel Med 2022; 29:6463573. [PMID: 34918125 DOI: 10.1093/jtm/taab192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Plasmodium ovale is a rather neglected plasmodium. Rarity, a milder disease, and diagnostic difficulties compared with P. falciparum and P. vivax have led to this situation. This study's objective is to present the epidemiological and diagnostical characteristics of imported P. ovale malaria in Israel. METHODS Malaria is a reportable disease in Israel. All highly suspected cases are sent to the Ministry of Health central parasitology laboratory for molecular verification. We retrieved epidemiological and diagnostic data on all polymerase chain reaction (PCR)-proven P. ovale infections imported to between 2008 and 2020. RESULTS In total, 508 malaria cases were identified, 489 monoinfections and 19 (3.7%) mixed. Fifty-one (10%) were due to P. ovale, among them 13 (25%) were mixed, comprising 68% of all mixed infections. Forty-eight of 51 (94%) underwent blood microscopy, with a sensitivity of 94% (45/48) for genus identification and 15% (7/48) for P. ovale identification. Only 8% (1/12) of mixed infections were identified as such by microscopy. Forty-two (82%) patients underwent RDTs, with a sensitivity of 69% (29/42) for genus identification, and 62% (26/42) for identifying non-falciparum infections. Cycle threshold (Ct) values of P. ovale were significantly higher compared with P. falciparum and P. vivax in both mono and mixed infections (P < 0.05, P < 0.005). Ct levels in RDT positive vs negative infections differed significantly (P < 0.05). CONCLUSIONS P. ovale is commonly imported to Israel from Africa, with a high rate of mixed infections. The use of RDTs and microscopy is insufficient for the species-specific diagnosis of P. ovale, and must be complemented by PCR.
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Affiliation(s)
- Dr Uri Manor
- Internal Medicine "C", Sheba Medical Center, Dereh Sheba 2, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Klatchkin 35, Tel-Aviv, Israel
| | - Dr Tamar Grossman
- Public Health Laboratories - Jerusalem (PHL-J), Public Health Services (PHS), Ministry of Health (MOH), Eliav Yaakov 9, Jerusalem, Israel
| | - Julia Vainer
- Public Health Laboratories - Jerusalem (PHL-J), Public Health Services (PHS), Ministry of Health (MOH), Eliav Yaakov 9, Jerusalem, Israel
| | - Professor Eli Schwartz
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Dereh Sheba 2, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Klatchkin 35, Tel-Aviv, Israel
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Silva-Ramos CR, Faccini-Martínez ÁA. Clinical, epidemiological, and laboratory features of Rickettsia africae infection, African tick-bite fever: A systematic review. LE INFEZIONI IN MEDICINA 2022; 29:366-377. [PMID: 35146341 DOI: 10.53854/liim-2903-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
African tick-bite fever (ATBF), caused by Rickettsia africae, is the main tick-borne rickettsiosis and the second most frequent cause of fever after malaria in travelers returning from sub-Saharan Africa. General descriptions on ATBF were made in the first two decades after recognized as a new infectious entity, and since then, many authors have contributed to the knowledge of the disease by reporting clinical cases in scientific literature. We developed a systematic review that evaluated all available evidence in the literature regarding clinical, epidemiological, and laboratory features of confirmed R. africae rickettsiosis cases. We followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide. A total of 48 scientific publications (108 confirmed cases) were analyzed in order to extract data for developing this review. Overall, our results show that R. africae rickettsiosis is more frequent in males in the age group of 18-64 years, more than 80% of the cases occurred in European travelers, South Africa was the country where most infections were acquired, and almost 40% of cases occurred in clusters. Clinically, more than 80% of the cases had fever and eschar (55% developed multiple eschars), rash was present in less than the half of cases, and lymphangitis was not a common sign (11%). Headache, myalgia and regional lymphadenopathy were predominant nonspecific clinical manifestation (mean of 60%, 49% and 51%, respectively). Our results show that at least 70% of R. africae cases had altered laboratory parameters, most often showing an increase in transaminases and C-reactive protein. Tetracycline-class antibiotics, as monotherapy, were used in most (>90%) of the patients. Overall, only 4% of cases had complications, 12% required hospitalization, and there was a 100% rate of clinical recovery.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Álvaro A Faccini-Martínez
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.,Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia
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Rainfall Variability and Trends over the African Continent Using TAMSAT Data (1983–2020): Towards Climate Change Resilience and Adaptation. REMOTE SENSING 2021. [DOI: 10.3390/rs14010096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study reveals rainfall variability and trends in the African continent using TAMSAT data from 1983 to 2020. In the study, a Mann–Kendall (MK) test and Sen’s slope estimator were used to analyze rainfall trends and their magnitude, respectively, under monthly, seasonal, and annual timeframes as an indication of climate change using different natural and geographical contexts (i.e., sub-regions, climate zones, major river basins, and countries). The study finds that the highest annual rainfall trends were recorded in Rwanda (11.97 mm/year), the Gulf of Guinea (river basin 8.71 mm/year), the tropical rainforest climate zone (8.21 mm/year), and the Central African region (6.84 mm/year), while Mozambique (−0.437 mm/year), the subtropical northern desert (0.80 mm/year), the west coast river basin of South Africa (−0.360 mm/year), and the Northern Africa region (1.07 mm/year) show the lowest annual rainfall trends. There is a statistically significant increase in the rainfall in the countries of Africa’s northern and central regions, while there is no statistically significant change in the countries of the southern and eastern regions. In terms of climate zones, in the tropical northern desert climates, tropical northern peninsulas, and tropical grasslands, there is a significant increase in rainfall over the entire timeframe of the month, season, and year. This implies that increased rainfall will have a positive effect on the food security of the countries in those climatic zones. Since a large percentage of Africa’s agriculture is based only on rainfall (i.e., rain-fed agriculture), increasing trends in rainfall can assist climate resilience and adaptation, while declining rainfall trends can badly affect it. This information can be crucial for decision-makers concerned with effective crop planning and water resource management. The rainfall variability and trend analysis of this study provide important information to decision-makers that need to effectively mitigate drought and flood risk.
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Abdel-Haq N, Asmar BI. Fever in the Returned Pediatric Traveler. Glob Pediatr Health 2021; 8:2333794X211026188. [PMID: 34423077 PMCID: PMC8375340 DOI: 10.1177/2333794x211026188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/15/2022] Open
Abstract
Global mobility has been steadily increasing in recent years. The assessment of the febrile child returning from international travel is a diagnostic challenge. The COVID-19 pandemic has profoundly affected international travel and made evaluation and management of the sick returned traveler more challenging. Children visiting friends and relatives abroad remain at higher risk of infection compared to tourists. This review presents a guidance on the initial assessment of a traveling febrile child including interpretation of medical history, physical examination, and laboratory findings. Important clues to etiology include exposure to different infectious agents, incubation periods of pathogens, and prophylaxis regimens and vaccines received. Early identification of potentially life-threatening and highly contagious infections is essential. In this article, we discuss the epidemiology, evaluation, and management of specific travel related infections such as malaria, typhoid fever, dengue fever, viral hemorrhagic fever, rickettsiosis, leptospirosis, schistosomiasis, gastrointestinal, and respiratory infections.
