1
|
Bird C, Hayward GN, Turner PJ, Wasala D, Merrick V, Lyttle MD, Mullen N, Fanshawe TR. Infections diagnosed in children and young people screened for malaria in UK emergency departments: a retrospective multi-centre study. Paediatr Int Child Health 2024; 44:1-7. [PMID: 38212934 DOI: 10.1080/20469047.2023.2299576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Data on imported infections in children and young people (CYP) are sparse. AIMS To describe imported infections in CYP arriving from malaria-endemic areas and presenting to UK emergency departments (ED) who were screened for malaria. METHODS This is a retrospective, multi-centre, observational study nested in a diagnostic accuracy study for malaria rapid diagnostic tests. Any CYP < 16 years presenting to a participating ED with a history of fever and travel to a malaria-endemic area between 1 January 2016 and 31 December 2017 and who had a malaria screen as a part of standard care were included. Geographical risk was calculated for the most common tropical infections. RESULTS Of the 1414 CYP screened for malaria, 44.0% (n = 622) arrived from South Asia and 33.3% (n = 471) from sub-Saharan Africa. Half (50.0%) had infections common in both tropical and non-tropical settings such as viral upper respiratory tract infection (URTI); 21.0% of infections were coded as tropical if gastro-enteritis is included, with a total of 4.2% (60) cases of malaria. CYP diagnosed with malaria were 7.44 times more likely to have arrived from sub-Saharan Africa than from South Asia (OR 7.44, 3.78-16.41). CONCLUSION A fifth of CYP presenting to participating UK EDs with fever and a history of travel to a malaria-endemic area and who were screened for malaria had a tropical infection if diarrhoea is included. A third of CYP had no diagnosis. CYP arriving from sub-Saharan Africa had the greatest risk of malaria.Abbreviations: CYP: children and young people; ED: emergency department; PERUKI: Paediatric Emergency Research in the UK and Ireland; RDT: rapid diagnostic test; VFR: visiting friends and relatives.
Collapse
Affiliation(s)
- Chris Bird
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Infection, Respiratory and Acute Care, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Desha Wasala
- Emergency Department, Bristol Royal Hospital for Children, UK
| | - Vanessa Merrick
- Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Niall Mullen
- Emergency Department, South Tyneside and Sunderland NHS Foundation Trust, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Camprubí-Ferrer D, Tomazatos A, Balerdi-Sarasola L, Cobuccio LG, Van Den Broucke S, Horváth B, Van Esbroeck M, Martinez MJ, Gandasegui J, Subirà C, Saloni M, Genton B, Bottieau E, Cadar D, Muñoz J. Assessing viral metagenomics for the diagnosis of acute undifferentiated fever in returned travellers: a multicenter cohort study. J Travel Med 2024; 31:taae029. [PMID: 38381609 DOI: 10.1093/jtm/taae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Up to 45% of febrile returning travellers remain undiagnosed after a thorough diagnostic work-up, even at referral centres. Although metagenomic next-generation sequencing (mNGS) has emerged as a promising tool, evidence of its usefulness in imported fever is very limited. METHODS Travellers returning with fever were prospectively recruited in three referral clinics from November 2017 to November 2019. Unbiased mNGS optimised for virus detection was performed on serum samples of participants with acute undifferentiated febrile illness (AUFI), and results were compared to those obtained by reference diagnostic methods (RDM). RESULTS Among 507 returned febrile travellers, 433(85.4%) presented with AUFI. Dengue virus (n = 86) and Plasmodium spp. (n = 83) were the most common causes of fever. 103/433(23.8%) AUFI remained undiagnosed at the end of the follow-up.Metagenomic next-generation sequencing unveiled potentially pathogenic microorganisms in 196/433(38.7%) AUFI. mNGS identifications were more common in patients with a shorter duration of fever (42.3% in ≤5 days vs 28.7% in >5 days, P = 0.005). Potential causes of fever were revealed in 25/103(24.2%) undiagnosed AUFI and 5/23(21.7%) travellers with severe undiagnosed AUFI. Missed severe aetiologies included eight bacterial identifications and one co-infection of B19 parvovirus and Aspergillus spp.Additional identifications indicating possible co-infections occurred in 29/316(9.2%) travellers with AUFI, and in 11/128(8.6%) travellers with severe AUFI, who had received a diagnosis through RDM. The most common co-infections detected in severe AUFI were caused by Gram-negative bacteria. Serum mNGS was unable to detect >50% of infectious diagnoses achieved by RDM and also yielded 607 non-pathogenic identifications. DISCUSSION mNGS of serum can be a valuable diagnostic tool for selected travellers with undiagnosed AUFI or severe disease in addition to reference diagnostic techniques, especially during the first days of symptoms. Nevertheless, mNGS results interpretation presents a great challenge. Further studies evaluating the performance of mNGS using different sample types and protocols tailored to non-viral agents are needed.
