Acute and Potentially Life-Threatening Tropical Diseases in Western Travelers--A GeoSentinel Multicenter Study, 1996-2011

University of Alabama, Birmingham, Alabama.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 01/2013; 88(2). DOI: 10.4269/ajtmh.12-0551
Source: PubMed


We performed a descriptive analysis of acute and potentially life-threatening tropical diseases among 82,825 ill western travelers reported to GeoSentinel from June of 1996 to August of 2011. We identified 3,655 patients (4.4%) with a total of 3,666 diagnoses representing 13 diseases, including falciparum malaria (76.9%), enteric fever (18.1%), and leptospirosis (2.4%). Ninety-one percent of the patients had fever; the median time from travel to presentation was 16 days. Thirteen (0.4%) patients died. Ten patients had falciparum malaria, 2 patients had melioidosis, and 1 patient had severe dengue. Falciparum malaria was mainly acquired in West Africa, and enteric fever was largely contracted on the Indian subcontinent; leptospirosis, scrub typhus, and murine typhus were principally acquired in Southeat Asia. Western physicians seeing febrile and recently returned travelers from the tropics need to consider a wide profile of potentially life-threatening tropical illnesses, with a specific focus on the most likely diseases described in our large case series.

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    • "Excluded articles concerned relapses of previously diagnosed melioidosis and cases without a travel history or clinical details. Among the 15 cases reported by Geo- Sentinel within travel-associated infections reviews, only some of them, including enough clinical information, have been reported here [3] [5]. The following elements were extracted from each case: gender, age, travel status, predisposing factors, exposure factors, region of exposure, clinical presentation, sample type, initial treatment and duration, maintenance treatment and duration, follow-up duration, outcome (recovery, relapse or death). "
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    ABSTRACT: Background: Increasing numbers of sporadic cases of melioidosis in returning travelers have been reported from non-endemic regions. Methods: We report a new case and undertook a literature review. Results: Eighty-two travelers with melioidosis infection were included. The mean age was 50.95 years, with only one case <15 years. A male predominance was noted, with 66 males (80.5%). Type of travel included tourism (51.2%), family visits (15.8%) and business (14.6%). The most common destinations were Asia (80.5%), America (9.7%) and Africa (7.3%). No cases were documented from Oceania. Underlying conditions were documented in 68 patients, showing a strong association with diabetes (37.8%). Exposure risks were documented in 32 patients, including contact with water. Pulmonary involvement was seen in 41 patients, cutaneous in 23, abdominal in 14, and urogenital in 10 cases. Blood cultures posed the diagnosis in 43 cases. Fifty-seven patients fully recovered, 12 died, and three relapsed. The mortality rate (14.6%) was close to that observed in Australia but lower than series in Southern Asia. Conclusion: Melioidosis should not only be considered in travelers returning from classically considered endemic areas (Australia and South-East Asia) but also from America and Africa, especially in diabetic patients or after contact with water.
    Travel Medicine and Infectious Disease 09/2015; DOI:10.1016/j.tmaid.2015.08.007 · 1.67 Impact Factor
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    • "Leptospirosis was responsible for 0.21% to 2.65% of all travel associated fever cases. Among Western travelers, which included travelers from North America, Europe, Israel, Japan, Australia and New Zealand, leptospirosis contributed to 2.65% of all travel related febrile illnesses [45]. Individual reports from Sweden [46], Australia [47] and Finland [48] and combined reports by Flores-Figueroa et al. [49] and Field et al. [50] showed less than 1% contribution. "
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    ABSTRACT: Leptospirosis remains the most widespread zoonotic disease in the world, commonly found in tropical or temperate climates. While previous studies have offered insight into intra-national and intra-regional transmission, few have analyzed transmission across international borders. Our review aimed at examining the impact of human travel and migration on the re-emergence of Leptospirosis. Results suggest that alongside regional environmental and occupational exposure, international travel now constitute a major independent risk factor for disease acquisition. Contribution of travel associated leptospirosis to total caseload is as high as 41.7% in some countries. In countries where longitudinal data is available, a clear increase of proportion of travel-associated leptospirosis over the time is noted. Reporting patterns is clearly showing a gross underestimation of this disease due to lack of diagnostic facilities. The rise in global travel and eco-tourism has led to dramatic changes in the epidemiology o
    Globalization and Health 08/2014; 10(1-1):61. DOI:10.1186/s12992-014-0061-0 · 2.25 Impact Factor
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    ABSTRACT: The emergence of decreased ciprofloxacin susceptibility (DCS) in Salmonella enterica serovar Typhi and serovar Paratyphi A, B or C limits treatment options. We studied the impact of DCS isolates on the fate of travellers returning with enteric fever and possible alternative treatment options. We evaluated the clinical features, susceptibility data and efficacy of empirical treatment in patients with positive blood cultures of a DCS isolate compared to patients infected with a ciprofloxacin-susceptible (CS) isolate in the period from January 2002 to August 2008. In addition, the pharmacokinetic and pharmacodynamic parameters of ciprofloxacin, levofloxacin and gatifloxacin were determined to assess if increasing the dose would result in adequate unbound fraction of the drug 24-h area under the concentration-time curve/minimum inhibitory concentration (ƒAUC0-24/MIC) ratio. Patients with DCS more often returned from the Indian subcontinent and had a longer fever clearance time and length of hospital stay compared to patients in whom the initial empirical therapy was adequate. The mean ƒAUC0-24/MIC was 41.3 ± 18.8 in the patients with DCS and 585.4 ± 219 in patients with a CS isolate. For DCS isolates, the mean ƒAUC0-24/MIC for levofloxacin was 60.5 ± 28.7 and for gatifloxacin, it was 97.9 ± 28.0. Increasing the dose to an adequate ƒAUC0-24/MIC ratio will lead to conceivably toxic drug levels in 50 % of the patients treated with ciprofloxacin. Emerging DCS isolates has led to the failure of empirical treatment in ill-returned travellers. We demonstrated that, in some cases, an adequate ƒAUC0-24/MIC ratio could be achieved by increasing the dose of ciprofloxacin or by the use of alternative fluoroquinolones.
    European Journal of Clinical Microbiology 04/2013; 32(10). DOI:10.1007/s10096-013-1878-9 · 2.67 Impact Factor
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