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Affiliation(s)
- Nahed Abdel-Haq
- Children’s Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
- Wayne State University, Detroit, MI, USA
| | - Basim I. Asmar
- Children’s Hospital of Michigan, Detroit, MI, USA
- Central Michigan University, Mount Pleasant, MI, USA
- Wayne State University, Detroit, MI, USA
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Rezaei SJ, Mateen FJ. Encephalitis and meningitis in Western Africa: a scoping review of pathogens. Trop Med Int Health 2021; 26:388-396. [PMID: 33340211 DOI: 10.1111/tmi.13539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To give an overview of the recently reported literature on the aetiologies of meningitis and encephalitis in western sub-Saharan Africa. METHODS We conducted a scoping review following PRISMA guidance on published meningitis and encephalitis cases in the 16 countries of the United Nations-defined western sub-Saharan African region as identified in cohort studies, case series, and case reports, published 01/01/2000-08/01/2020, and available in four databases in August 2020 with an abstract in English, French or Italian. RESULTS There were 38 distinct pathogens identified from 91 cohort studies' data and 48 case reports or case series' data. In cohort-level data, the majority of cases were caused by Neisseria meningitidis (71.5%), Streptococcus pneumoniae (17.6%) and Haemophilus influenzae (7.3%). In case report- and case series-level data, 40.5% of patients were <18 years old, 28.6% were female, and 28.6% were known to be immunocompromised. The case fatality rate was 39.3%. The most commonly reported pathogens among immunocompetent patients were Salmonella species (13 cases) and Ebola virus (9 cases), and the most commonly reported pathogen among immunocompromised patients was Cryptococcus neoformans (18 cases). Most cohort cases (52.3%) derived from Niger followed by Burkina Faso (28.6%). Most cases from single reports or series were reported from Nigeria (21.4%), Mali (20.2%) and Burkina Faso (19.0%). CONCLUSIONS Given the small number of pathogens reported, our findings underscore the need to better screen, diagnose and monitor populations in western sub-Saharan Africa for additional CNS pathogens, including those posing significant outbreak risks.
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Affiliation(s)
- Shawheen J Rezaei
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Buss I, Genton B, D'Acremont V. Aetiology of fever in returning travellers and migrants: a systematic review and meta-analysis. J Travel Med 2020; 27:5955503. [PMID: 33146395 PMCID: PMC7665639 DOI: 10.1093/jtm/taaa207] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Numerous publications focus on fever in returning travellers, but there is no known systematic review considering all diseases, or all tropical diseases causing fever. Such a review is necessary in order to develop appropriate practice guidelines. OBJECTIVES Primary objectives of this review were (i) to determine the aetiology of fever in travellers/migrants returning from (sub) tropical countries as well as the proportion of patients with specific diagnoses, and (ii) to assess the predictors for specific tropical diseases. METHOD Embase, MEDLINE and Cochrane Library were searched with terms combining fever and travel/migrants. All studies focusing on causes of fever in returning travellers and/or clinical and laboratory predictors of tropical diseases were included. Meta-analyses were performed on frequencies of etiological diagnoses. RESULTS 10 064 studies were identified; 541 underwent full-text review; 30 met criteria for data extraction. Tropical infections accounted for 33% of fever diagnoses, with malaria causing 22%, dengue 5% and enteric fever 2%. Non-tropical infections accounted for 36% of febrile cases, with acute gastroenteritis causing 14% and respiratory tract infections 13%. Positive likelihood ratios demonstrated that splenomegaly, thrombocytopenia and hyperbilirubinemia were respectively 5-14, 3-11 and 5-7 times more likely in malaria than non-malaria patients. High variability of results between studies reflects heterogeneity in study design, regions visited, participants' characteristics, setting, laboratory investigations performed and diseases included. CONCLUSION Malaria accounted for one-fifth of febrile cases, highlighting the importance of rapid malaria testing in febrile returning travellers, followed by other rapid tests for common tropical diseases. High variability between studies highlights the need to harmonize study designs and to promote multi-centre studies investigating predictors of diseases, including of lower incidence, which may help to develop evidence-based guidelines. The use of clinical decision support algorithms by health workers which incorporate clinical predictors, could help standardize studies as well as improve quality of recommendations.
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Affiliation(s)
- Imogen Buss
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Blaise Genton
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Valérie D'Acremont
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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12
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Wu Y, Liu MY, Wang JL, Zhang HY, Sun Y, Yuan Y, Zhou SX, Wang YX, Wang ZB, Zhu YX, Han Y, Liu MM, Li WM, Wang LP, Guo XH, Fang LQ, Liu W. Epidemiology of imported infectious diseases, China, 2014-18. J Travel Med 2020; 27:6018450. [PMID: 33283238 PMCID: PMC7757385 DOI: 10.1093/jtm/taaa211] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The frequent movement of population between countries brings an increasing number of travel-related infections. This study aims to define the spectrum and dynamics of imported infections observed from international travel in the Chinese mainland. METHODS Sick travellers were screened by inbound sentinel surveillance and post-travel clinic visits from 2014 to 18. The infections were classified as respiratory, gastrointestinal, vector-borne, blood/sexually transmitted and mucocutaneous. The analysed variables included the place of origin of the travellers (Chinese or foreign) and the time when travel-related infection was present (at the time of return, during travel and post-travel visits to the clinic). RESULTS In total, 58 677 cases were identified amongst 1 409 265 253 travellers, with an incidence of 41.64/million, comprising during-travel incidence of 27.44/million and a post-travel incidence of 14.20/million. Respiratory infections constituted the highest proportion of illnesses during travel (81.19%, 31 393 of 38 667), which mainly came from Asian countries and tourists; with influenza virus and rhinovirus infections being mainly diagnosed. Vector-borne diseases constituted the highest proportion of post-travel illnesses (98.14%, 19 638 of 20 010), which were mainly diagnosed from African countries and labourers; with malaria and dengue fever being mainly diagnosed. The differential infection spectrum varied in terms of the traveller's demography, travel destination and travel purpose. As such, a higher proportion of foreign travellers had blood/sexually transmitted diseases (89.85%, 2832 of 3152), while Chinese citizens had a higher prevalence of vector-borne diseases (85.98%, 19 247 of 22 387) and gastrointestinal diseases (79.36%, 1115 of 1405). The highest incidence rate was observed amongst travellers arriving from Africa, while the lowest was observed amongst travellers arriving from Europe. CONCLUSIONS The findings might help in preparing recommendations for travellers and also aid in primary care or other clinics that prepare travellers before trips abroad. The findings will also help to identify locations and the associated types of infections that might require attention.