Collapse
Affiliation(s)
- Daniel Camprubí-Ferrer
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Alexandru Tomazatos
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
| | - Leire Balerdi-Sarasola
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Ludovico G Cobuccio
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | - Balázs Horváth
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Miguel J Martinez
- Microbiology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Javier Gandasegui
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Carme Subirà
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Meritxell Saloni
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Blaise Genton
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany
| | - Jose Muñoz
- International Health Department ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| |
Collapse
|
3
|
Lydia S, Blaise G. Usefulness of serial testing for the diagnosis of malaria in cases of fever upon return from travel. J Travel Med 2024; 31:taae030. [PMID: 38431851 DOI: 10.1093/jtm/taae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND When malaria is suspected in case of fever after travel in endemic areas, the current recommendation is to repeat the malaria test at 24-hour intervals, with up to two additional tests, as long as the test result is negative. A retrospective analysis was conducted to investigate the appropriateness of this recommendation by determining the proportion of tests with negative result at first and subsequently with a positive one at second or third attempt. METHODS A retrospective study was conducted at the Centre for Primary Care and Public Health, Lausanne, covering a period of 15 years. All patients tested once for malaria were included. Testing included microscopy thick and thin films as well as malaria rapid diagnostic test used in combination. The main outcome measure was the proportion of patients with a first negative test result, subsequently positive on second or third test over the total patients with suspected malaria assessed. Demographic, travel, clinical, and laboratory variables were collected from patients' records to identify potential predictors of an initially negative and then positive test result. RESULTS Four thousand nine hundred seventy-two patients were included. Of those, 4557 (91.7%) had definitive negative test results, and 415 (8.3%) had a positive result on the first test [332/415 (80%) Plasmodium falciparum, 40/415 (9.6%) P. vivax, 21/415 (5.1%) P. ovale, 12/415 (2.9%) P. vivax/ovale, 9/415 (2.2%) P. malariae and 1/415 (0.2%) P. knowlesi], and 3/4972 (0.06%) had a positive result on the second test after a first negative result, 1/4972(0.02%) had a positive test result after 2 negative results, all with P. falciparum. One of the four patients that were positive after their initial negative test was pregnant. The very small number of patients with an initially negative test result and secondarily positive did not allow for risk factor analysis. CONCLUSIONS The current recommendation of serial malaria testing is not supported by the present study, a fortiori for those who do not present with a strong clinical or laboratory predictor of malaria.