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Affiliation(s)
- Yang Wu
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing, P.R. China
| | - Meng-Yang Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P.R. China
| | - Jin-Long Wang
- Division of Science and Technology, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Hai-Yang Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P.R. China
| | - Yu Sun
- Tsinghua University Press, Beijing, P.R. China
| | - Yang Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P.R. China
| | - Shi-Xia Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P.R. China
| | - Yi-Xing Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P.R. China
| | - Zhi-Bo Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P.R. China
| | - Ying-Xuan Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P.R. China
| | - Yong Han
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P.R. China
| | - Meng-Meng Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P.R. China
| | - Wei-Ming Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P.R. China
| | - Li-Ping Wang
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Xiu-Hua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P.R. China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P.R. China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P.R. China.,Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, P.R. China
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13
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Osman S, Preet R. Dengue, chikungunya and Zika in GeoSentinel surveillance of international travellers: a literature review from 1995 to 2020. J Travel Med 2020; 27:6007546. [PMID: 33258476 DOI: 10.1093/jtm/taaa222] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION GeoSentinel is a global surveillance network of travel medicine providers seeing ill-returned travellers. Much of our knowledge on health problems and infectious encountered by international travellers has evolved as a result of GeoSentinel surveillance, providing geographic and temporal trends in morbidity among travellers while contributing to improved pre-travel advice. We set out to synthesize epidemiological information, clinical manifestations and time trends for dengue, chikungunya and Zika in travellers as captured by GeoSentinel. METHODS We conducted a systematic literature search in PubMed on international travellers who presented with dengue, chikungunya or Zika virus infections to GeoSentinel sites around the world from 1995 until 2020. RESULTS Of 107 GeoSentinel publications, 42 articles were related to dengue, chikungunya and/or Zika. The final analyses and synthesis of and results presented here are based on the findings from 27 original articles covering the three arboviral diseases. CONCLUSIONS Dengue is the most frequent arboviral disease encountered in travellers presenting to GeoSentinel sites, with increasing trends over the past two decades. In Southeast Asia, annual proportionate morbidity increased from 50 dengue cases per 1000 ill returned travellers in non-epidemic years to an average of 159 cases per 1000 travellers during epidemic years. The highest number of travellers with chikungunya virus infections was reported during the chikungunya outbreak in the Americas and the Caribbean in the years 2013-16. Zika was first reported by GeoSentinel already in 2012, but notifications peaked in the years 2016-17 reflecting the public health emergency in the Americas at the time.
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Affiliation(s)
- S Osman
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, 90185, Sweden
| | - R Preet
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, 90185, Sweden
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14
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Meltzer E, Rahav G, Schwartz E. Vivax Malaria Chemoprophylaxis: The Role of Atovaquone-Proguanil Compared to Other Options. Clin Infect Dis 2019; 66:1751-1755. [PMID: 29228132 DOI: 10.1093/cid/cix1077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/04/2017] [Indexed: 01/01/2023] Open
Abstract
Background Atovaquone-proguanil is considered causal prophylaxis (inhibition of liver-stage schizonts) for Plasmodium falciparum; however, its causal prophylactic efficacy for Plasmodium vivax is not known. Travelers returning to nonendemic areas provide a unique opportunity to study P. vivax prophylaxis. Methods In a retrospective observational study, for 11 years, Israeli rafters who had traveled to the Omo River in Ethiopia, a highly malaria-endemic area, were followed for at least 1 year after their return. Malaria prophylaxis used during this period included mefloquine, doxycycline, primaquine, and atovaquone-proguanil. Prophylaxis failure was divided into early (within a month of exposure) and late malaria. Results Two hundred fifty-two travelers were included in the study. Sixty-two (24.6%) travelers developed malaria, 56 (91.9%) caused by P. vivax, with 54 (87.1%) cases considered as late malaria. Among travelers using atovaquone-proguanil, there were no cases of early P. falciparum or P. vivax malaria. However, 50.0% of atovaquone-proguanil users developed late vivax malaria, as did 46.5% and 43.5% of mefloquine and doxycycline users, respectively; only 2 (1.4%) primaquine users developed late malaria (P < .0001). Conclusions Short-course atovaquone-proguanil appears to provide causal (liver schizont stage) prophylaxis for P. vivax, but is ineffective against late, hypnozoite reactivation-related attacks. These findings suggest that primaquine should be considered as the chemoprophylactic agent of choice for areas with high co-circulation of P. falciparum and P. vivax.
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Affiliation(s)
- Eyal Meltzer
- Center for Geographic Medicine and Tropical Diseases, Tel Hashomer, Israel.,Department of Medicine C, Tel Hashomer, Israel
| | - Galia Rahav
- Infectious Diseases Unit, The Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
| | - Eli Schwartz
- Center for Geographic Medicine and Tropical Diseases, Tel Hashomer, Israel.,Department of Medicine C, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Israel
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15
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Odeniran PO, Ademola IO, Jegede HO. A review of wildlife tourism and meta-analysis of parasitism in Africa's national parks and game reserves. Parasitol Res 2018; 117:2359-2378. [PMID: 29948206 DOI: 10.1007/s00436-018-5958-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/05/2018] [Indexed: 12/14/2022]
Abstract
The recent increase of parasitic diseases associated with wildlife tourism can be traced to human contact with wildlife and intense modification of wildlife habitat. The continental estimates of parasitic diseases among visited wildlife-tourists and mammalian wildlife present in conservation areas are lacking; therefore, a general review was necessary to provide insights into Africa's parasitic disease burden and transmission between humans and wildlife. A two-step analysis was conducted with searches in Ovid MEDLINE, EMBASE, PubMed, Web of Science and Global Health. All diseases reported without prevalence were grouped and analysed as categorical data while meta-analysis of prevalence rates of parasitic diseases in wildlife from national parks and reserves in Africa was conducted. Only 4.7% of the tourist centres reported routine wildlife diagnosis for parasitic diseases. Disease intensity shows that cryptosporidiosis and seven other parasitic diseases were observed in both human and wildlife; however, no significant difference in intensity between human and wildlife hosts was observed. Schistosomiasis intensity reports showed a significant increase (P < 0.05) while entamoebiasis showed a significant decrease (P < 0.05) in humans as compared to wildlife. Visiting tourists were more infected with malaria, while wildlife was more infected with parasitic gastroenteritis (PGE). The meta-analysis of wildlife revealed the highest prevalence of PGE with mixed parasites and lowest prevalence of Giardia spp. at 99.9 and 5.7%, respectively. The zoonotic and socioeconomic impact of some of these parasites could pose a severe public threat to tourism. Pre- and post-travel clinical examinations are important for tourists while routine examination, treatment and rational surveillance are important for these animals to improve wildlife tourism.
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Affiliation(s)
- Paul Olalekan Odeniran
- Department of Veterinary Parasitology and Entomology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Isaiah Oluwafemi Ademola
- Department of Veterinary Parasitology and Entomology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
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16
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Frickmann H, Hagen RM, Geiselbrechtinger F, Hoysal N. Infectious diseases during the European Union training mission Mali (EUTM MLI) - a four-year experience. Mil Med Res 2018; 5:19. [PMID: 29848381 PMCID: PMC5977544 DOI: 10.1186/s40779-018-0166-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The European Union Training Mission Mali (EUTM MLI) is a multinational military training deployment to the Western African tropical nation of Mali. Based on routinely collected disease and non-battle injury surveillance data, this study quantifies the true impact of infectious diseases for this tropical mission and potential seasonal variations in infectious disease threats. METHODS Categorized health events during the EUTM MLI mission and associated lost working days were reported using the EpiNATO-2 report. Infection-related health events were descriptively analyzed for a 4-year period from the 12th week in 2013 to the 13th week in 2017. Aggregated EpiNATO-2 data collected from all missions other than EUTM MLI were used as a comparator. RESULTS Among the infectious diseases reported by EUTM MLI, non-severe upper respiratory infections and gastrointestinal diseases dominated quantitatively, accounting for 1.65 and 1.42 consultations per 100 person-weeks, respectively. The number of recorded infectious disease-associated lost working days during the whole study interval was 723. Seasonal changes in disease frequency were detectable. More gastrointestinal infections were seen in the rainy season, and more respiratory infections occurred in the dry season; these were associated with peaks of more than 2.5 consultations per 100 person-weeks for both categories. CONCLUSIONS Despite initial concerns focused on tropical infectious diseases during this mission in tropical Mali, upper respiratory tract and gastrointestinal infections predominate. The relatively low number of reported lost working days may indicate that these infections are at the milder end of the spectrum of infectious diseases despite a likely reporting bias.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359, Hamburg, Germany. .,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany.
| | - Ralf Matthias Hagen
- Department of Preventive Medicine, Bundeswehr Medical Academy, Neuherbergstraße 11, 80937, Munich, Germany
| | - Florian Geiselbrechtinger
- NATO Center of Excellence for Military Medicine (MilMedCOE), Deployment Health Surveillance Capability (DHSC), Dachauer Str. 128, 80637, Munich, Germany.,Institute of Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchionini-Str. 15, 81377, Munich, Germany
| | - Nagpal Hoysal
- NATO Center of Excellence for Military Medicine (MilMedCOE), Deployment Health Surveillance Capability (DHSC), Dachauer Str. 128, 80637, Munich, Germany
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17
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Abstract
: The role of the corporate medical director (CMD) has evolved over the last 300 years since Ramazzini first identified diseases of Italian workers in the early 1700s. Since then, there has been a gradual blurring of the boundaries between private and workplace health concerns. Today's CMD must have intimate knowledge of their corporation's industry and the businesses that they support, particularly the occupational and environmental programs that comply with all local, state, and/or national standards and regulations. Leading companies not only measure compliance with such standards but also may hold programs to their own internal corporate global standards even if these go beyond local government requirements. This document will explore in greater depth the strength and importance that the CMD brings to the business operations to support a healthy, engaged, and high performing workforce. Part 1 describes the role and value of the CMD, while Part 2 provides collective wisdom for the new CMD from current and past highly experienced CMDs.
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18
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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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19
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Nouchi A, Monsel G, Jaspard M, Jannic A, Angelakis E, Caumes E. Rickettsia sibirica mongolitimonae infection in a woman travelling from Cameroon: a case report and review of the literature. J Travel Med 2018; 25:4780169. [PMID: 29394384 DOI: 10.1093/jtm/tax074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/13/2017] [Indexed: 11/12/2022]
Abstract
Rickettsia sibirica mongolitimonae is now a well-known cause of human rickettsial infection, with 52 reported cases, including 47 in southern Europe and one in South Africa. We report the first case of R. sibirica mongolitimonae in Central Africa, likely a sentinel case for a more common disease than originally suspected.
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Affiliation(s)
- Agathe Nouchi
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gentiane Monsel
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Jaspard
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Arnaud Jannic
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Emmanouil Angelakis
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut Hospitalo-Universitaire Méditerranée Infection, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Eric Caumes
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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20
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Lingscheid T, Kurth F, Clerinx J, Marocco S, Trevino B, Schunk M, Muñoz J, Gjørup IE, Jelinek T, Develoux M, Fry G, Jänisch T, Schmid ML, Bouchaud O, Puente S, Zammarchi L, Mørch K, Björkman A, Siikamäki H, Neumayr A, Nielsen H, Hellgren U, Paul M, Calleri G, Kosina P, Myrvang B, Ramos JM, Just-Nübling G, Beltrame A, Saraiva da Cunha J, Kern P, Rochat L, Stich A, Pongratz P, Grobusch MP, Suttorp N, Witzenrath M, Hatz C, Zoller T. Schistosomiasis in European Travelers and Migrants: Analysis of 14 Years TropNet Surveillance Data. Am J Trop Med Hyg 2017; 97:567-574. [PMID: 28722637 PMCID: PMC5544096 DOI: 10.4269/ajtmh.17-0034] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/30/2017] [Indexed: 02/05/2023] Open
Abstract
Schistosomiasis remains one of the most prevalent parasitic diseases worldwide and the infection is frequently found in travelers and migrants. The European Network for Tropical Medicine and Travel Health conducted a sentinel surveillance study on imported schistosomiasis between 1997 and 2010. This report summarizes epidemiological and clinical data from 1,465 cases of imported schistosomiasis. Direct pathogen detection and serology were the main diagnostic tools applied. Of these, 486 (33%) cases were identified among European travelers, 231 (16%) among long-term expatriates, and 748 (51%) among non-European immigrants. Overall, only 18.6% of travelers had received pretravel advice; 95% of infections were acquired in the African region. On species level, Schistosoma mansoni was identified in 570 (39%) and Schistosoma haematobium in 318 (22%) cases; 57.5% of patients were symptomatic. Acute symptoms were reported in 27% of patients leading to earlier presentation within 3 months. Praziquantel was used in all patients to treat schistosomiasis. Many infections were detected in asymptomatic patients. In 47.4% of asymptomatic patients infection was detected by microscopy and in 39% by serology or antigen testing. Schistosomiasis remains a frequent infection in travelers and migrants to Europe. Travelers should be made aware of the risk of schistosomiasis infection when traveling to sub-Saharan Africa. Posttravel consultations particularly for returning expatriates are useful given the high potential for detecting asymptomatic infections.