Collapse
Affiliation(s)
- Slack Lydia
- University of Lausanne, Lausanne, Switzerland
| | - Genton Blaise
- University of Lausanne, Lausanne, Switzerland
- Center For Primary Care and Public Health, Unisanté, Travel Clinic, Lausanne, Switzerland
| |
Collapse
|
4
|
Potin M, Carron PN, Genton B. Injuries and medical emergencies among international travellers. J Travel Med 2024; 31:taad088. [PMID: 37405992 DOI: 10.1093/jtm/taad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries and accidents that occur during travel are not emphasized enough in these settings. METHODS We performed a narrative review based on a literature search of PubMed, Google Scholar, UpToDate, DynaMed and LiSSa and on reference textbooks and medical journals dedicated to travel, emergency and wilderness medicine. Relevant secondary references were extracted. We also aimed to discuss newer or neglected issues, such as medical tourism, Coronavirus Disease 2019, exacerbations of co-morbidities associated with international travel, insurance coverage, health care seeking abroad, medical evacuation or repatriation and tips for different types of travellers' emergency medical kits (personal, group, physician handled). RESULTS All sources reviewed led to the selection of >170 references. Among epidemiological data on morbidity and deaths while abroad, only retrospective data are available. Deaths are estimated to occur in 1 in 100 000 travellers, with 40% caused by trauma and 60% by diseases, and <3% linked to infectious diseases. Trauma and other injuries acquired during travel, such as traffic accidents and drowning, can be reduced by up to 85% with simple preventive recommendations such as avoiding simultaneous alcohol intake. In-flight emergencies occur on 1 in 604 flights on average. Thrombosis risk is two to three times greater for travellers than for non-travellers. Fever during or after travel can occur in 2-4% of travellers, but in up to 25-30% in tertiary centres. Traveller's diarrhoea, although rarely severe, is the most common disease associated with travel. Autochthonous emergencies (acute appendicitis, ectopic pregnancy, dental abscess) can also occur. CONCLUSIONS Pre-travel medicine encounters must include the topic of injuries and medical emergencies, such as the risk-taking behaviours and foster better planning in a comprehensive approach along with vaccines and infectious diseases advices.
Collapse
Affiliation(s)
- Mathieu Potin
- ISTM CTH (Certificate of Travel Health), Chemin des Croix-Rouges 12, Lausanne CH-1007, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland
| | - Blaise Genton
- Policlinic of Tropical, Travel Medicine and Vaccination, Centre for Primary Care and Public Health, Unisanté, University of Lausanne, Rue du Bugnon 44, Lausanne CH-1011, Switzerland
| |
Collapse
|
5
|
Flateau C, Pitsch A, Cornaglia C, Picque M, de Pontfarcy A, Leroy P, Jault T, Thach C, Camus M, Dolveck F, Diamantis S. Management of imported malaria in the emergency department: Adequacy compared to guidelines, and impact of the SARS-CoV-2 pandemic. Infect Dis Now 2023; 53:104672. [PMID: 36773811 PMCID: PMC9912039 DOI: 10.1016/j.idnow.2023.104672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/13/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES Adequacy of imported malaria management with respect to guidelines in emergency departments (ED) is low. We aimed to identify factors associated with this non-compliance, and a potential impact of the SARS-CoV-2 pandemic. PATIENTS AND METHODS Patients presenting with imported malaria at the ED of the hospital of Melun (France), from January 1, 2017 to February 14, 2022 were retrospectively included. RESULTS Among 205 adults and 25 children, biological criteria of severity were fully assessed in 10% of cases; lactates (40%) and blood pH (21%) levels were the main missing variables. Of 74 patients (32%) with severe malaria, 13 were misclassified as uncomplicated malaria. The choice and dosage of treatment were adequate in 85% and 92% of cases, respectively. Treatment conformity was lower in severe malaria cases than in non-severe malaria cases (OR 0.15 [95% CI 0.07-0.31]), with oral treatment in 17 patients with severe malaria; conformity was higher in the intensive care unit (OR 4.10 [95% CI 1.21-13.95]). Patients with severe malaria were more likely to start treatment within 6hours than patients with uncomplicated malaria (OR 1.97 [95% CI 1.08-3.43]), as were patients infected by P.falciparum compared to other species (OR 4.63 [95% CI 1.03-20.90]). Consulting during the SARS-CoV-2 pandemic was the only organizational factor associated with a lower probability of adequate management (OR 0.42 [95% CI 0.23-0.75]). CONCLUSION Initial evaluation of malaria severity and time to treatment administration could be improved. These have been adversely impacted by the SARS-CoV-2 pandemic.