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Affiliation(s)
- Tilman Lingscheid
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Kurth
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Clerinx
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Stefania Marocco
- Centro per le Malattie Tropicali, Ospedale S. Cuore, Negrar, Verona, Italy
| | - Begoña Trevino
- Tropical Medicine and International Health Unit, Hospital Vall d’Hebron Drassanes, PROSICS Barcelona, Barcelona, Spain
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the Ludwig-Maximilians-University (LMU), Munich, Germany
| | - José Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ida E. Gjørup
- Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark
| | - Tomas Jelinek
- Berlin Centre for Travel and Tropical Medicine, Berlin, Germany
| | - Michel Develoux
- Service de Parasitologie, Hôpital Saint-Antoine, Paris, France
| | - Graham Fry
- Tropical Medical Bureau, Dublin, Ireland
| | - Thomas Jänisch
- Department of Infectious Diseases, University Hospital Heideberg, Heidelberg, Germany
| | - Matthias L. Schmid
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Olivier Bouchaud
- Consultation de médecine tropicale, Hôpital Avicenne, Bobigny, France
| | | | - Lorenzo Zammarchi
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Kristine Mørch
- Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Anders Björkman
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Heli Siikamäki
- Inflammation Centre, Clinic of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Urban Hellgren
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Paul
- Department and Clinic of Tropical and Parasitic Diseases, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Guido Calleri
- Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy
| | - Pavel Kosina
- Department of Infectious Diseases, University Hospital, Hradec Králové, Czech Republic
| | | | - José M. Ramos
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
| | - Gudrun Just-Nübling
- Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt, Main, Germany
| | - Anna Beltrame
- Centro per le Malattie Tropicali, Ospedale S. Cuore, Negrar, Verona, Italy
- Clinic of Infectious Diseases, University of Udine, Udine, Italy
| | | | - Peter Kern
- Department of Internal Medicine III, Comprehensive Infectious Diseases Center, Ulm University Hospital, Ulm, Germany
| | - Laurence Rochat
- Department of Ambulatory Care and Community Medicine, Travel Clinic, University Hospital, Lausanne, Switzerland
| | - August Stich
- Abteilung Tropenmedizin, Missionsärztliche Klinik, Würzburg, Germany
| | - Peter Pongratz
- Division of Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Germany
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Norbert Suttorp
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Witzenrath
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Zoller
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - TropNet Schistosomiasis Investigator Group
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of Tropical Medicine, Antwerp, Belgium
- Centro per le Malattie Tropicali, Ospedale S. Cuore, Negrar, Verona, Italy
- Tropical Medicine and International Health Unit, Hospital Vall d’Hebron Drassanes, PROSICS Barcelona, Barcelona, Spain
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the Ludwig-Maximilians-University (LMU), Munich, Germany
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark
- Berlin Centre for Travel and Tropical Medicine, Berlin, Germany
- Service de Parasitologie, Hôpital Saint-Antoine, Paris, France
- Tropical Medical Bureau, Dublin, Ireland
- Department of Infectious Diseases, University Hospital Heideberg, Heidelberg, Germany
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Consultation de médecine tropicale, Hôpital Avicenne, Bobigny, France
- Hospital Carlos III, Madrid, Spain
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Inflammation Centre, Clinic of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department and Clinic of Tropical and Parasitic Diseases, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
- Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy
- Department of Infectious Diseases, University Hospital, Hradec Králové, Czech Republic
- Oslo University Hospital, Ullevål, Norway
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
- Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt, Main, Germany
- Clinic of Infectious Diseases, University of Udine, Udine, Italy
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Department of Internal Medicine III, Comprehensive Infectious Diseases Center, Ulm University Hospital, Ulm, Germany
- Department of Ambulatory Care and Community Medicine, Travel Clinic, University Hospital, Lausanne, Switzerland
- Abteilung Tropenmedizin, Missionsärztliche Klinik, Würzburg, Germany
- Division of Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Germany
- Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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21
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Duplessis CA, Gutierrez RL, Porter CK. Review: chronic and persistent diarrhea with a focus in the returning traveler. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2017; 3:9. [PMID: 28883979 PMCID: PMC5531020 DOI: 10.1186/s40794-017-0052-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 04/18/2017] [Indexed: 02/08/2023]
Abstract
Background Travelers’ diarrhea is a common malady afflicting up to 50% of travelers after a 2-week travel period. An appreciable percentage of these cases will become persistent or chronic. We summarized the published literature reporting persistent/chronic diarrhea in travelers elucidating current understanding of disease incidence, etiology and regional variability. Methods We searched electronic databases (Medline, Embase, and Cochrane database of clinical trials) from 1990 to 2015 using the following terms: “chronic or persistent diarrh* and (returning) travel* or enteropathogen, GeoSentinel, and travel-associated infection. Included studies published in the English language on adult returning travelers (duration < 3-months) reporting denominator data. Point estimates and standard 95% confidence intervals were calculated for incidence using a random-effects model. Study incidence heterogeneity rates were assessed using x2 heterogeneity statistics, graphically represented with Forest plots. Results We identified 19 studies meeting the inclusion criteria (all published after 1999). 18 studies reported upon the incidence of persistent/chronic diarrhea as a syndromic diagnosis in returning travelers; one study reported adequate denominator data from which to assess pathogen specific etiology. Giardiasis comprise an appreicaible percentage of infectious mediated persistent/chronic diarrhea in returning travelers. The overall estimate of persistent/chronic diarrhea incidence was 6% (0.05–0.07) in 321,454, travelers; with significant heterogeniety observed across regions. The total number of regional travelers, and point estimates for incidence (95% CI) for Latin American, African, and Asian travelers were [15816 (0.09 [0.07–0.11]), 42290 (0.06 [0.05–0.07]), and 27433 (0.07 [0.06–0.09])] respectively. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Persistent/chronic diarrhea ranked fourth as a syndromic diagnosis in all regions. Conclusions Persistent/Chronic diarrhea is a leading syndromic diagnosis in returning travelers across all regions. The 6% incidence [proportionate morbidity (PM) of 60] observed in over >300,000 global travelers is comparable to prior estimates. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Giardiasis comprises an appreciabile percentatge of travel-associated infectious mediated persistent/chronic diarrhea. There’s a dearth of published data characterizing the incidence of specific enteropathogenic etiologies for persistent/chronic diarrhea in returning travelers.
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Affiliation(s)
- Christopher A Duplessis
- Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | - Ramiro L Gutierrez
- Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
| | - Chad K Porter
- Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA
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Burchard GD, Grobusch MP. Central Africa. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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23
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Antinori S, Parravicini C, Galimberti L, Tosoni A, Giunta P, Galli M, Corbellino M, Ridolfo AL. Is imported onchocerciasis a truly rare entity? Case report and review of the literature. Travel Med Infect Dis 2017; 16:11-17. [PMID: 28232074 DOI: 10.1016/j.tmaid.2017.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Onchocerciasis is endemic in a number of tropical countries in Africa and South America, and it is occasionally diagnosed as an imported disease in non-endemic areas. METHODS We describe the case of an African migrant with long-lasting pruritus and a cutaneous nodule who was diagnosed with onchocerciasis after nodulectomy, and review the medical literature regarding imported cases of onchocerciasis in the period 1994-2014. RESULTS Twenty-nine cases of onchocerciasis diagnosed in migrants from endemic countries, and in expatriates and travellers from non-endemic areas were retrieved. They were predominantly males (73.3%), had a median age of 37 years (two were aged <15 years), and acquired the diseases in sub-Saharan Africa, most frequently in Cameroon (43.3%). Diagnosis of onchocercosis was proven in 73.3% of patients. The most frequent clinical manifestations in these and our own patient were pruritus (23/30, 76.7%), unilateral leg or forearm swelling (13/30, 43.3%) and rash (12/30, 40.0%), whereas only two (6.9%) complained of eye symptoms. Eosinophilia was observed in almost all of the patients (92.0%), with median counts of 2915/μL among migrants and 1960/μL among travellers/expatriates. Eighteen patients underwent a skin snip biopsy, which was positive in 10 cases (55.5%); in the other 13 patients the parasite was directly demonstrated by means of a skin or nodule biopsy (n = 5), nodulectomy (n = 5) or slit lamp examination (n = 3). Eighteen received ivermectin, alone, and seven ivermectin combined with diethylcarbamazine or doxycycline. Outcome details were available for only 14 patients, all of whom were asymptomatic after a median follow-up of 10 months (range 1-48). CONCLUSIONS Onchocerciasis is a neglected tropical disease whose subtle and non-specific features may lead to under-diagnosis or underreporting in non-endemic areas. Physicians should consider this tropical disease when caring for migrants and travellers/expatriates with pruritus, skin lesions and eosinophilia.
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Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milano, Italy; III Division of Infectious Diseases, Luigi Sacco Hospital, Fatebenefratelli Sacco ASST, Milano, Italy.
| | - Carlo Parravicini
- Pathology Unit, Luigi Sacco Hospital, Fatebenefratelli Sacco ASST, Milano, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, Luigi Sacco Hospital, Fatebenefratelli Sacco ASST, Milano, Italy
| | - Antonella Tosoni
- Pathology Unit, Luigi Sacco Hospital, Fatebenefratelli Sacco ASST, Milano, Italy
| | - Paolo Giunta
- Pathology Unit, Melegnano and Martesana ASST, Vizzolo Predabissi, Italy
| | - Massimo Galli
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milano, Italy; III Division of Infectious Diseases, Luigi Sacco Hospital, Fatebenefratelli Sacco ASST, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, Luigi Sacco Hospital, Fatebenefratelli Sacco ASST, Milano, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, Luigi Sacco Hospital, Fatebenefratelli Sacco ASST, Milano, Italy
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Approach to Eosinophilia in a Traveler from the Tropics. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Affiliation(s)
- David O Freedman
- From the William C. Gorgas Center for Geographic Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (D.O.F.); the Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA (L.H.C.); the Department of Medicine, Harvard Medical School, Boston (L.H.C.); and the Division of Infectious Diseases, Emory University, Atlanta (P.E.K.)
| | - Lin H Chen
- From the William C. Gorgas Center for Geographic Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (D.O.F.); the Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA (L.H.C.); the Department of Medicine, Harvard Medical School, Boston (L.H.C.); and the Division of Infectious Diseases, Emory University, Atlanta (P.E.K.)
| | - Phyllis E Kozarsky
- From the William C. Gorgas Center for Geographic Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham (D.O.F.); the Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA (L.H.C.); the Department of Medicine, Harvard Medical School, Boston (L.H.C.); and the Division of Infectious Diseases, Emory University, Atlanta (P.E.K.)
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26
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Vilkman K, Pakkanen SH, Lääveri T, Siikamäki H, Kantele A. Travelers' health problems and behavior: prospective study with post-travel follow-up. BMC Infect Dis 2016; 16:328. [PMID: 27412525 PMCID: PMC4944265 DOI: 10.1186/s12879-016-1682-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022] Open
Abstract
Background The annual number of international tourist arrivals has recently exceeded one billion, yet surprisingly few studies have characterized travelers’ behavior, illness, and risk factors in a prospective setting. Particularly scarce are surveys of data spanning travel, return, and follow-up of the same cohort. This study examines behavior and illness among travelers while abroad, after return home, and at follow-up. Patterns of behavior connected to type of travel and illness are characterized so as to identify risk factors and provide background data for pre-travel advice. Methods Volunteers to this prospective cohort study were recruited at visits to a travel clinic prior to departure. Data on the subjects’ health and behavior were collected by questionnaires before and after journeys and over a three-week follow-up. In addition, the subjects were asked to fill in health diaries while traveling. Results The final study population consisted of 460 subjects, 79 % of whom reported illness during travel or on arrival: 69 % had travelers’ diarrhea (TD), 17 % skin problems, 17 % fever, 12 % vomiting, 8 % respiratory tract infection, 4 % urinary tract infection, 2 % ear infection, 4 % gastrointestinal complaints other than TD or vomiting, and 4 % other symptoms. Of all subjects, 10 % consulted a doctor and 0.7 % were hospitalized; 18 % took antimicrobials, with TD as the most common indication (64 %). Ongoing symptoms were reported by 25 % of all travelers upon return home. During the three-week follow-up (return rate 51 %), 32 % of respondents developed new-onset symptoms, 20 % visited a doctor and 1.7 % were hospitalized. Factors predisposing to health problems were identified by multivariable analysis: certain regions (Southern Asia, South-Eastern Asia, and Eastern Africa), female gender, young age, and long travel duration. Conclusions Despite proper preventive measures like vaccinations, malaria prophylaxis, and travel advice, the majority of our subjects fell ill during or after travel. As the symptoms mostly remained mild, health care services were seldom needed. Typical traveler profiles were identified, thereby providing a tool for pre-travel advice. The finding that one third reported new-onset illness during follow-up attests to the importance of advising clients on potential post-travel health problems already during pre-travel visits. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1682-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katri Vilkman
- Department of Bacteriology and Immunology, University of Helsinki, Haartmaninkatu 3, (P.O. Box 21), 00014, Helsinki, Finland.,Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland
| | - Sari H Pakkanen
- Department of Bacteriology and Immunology, University of Helsinki, Haartmaninkatu 3, (P.O. Box 21), 00014, Helsinki, Finland
| | - Tinja Lääveri
- Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland
| | - Heli Siikamäki
- Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland
| | - Anu Kantele
- Inflammation Center, Clinic of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Aurora Hospital, Nordenskiöldinkatu 20, (P.O. Box 348), Helsinki, Finland. .,Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland. .,Aava Travel Clinic, Medical Centre Aava, Annankatu 32, 00100, Helsinki, Finland. .,Unit of Infectious Diseases, Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
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27
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Fairley JK, Kozarsky PE, Kraft CS, Guarner J, Steinberg JP, Anderson E, Jacob JT, Meloy P, Gillespie D, Espinoza TR, Isakov A, Vanairsdale S, Baker E, Wu HM. Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa. Open Forum Infect Dis 2016; 3:ofw005. [PMID: 26925428 PMCID: PMC4766384 DOI: 10.1093/ofid/ofw005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/12/2016] [Indexed: 11/25/2022] Open
Abstract
Most ill travelers returning from Ebola-affected countries have not had Ebola. However, institutions and public health departments need to be prepared. We present our experience triaging, evaluating and managing 25 ill returned travelers from these countries. Background. The 2014–2015 Ebola epidemic in West Africa had global impact beyond the primarily affected countries of Guinea, Liberia, and Sierra Leone. Other countries, including the United States, encountered numerous patients who arrived from highly affected countries with fever or other signs or symptoms consistent with Ebola virus disease (EVD). Methods. We describe our experience evaluating 25 travelers who met the US Centers for Disease Control and Prevention case definition for a person under investigation (PUI) for EVD from July 20, 2014 to January 28, 2015. All patients were triaged and evaluated under the guidance of institutional protocols to the emergency department, outpatient tropical medicine clinic, or Emory's Ebola treatment unit. Strict attention to infection control and early involvement of public health authorities guided the safe evaluation of these patients. Results. None were diagnosed with EVD. Respiratory illnesses were common, and 8 (32%) PUI were confirmed to have influenza. Four patients (16%) were diagnosed with potentially life-threatening infections or conditions, including 3 with Plasmodium falciparum malaria and 1 with diabetic ketoacidosis. Conclusions. In addition to preparing for potential patients with EVD, Ebola assessment centers should consider other life-threatening conditions requiring urgent treatment, and travelers to affected countries should be strongly advised to seek pretravel counseling. Furthermore, attention to infection control in all aspects of PUI evaluation is paramount and has presented unique challenges. Lessons learned from our evaluation of potential patients with EVD can help inform preparations for future outbreaks of highly pathogenic communicable diseases.