Collapse
Affiliation(s)
- C. Flateau
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France,Corresponding author at: Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France. Fax: + 33 1 81 74 18 12
| | - A. Pitsch
- Laboratoire de biologie médicale, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - C. Cornaglia
- Service d’accueil des urgences, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - M. Picque
- Laboratoire de biologie médicale, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - A. de Pontfarcy
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - P. Leroy
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - T. Jault
- Service de gynécologie-obstétrique, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - C. Thach
- Service de pédiatrie, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - M. Camus
- Pharmacie hospitalière, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - F. Dolveck
- Service d’accueil des urgences, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - S. Diamantis
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| |
Collapse
|
6
|
Piyaphanee W, Stoney RJ, Asgeirsson H, Appiah GD, Díaz-Menéndez M, Barnett ED, Gautret P, Libman M, Schlagenhauf P, Leder K, Plewes K, Grobusch MP, Huits R, Mavunda K, Hamer DH, Chen LH. Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers. J Travel Med 2023; 30:taad002. [PMID: 36637429 PMCID: PMC10979637 DOI: 10.1093/jtm/taad002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists. METHODS Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis. RESULTS From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9; 19%), expertise abroad (n = 9; 19%), lower cost (n = 8; 17%) and convenience (n = 7; 15%); a third (n = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter. CONCLUSIONS International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.
Collapse
Affiliation(s)
- Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rhett J. Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Unit of Infectious Diseases, Department of Medicine Huddinge, Stockholm Sweden
| | - Grace D. Appiah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marta Díaz-Menéndez
- Tropical and Travel Medicine Unit, RICET, Hospital La Paz-Carlos III, Madrid, Spain
| | - Elizabeth D. Barnett
- Section of Pediatric Infectious Diseases, Boston Medical Center; Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille; IHU-Méditerranée Infection, Marseille, France
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Zürich, Switzerland
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University; Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Katherine Plewes
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralph Huits
- Department of Infectious Tropical diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine; Center for Emerging Infectious Diseases Research and Policy, Boston University, Boston, MA, USA
| | - Lin H. Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge; Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Camprubí-Ferrer D, Oteo JA, Bottieau E, Genton B, Balerdi-Sarasola L, Portillo A, Cobuccio L, Van Den Broucke S, Santibáñez S, Cadar D, Rodriguez-Valero N, Almuedo-Riera A, Subirà C, d'Acremont V, Martinez MJ, Roldán M, Navero-Castillejos J, Van Esbroeck M, Muñoz J. Doxycycline responding illnesses in returning travellers with undifferentiated non-malaria fever: a European multicentre prospective cohort study. J Travel Med 2023; 30:6657742. [PMID: 35932455 DOI: 10.1093/jtm/taac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/11/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of undifferentiated non-malaria fevers (NMF) in returning travellers is a great challenge. Currently, there is no consensus about the use of empirical antibiotics in returning travellers with undifferentiated NMF. Although studies in endemic areas showed that a wide range of pathogens implicated in undifferentiated NMF are treatable with doxycycline, the role of doxycycline in returning travellers with fever still has to be explored. METHODS Prospective European multicentre cohort study of febrile international travellers (November 2017-November 2019). Immunological and molecular diagnostic techniques for doxycycline responding illnesses (DRI) agents such as Anaplasma phagocytophilum, spotted fever group Rickettsia spp., typhus group Rickettsia spp., Coxiella burnetii, Bartonella spp., Orientia tsutsugamushi, Borrelia miyamotoi, Borrelia recurrentis and Leptospira spp. were systematically performed in all patients with undifferentiated NMF. We estimated the prevalence and predictive factors of DRI in returning travellers with undifferentiated NMF. RESULTS Among 347 travellers with undifferentiated NMF, 106 (30·5%) were finally diagnosed with DRI. Only 57 (53·8%) of the 106 DRI infections were diagnosed by the standard of care. The main causes of DRI were: 55 (51·9%) Rickettsia spp., 16 (15·1%) C. burnetii; 15 (14·2%) Bartonella spp.; 13 (12·3%) Leptospira spp. and 10 (9·5%) A. phagocytophilum. The only predictive factor associated with DRI was presenting an eschar (aOR 39·52, 95%CI 4·85-322·18). Features of dengue such as retro-orbital pain (aOR 0·40, 95%CI 0·21-0·76) and neutropenia (aOR 0·41, 95%CI 0·21-0·79) were negatively associated with DRI. CONCLUSIONS Although DRI are responsible for 30% of undifferentiated NMF cases in travellers, those are seldom recognized during the first clinical encounter. Empirical treatment with doxycycline should be considered in returning travellers with undifferentiated fever and negative tests for malaria and dengue, particularly when presenting severe illness, predictive factors for rickettsiosis or no features of dengue.