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Affiliation(s)
| | | | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine; Department of Pathology and Laboratory Medicine
| | - Jeannette Guarner
- Division of Infectious Diseases, Department of Medicine; Department of Pathology and Laboratory Medicine
| | | | - Evan Anderson
- Division of Infectious Diseases, Department of Medicine; Division of Pediatric Infectious Diseases, Department of Pediatrics
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine
| | | | | | | | | | | | - Esther Baker
- Department of Quality and Safety: Infection Prevention and Control , Emory Healthcare , Atlanta, Georgia
| | - Henry M Wu
- Division of Infectious Diseases, Department of Medicine
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Halajian A, Palomar AM, Portillo A, Heyne H, Luus-Powell WJ, Oteo JA. Investigation of Rickettsia, Coxiella burnetii and Bartonella in ticks from animals in South Africa. Ticks Tick Borne Dis 2015; 7:361-6. [PMID: 26718068 DOI: 10.1016/j.ttbdis.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/26/2015] [Accepted: 12/07/2015] [Indexed: 01/05/2023]
Abstract
Ticks are involved in the epidemiology of several human pathogens including spotted fever group (SFG) Rickettsia spp., Coxiella burnetii and Bartonella spp. Human diseases caused by these microorganisms have been reported from South Africa. The presence of SFG Rickettsia spp., C. burnetii and Bartonella spp. was investigated in 205 ticks collected from domestic and wild animals from Western Cape and Limpopo provinces (South Africa). Rickettsia massiliae was detected in 10 Amblyomma sylvaticum and 1 Rhipicephalus simus whereas Rickettsia africae was amplified in 7 Amblyomma hebraeum. Neither C. burnetii nor Bartonella spp. was found in the examined ticks. This study demonstrates the presence of the tick borne pathogen R. massiliae in South Africa (Western Cape and Limpopo provinces), and corroborates the presence of the African tick-bite fever agent (R. africae) in this country (Limpopo province).
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Affiliation(s)
- Ali Halajian
- Department of Biodiversity (Zoology), University of Limpopo, Sovenga 0727, South Africa
| | - Ana M Palomar
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital San Pedro-CIBIR, Logroño, La Rioja, Spain
| | - Aránzazu Portillo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital San Pedro-CIBIR, Logroño, La Rioja, Spain
| | - Heloise Heyne
- Parasites, Vectors & Vector-borne Diseases, ARC-Onderstepoort Veterinary Institute, South Africa
| | - Wilmien J Luus-Powell
- Department of Biodiversity (Zoology), University of Limpopo, Sovenga 0727, South Africa
| | - José A Oteo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital San Pedro-CIBIR, Logroño, La Rioja, Spain.
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Lopez-Velez R, Palomar AM, Oteo JA, Norman FF, Pérez-Molina JA, Portillo A. Novel Candidatus rickettsia species detected in nostril tick from human, Gabon, 2014. Emerg Infect Dis 2015; 21:325-7. [PMID: 25625886 PMCID: PMC4313649 DOI: 10.3201/eid2102.141048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We report the identification of a nymphal nostril tick (Amblyomma sp.) from a national park visitor in Gabon and subsequent molecular detection and characterization of tickborne bacteria. Our findings provide evidence of a potentially new Rickettsia sp. circulating in Africa and indicate that tick bites may pose a risk to persons visiting parks in the region.
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McLoughlin H. Conference report from International Congress on Infectious Diseases 2014: part 2. Future Microbiol 2015; 9:1299-301. [PMID: 25517896 DOI: 10.2217/fmb.14.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This second and final instalment of the conference report from International Congress on Infectious Diseases 2014 follows on from part one, published in Future Microbiology (volume 9/issue 11). The 16th International Congress on Infectious Diseases was held in Cape Town this year, marking the return of the conference to Africa for the first time in 22 years. While infectious diseases such as malaria, tuberculosis and HIV--all still prevalent in the African healthcare landscape--dominated the program, the conference featured several important sessions on fungal infection and a significant number of posters devoted to this critical medical area. Within the context of the rise of antimicrobial resistance, now identified by WHO as one of the three greatest threats to human health, came the message that resistance is not limited to antimicrobials, but that antifungal resistance is also a significant and emerging threat worldwide.
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Flores MS, Hickey PW, Fields JH, Ottolini MG. A "Syndromic" Approach for Diagnosing and Managing Travel-Related Infectious Diseases in Children. Curr Probl Pediatr Adolesc Health Care 2015; 45:231-43. [PMID: 26253891 PMCID: PMC7106018 DOI: 10.1016/j.cppeds.2015.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle S Flores
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Patrick W Hickey
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Joshua H Fields
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Martin G Ottolini
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814; Office of Curriculum, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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32
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Boggild AK, Esposito DH, Kozarsky PE, Ansdell V, Beeching NJ, Campion D, Castelli F, Caumes E, Chappuis F, Cramer JP, Gkrania-Klotsas E, Grobusch MP, Hagmann SH, Hynes NA, Lim PL, López-Vélez R, Malvy DJ, Mendelson M, Parola P, Sotir MJ, Wu HM, Hamer DH. Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network. Ann Intern Med 2015; 162:757-64. [PMID: 25961811 PMCID: PMC4629254 DOI: 10.7326/m15-0074] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. OBJECTIVE To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread. DESIGN Descriptive, using GeoSentinel records. SETTING 57 travel or tropical medicine clinics in 25 countries. PATIENTS 805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014. MEASUREMENTS Frequencies of demographic and travel-related characteristics and illnesses reported. RESULTS The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered. LIMITATION Surveillance data collected by specialist clinics may not be representative of all ill returned travelers. CONCLUSION Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Andrea K. Boggild
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Douglas H. Esposito
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Phyllis E. Kozarsky
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Vernon Ansdell
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Nicholas J. Beeching
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Daniel Campion
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Francesco Castelli
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Eric Caumes
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Francois Chappuis
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Jakob P. Cramer
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Effrossyni Gkrania-Klotsas
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Martin P. Grobusch
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Stefan H.F. Hagmann
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Noreen A. Hynes
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Poh Lian Lim
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Rogelio López-Vélez
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Denis J.M. Malvy
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Marc Mendelson
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Philippe Parola
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Mark J. Sotir
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Henry M. Wu
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
| | - Davidson H. Hamer
- From the Tropical Disease Unit of Toronto General Hospital, University of Toronto, and Public Health Ontario Laboratory, Toronto, Ontario, Canada; Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia; University of Hawaii, Honolulu, Hawaii; Liverpool School of Tropical Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom; InterHealth Worldwide, London, United Kingdom; University of
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Saltzman I, Boggild AK, Keystone JS. Fever in a returned traveller from West Africa. CMAJ 2015; 187:429-432. [PMID: 25646284 PMCID: PMC4387035 DOI: 10.1503/cmaj.141146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ilana Saltzman
- Department of Medicine (Saltzman, Boggild, Keystone), University of Toronto, Toronto, Ont.; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Tropical Disease Unit, Division of Infectious Diseases (Boggild, Keystone), University Health Network, Toronto General Hospital, Toronto, Ont
| | - Andrea K Boggild
- Department of Medicine (Saltzman, Boggild, Keystone), University of Toronto, Toronto, Ont.; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Tropical Disease Unit, Division of Infectious Diseases (Boggild, Keystone), University Health Network, Toronto General Hospital, Toronto, Ont
| | - Jay S Keystone
- Department of Medicine (Saltzman, Boggild, Keystone), University of Toronto, Toronto, Ont.; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Tropical Disease Unit, Division of Infectious Diseases (Boggild, Keystone), University Health Network, Toronto General Hospital, Toronto, Ont.