Collapse
Affiliation(s)
| | - José Antonio Oteo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland
- Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland
| | | | - Aránzazu Portillo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain
| | - Ludovico Cobuccio
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland
- Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland
| | | | - Sonia Santibáñez
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Hamburg 20359, Germany
| | | | - Alex Almuedo-Riera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| | - Carme Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| | - Valérie d'Acremont
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland
- Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland
| | | | - Montserrat Roldán
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| | | | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Jose Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain
| |
Collapse
|
8
|
Mace KE, Lucchi NW, Tan KR. Malaria Surveillance — United States, 2018. MMWR. SURVEILLANCE SUMMARIES 2022; 71:1-35. [PMID: 36048717 PMCID: PMC9470224 DOI: 10.15585/mmwr.ss7108a1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Problem/Condition Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles species mosquito. Most malaria infections in the United States and its territories occur among persons who have traveled to regions with ongoing malaria transmission. However, among persons who have not traveled out of the country, malaria is occasionally acquired through exposure to infected blood or tissues, congenital transmission, nosocomial exposure, or local mosquitoborne transmission. Malaria surveillance in the United States and its territories provides information on its occurrence (e.g., temporal, geographic, and demographic), guides prevention and treatment recommendations for travelers and patients, and facilitates rapid transmission control measures if locally acquired cases are identified. Period Covered This report summarizes confirmed malaria cases in persons with onset of illness in 2018 and trends in previous years. Description of System Malaria cases diagnosed by blood smear microscopy, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments through electronic laboratory reports or by health care providers or laboratory staff members directly reporting to CDC or health departments. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS), the National Notifiable Diseases Surveillance System (NNDSS), or direct CDC clinical consultations. CDC reference laboratories provide diagnostic assistance and conduct antimalarial drug resistance marker testing on blood specimens submitted by health care providers or local or state health departments. This report summarizes data from the integration of all cases from NMSS and NNDSS, CDC clinical consultations, and CDC reference laboratory reports. Results CDC received reports of 1,823 confirmed malaria cases with onset of symptoms in 2018, including one cryptic case and one case acquired through a bone marrow transplant. The number of cases reported in 2018 is 15.6% fewer than in 2017. The number of cases diagnosed in the United States and its territories has been increasing since the mid-1970s; the number of cases reported in 2017 was the highest since 1972. Of the cases in 2018, a total of 1,519 (85.0%) were imported cases that originated from Africa; 1,061 (69.9%) of the cases from Africa were from West Africa, a similar proportion to what was observed in 2017. Among all cases, P. falciparum accounted for most infections (1,273 [69.8%]), followed by P. vivax (173 [9.5%]), P. ovale (95 [5.2%]), and P. malariae (48 [2.6%]). For the first time since 2008, an imported case of P. knowlesi was identified in the United States and its territories. Infections by two or more species accounted for 17 cases (<1.0%). The infecting species was not reported or was undetermined in 216 cases (11.9%). Most patients (92.6%) had symptom onset <90 days after returning to the United States or its territories from a country with malaria transmission. Of the U.S. civilian patients who reported reason for travel, 77.0% were visiting friends and relatives. Chemoprophylaxis with antimalarial medications are recommended for U.S. residents to prevent malaria while traveling in countries where it is endemic. Fewer U.S. residents with imported malaria reported taking any malaria chemoprophylaxis in 2018 (24.5%) than in 2017 (28.4%), and adherence was poor among those who took chemoprophylaxis. Among the 864 U.S. residents with malaria for whom information on chemoprophylaxis use and travel region were known, 95.0% did not adhere to or did not take a CDC-recommended chemoprophylaxis regimen. Among 683 women with malaria, 19 reported being pregnant. Of these, 11 pregnant women were U.S. residents, and one of whom reported taking chemoprophylaxis to prevent malaria but her adherence to chemoprophylaxis was not reported. Thirty-eight (2.1%) malaria cases occurred among U.S. military personnel in 2018, more than in 2017 (26 [1.2%]). Among all reported malaria cases in 2018, a total of 251 (13.8%) were classified as severe malaria illness, and seven persons died from malaria. In 2018, CDC analyzed 106 P. falciparum-positive and four P. falciparum mixed species specimens for antimalarial resistance markers (although certain loci were untestable in some specimens); identification of genetic polymorphisms associated with resistance to pyrimethamine were found in 99 (98.0%), to sulfadoxine in 49 (49.6%), to chloroquine in 50 (45.5%), and to mefloquine in two (2.0%); no specimens tested contained a marker for atovaquone or artemisinin resistance. Interpretation The importation of malaria reflects the overall trends in global travel to and from areas where malaria is endemic, and 15.6% fewer cases were imported in 2018 compared with 2017. Of imported cases, 59.3% were among persons who had traveled from West Africa. Among U.S. civilians, visiting friends and relatives was the most common reason for travel (77.1%). Public Health Actions The best way for U.S. residents to prevent malaria is to take chemoprophylaxis medication before, during, and after travel to a country where malaria is endemic. Adherence to recommended malaria prevention strategies among U.S. travelers would reduce the number of imported cases. Reported reasons for nonadherence include prematurely stopping after leaving the area where malaria was endemic, forgetting to take the medication, and experiencing a side effect. Health care providers can make travelers aware of the risks posed by malaria and incorporate education to motivate them to be adherent to chemoprophylaxis. Malaria infections can be fatal if not diagnosed and treated promptly with antimalarial medications appropriate for the patient’s age, pregnancy status, medical history, the likely country of malaria acquisition, and previous use of antimalarial chemoprophylaxis. Antimalarial use for chemoprophylaxis and treatment should be determined by the CDC guidelines, which are frequently updated. In April 2019, intravenous (IV) artesunate became the first-line medication for treatment of severe malaria in the United States and its territories. Artesunate was approved by the Food and Drug Administration (FDA) in 2020 and is commercially available (Artesunate for Injection) from major U.S. drug distributors (https://amivas.com). Stocking IV artesunate locally allows for immediate treatment of severe malaria once diagnosed and provides patients with the best chance of a complete recovery and no sequelae. With commercial IV artesunate now available, CDC will discontinue distribution of non–FDA-approved IV artesunate under an investigational new drug protocol on September 30, 2022. Detailed recommendations for preventing malaria are online at https://www.cdc.gov/malaria/travelers/drugs.html. Malaria diagnosis and treatment recommendations are also available online at https://www.cdc.gov/malaria/diagnosis_treatment. Health care providers who have sought urgent infectious disease consultation and require additional assistance on diagnosis and treatment of malaria can call the Malaria Hotline 9:00 a.m.–5:00 p.m. Eastern Time, Monday–Friday, at 770-488-7788 or 855-856-4713 or after hours for urgent inquiries at 770-488-7100. Persons submitting malaria case reports (care providers, laboratories, and state and local public health officials) should provide complete information because incomplete reporting compromises case investigations and public health efforts to prevent future infections and examine trends in malaria cases. Molecular surveillance of antimalarial drug resistance markers enables CDC to track, guide treatment, and manage drug resistance in malaria parasites both domestically and globally. A greater proportion of specimens from domestic malaria cases are needed to improve the completeness of antimalarial drug resistance analysis; therefore, CDC requests that blood specimens be submitted for any case of malaria diagnosed in the United States and its territories.