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Wu HM, Fairley JK, Steinberg J, Kozarsky P. The potential Ebola-infected patient in the ambulatory care setting: preparing for the worst without compromising care. Ann Intern Med 2015; 162:66-7. [PMID: 25329137 DOI: 10.7326/m14-2312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Henry M. Wu
- From the Emory TravelWell Center and Emory University School of Medicine, Atlanta, Georgia
| | - Jessica K. Fairley
- From the Emory TravelWell Center and Emory University School of Medicine, Atlanta, Georgia
| | - James Steinberg
- From the Emory TravelWell Center and Emory University School of Medicine, Atlanta, Georgia
| | - Phyllis Kozarsky
- From the Emory TravelWell Center and Emory University School of Medicine, Atlanta, Georgia
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Kutsuna S, Hayakawa K, Kato Y, Fujiya Y, Mawatari M, Takeshita N, Kanagawa S, Ohmagari N. Comparison of clinical characteristics and laboratory findings of malaria, dengue, and enteric fever in returning travelers: 8-year experience at a referral center in Tokyo, Japan. J Infect Chemother 2014; 21:272-6. [PMID: 25592811 DOI: 10.1016/j.jiac.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/28/2014] [Accepted: 12/09/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Without specific symptoms, diagnosis of febrile illness in returning travelers is challenging. Dengue, malaria, and enteric fever are common causes of fever in returning travelers and timely and appropriate treatment is important. However, differentiation is difficult without specific diagnostic tests. METHODS A retrospective study was conducted at the National Centre for Global Health and Medicine (NCGM) from April 2005 to March 2013. Febrile travelers returning from overseas who were diagnosed with dengue, malaria, or enteric fever were included in this study. Clinical characteristics and laboratory findings were compared for each diagnosis. RESULTS During the study period, 86 malaria, 85 dengue, and 31 enteric fever cases were identified. The mean age of the study cohort was 33.1 ± 12 years and 134 (66.3%) study participants were male. Asia was the most common area visited by returning travelers with fevers (89% of dengue, 18.6% of malaria, and 100% of enteric fever cases), followed by Africa (1.2% of dengue and 70.9% of malaria cases). Clinical characteristics and laboratory findings were significantly different among each group with each diagnosis. Decision tree models revealed that returning from Africa and CRP levels <10 mg/L were factors specific for diagnosis of malaria and dengue fever, respectively. CONCLUSION Clinical manifestations, simple laboratory test results, and regions of travel are helpful to distinguish between dengue, malaria, and enteric fever in febrile returning travelers with non-specific symptoms.
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Affiliation(s)
- Satoshi Kutsuna
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
| | - Kayoko Hayakawa
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Yasuyuki Kato
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Yoshihiro Fujiya
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Momoko Mawatari
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Nozomi Takeshita
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Shuzo Kanagawa
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Norio Ohmagari
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
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Affiliation(s)
- Nicholas J Beeching
- Liverpool School of Tropical Medicine, Royal Liverpool University Hospital, Liverpool, UK Royal Liverpool University Hospital, Liverpool, UK
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Schlagenhauf P, Weld L, Goorhuis A, Gautret P, Weber R, von Sonnenburg F, Lopez-Vélez R, Jensenius M, Cramer JP, Field VK, Odolini S, Gkrania-Klotsas E, Chappuis F, Malvy D, van Genderen PJJ, Mockenhaupt F, Jauréguiberry S, Smith C, Beeching NJ, Ursing J, Rapp C, Parola P, Grobusch MP. Travel-associated infection presenting in Europe (2008-12): an analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation. THE LANCET. INFECTIOUS DISEASES 2014; 15:55-64. [PMID: 25477022 DOI: 10.1016/s1473-3099(14)71000-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Travel is important in the acquisition and dissemination of infection. We aimed to assess European surveillance data for travel-related illness to profile imported infections, track trends, identify risk groups, and assess the usefulness of pre-travel advice. METHODS We analysed travel-associated morbidity in ill travellers presenting at EuroTravNet sites during the 5-year period of 2008-12. We calculated proportionate morbidity per 1000 ill travellers and made comparisons over time and between subgroups. We did 5-year trend analyses (2008-12) by testing differences in proportions between subgroups using Pearson's χ(2) test. We assessed the effect of the pre-travel consultation on infection acquisition and outcome by use of proportionate morbidity ratios. FINDINGS The top diagnoses in 32 136 patients, ranked by proportionate morbidity, were malaria and acute diarrhoea, both with high proportionate morbidity (>60). Dengue, giardiasis, and insect bites had high proportionate morbidity (>30) as well. 5-year analyses showed increases in vector borne infections with significant peaks in 2010; examples were increased Plasmodium falciparum malaria (χ(2)=37·57, p<0·001); increased dengue fever (χ(2)=135·9, p<0·001); and a widening geographic range of acquisition of chikungunya fever. The proportionate morbidity of dengue increased from 22 in 2008 to 36 in 2012. Five dengue cases acquired in Europe contributed to this increase. Dermatological diagnoses increased from 851 in 2008 to 1102 in 2012, especially insect bites and animal-related injuries. Respiratory infection trends were dominated by the influenza H1N1 pandemic in 2009. Illness acquired in Europe accounted for 1794 (6%) of all 32 136 cases-mainly, gastrointestinal (634) and respiratory (357) infections. Migration within Europe was associated with more serious infection such as hepatitis C, tuberculosis, hepatitis B, and HIV/AIDS. Pre-travel consultation was associated with significantly lower proportionate morbidity ratios for P falciparum malaria and also for acute hepatitis and HIV/AIDS. INTERPRETATION The pattern of travel-related infections presenting in Europe is complex. Trend analyses can inform on emerging infection threats. Pre-travel consultation is associated with reduced malaria proportionate morbidity ratios and less severe illness. These findings support the importance and effectiveness of pre-travel advice on malaria prevention, but cast doubt on the effectiveness of current strategies to prevent travel-related diarrhoea. FUNDING European Centre for Disease Prevention and Control, University Hospital Institute Méditerranée Infection, US Centers for Disease Control and Prevention, and the International Society of Travel Medicine.
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Affiliation(s)
- Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Epidemiology, Biostatistics, and Prevention Institute, Zürich, Switzerland.
| | | | - Abraham Goorhuis
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Philippe Gautret
- University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France
| | - Rainer Weber
- University Hospital, Department of Infectious Diseases, University of Zürich, Switzerland
| | - Frank von Sonnenburg
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilian's University of Munich, Munich, Germany
| | - Rogelio Lopez-Vélez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Mogens Jensenius
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Jakob P Cramer
- University Medical Center Hamburg-Eppendorf, Department of Tropical Medicine and Infectious Diseases, Bernhard Nocht Clinic, Hamburg, Germany
| | - Vanessa K Field
- InterHealth Worldwide and National Travel Health Network and Centre (NaTHNaC), London, UK
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy
| | | | - Francois Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Denis Malvy
- Department of Internal Medicine and Tropical Disease, University Hospital Centre, Bordeaux, France
| | | | - Frank Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Germany
| | - Stéphane Jauréguiberry
- Service des Maladies Infectieuses et Tropicales (Department of Infectious and Tropical Diseases), Hôpital Pitié-Salpétrière, Paris, France
| | - Catherine Smith
- Travel Medicine and International Health Team, Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Nicholas J Beeching
- Liverpool School of Tropical Medicine and National Institute for Health Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
| | - Johan Ursing
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Philippe Parola
- University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France
| | - Martin P Grobusch
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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