Collapse
Affiliation(s)
- Kimberly E. Mace
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Kathrine R. Tan
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| |
Collapse
|
9
|
Paquet D, Jung L, Trawinski H, Wendt S, Lübbert C. Fever in the Returning Traveler. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:400-407. [PMID: 35469592 PMCID: PMC9492913 DOI: 10.3238/arztebl.m2022.0182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/10/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND It is predicted that approximately two billion tourist trips to foreign countries will be taken worldwide each year by 2030. Germany has long been among the most active countries in tourism. The frequency of illness among persons returning from developing and newly industrialized countries is 43-79%. The appropriate diagnosis of fever in returning travelers is a clinically important matter, as it can be a sign of a life-threatening illness. METHODS This review is based on publications (2001-2022) retrieved by a selective search in PubMed for studies on the epidemiology, diagnosis, and treatment of febrile illnesses in returning travelers, or on specific tropical diseases. RESULTS Diarrhea, fever, and skin changes are the most common manifestations of disease after travel to tropical and sub - tropical areas. The diagnostic evaluation should be performed in a series of steps, beginning with a precise travel history and the identification of specific risk factors. Among travelers returning from sub-Saharan Africa, Plasmodium falciparum malaria is the most common cause of fever on presentation to centers for infectious diseases and tropical medicine, affecting approximately 50 per 1000 travelers. Among persons returning from travel to Southeast Asia, dengue fever is the most common infectious disease, affecting 50-160 per 1000 travelers. Further potentially dangerous diseases include chikungunya and zika fever, typhoid and paratyphoid fever, amoebic liver abscess, visceral leishmaniasis (kala-azar), leptospirosis, and, very rarely, imported cases of viral hemorrhagic fever. COVID-19 and influenza are important differential diagnoses. CONCLUSION The differential diagnosis can be narrowed by thorough history-taking with particular attention to the patient's travel route, combined with a good knowledge of the geographic spread and incubation times of the main tropical diseases. Algorithms help clinicians to focus the diagnostic work-up and select the appropriate further laboratory tests and diagnostic procedures.
Collapse
Affiliation(s)
- Dennis Paquet
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Laura Jung
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Henning Trawinski
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Sebastian Wendt
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Division of Microbiology, Institute of Medical Microbiology and Virology, Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Klinikum St. Georg gGmbH, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| |
Collapse
|
10
|
Kumar A, Rajendran A, Usman M, Ahuja J, Samad S, Mittal A, Garg P, Baitha U, Ranjan P, Wig N. Development and validation of a questionnaire to evaluate the knowledge, attitude and practices regarding travel medicine amongst physicians in an apex tertiary hospital in Northern India. Trop Dis Travel Med Vaccines 2022; 8:13. [PMID: 35642069 PMCID: PMC9155205 DOI: 10.1186/s40794-022-00170-w] [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: 02/16/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Travel medicine focuses primarily on pre-travel preventive care and the conditions and diseases acquired during or after travel. There is a paucity of validated tools to assess the knowledge, attitude and practises of physicians with regard to travel medicine. We attempted to develop a tool to assess existing expertise among Medicine and Infectious Diseases resident doctors with respect to travel medicine. METHODS Item level content validity index (I-CVI) and scale level content validity index (S-CVI/Ave) were estimated for each of the items to establish the content validity. Refined measures of inter-rater agreement (Brennan and Prediger Agreement Coefficient and Gwet's Agreement Coefficient) were estimated for the tool. RESULTS The final version of the questionnaire had satisfactory content validity (I-CVI > 0∙6 and S-CVI/Ave > 0∙9) and possessed high agreement among the raters (Brennan and Prediger AC > 0∙7, p < 0∙01 and Gwet's AC > 0∙8, p < 0∙01) with regard to necessity, clarity and relevance of the scale. CONCLUSIONS This tool covers a wide range of questions and is scientifically validated. The final version of the tool can be used largely for the assessment of knowledge, attitude and practices among medical practitioners. This is instrumental to build targeted intervention programs to enhance the knowledge regarding travel medicine among health care providers.
Collapse
Affiliation(s)
- Arvind Kumar
- Department of Medicine, AIIMS, New Delhi, India.
| | | | - Mohd Usman
- Department of Medicine, AIIMS, New Delhi, India
| | - Jatin Ahuja
- Infectious Diseases & Travel Health Specialist, Indraprastha Apollo Hospital, New Delhi, India
| | | | | | - Prerna Garg
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
| |
Collapse
|
11
|
Camprubí-Ferrer D, Cobuccio L, Van Den Broucke S, Genton B, Bottieau E, d'Acremont V, Rodriguez-Valero N, Almuedo-Riera A, Balerdi-Sarasola L, Subirà C, Fernandez-Pardos M, Martinez MJ, Navero-Castillejos J, Vera I, Llenas-Garcia J, Rothe C, Cadar D, Van Esbroeck M, Foque N, Muñoz J. Causes of fever in returning travelers: a European multicenter prospective cohort study. J Travel Med 2022; 29:6510556. [PMID: 35040473 DOI: 10.1093/jtm/taac002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Etiological diagnosis of febrile illnesses in returning travelers is a great challenge, particularly when presenting with no focal symptoms [acute undifferentiated febrile illnesses (AUFI)], but is crucial to guide clinical decisions and public health policies. In this study, we describe the frequencies and predictors of the main causes of fever in travelers. METHODS Prospective European multicenter cohort study of febrile international travelers (November 2017-November 2019). A predefined diagnostic algorithm was used ensuring a systematic evaluation of all participants. After ruling out malaria, PCRs and serologies for dengue, chikungunya and Zika viruses were performed in all patients presenting with AUFI ≤ 14 days after return. Clinical suspicion guided further microbiological investigations. RESULTS Among 765 enrolled participants, 310/765 (40.5%) had a clear source of infection (mainly traveler's diarrhea or respiratory infections), and 455/765 (59.5%) were categorized as AUFI. AUFI presented longer duration of fever (p < 0.001), higher hospitalization (p < 0.001) and ICU admission rates (p < 0.001). Among travelers with AUFI, 132/455 (29.0%) had viral infections, including 108 arboviruses, 96/455 (21.1%) malaria and 82/455 (18.0%) bacterial infections. The majority of arboviral cases (80/108, 74.1%) was diagnosed between May and November. Dengue was the most frequent arbovirosis (92/108, 85.2%). After 1 month of follow-up, 136/455 (29.9%) patients with AUFI remained undiagnosed using standard diagnostic methods. No relevant differences in laboratory presentation were observed between undiagnosed and bacterial AUFI. CONCLUSIONS Over 40% of returning travelers with AUFI were diagnosed with malaria or dengue, infections that can be easily diagnosed by rapid diagnostic tests. Arboviruses were the most common cause of AUFI (above malaria) and most cases were diagnosed during Aedes spp. high season. This is particularly relevant for those areas at risk of introduction of these pathogens. Empirical antibiotic regimens including doxycycline or azithromycin should be considered in patients with AUFI, after ruling out malaria and arboviruses.
Collapse
Affiliation(s)
| | - Ludovico Cobuccio
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Valérie d'Acremont
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | | | | | - Carme Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Isabel Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jara Llenas-Garcia
- Internal Medicine - Infectious Diseases, Vega Baja Hospital, Orihuela, Alicante, Spain.,Clinical Medicine Department, University Miguel Hernández, Elche, Alicante, Spain
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital LMU, Munich, Germany
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Hamburg, Germany
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nikki Foque
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jose Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
12
|
Kechaou-Cherif S, Hsairi M, Bouratbine A, Benkahla A, Khoufi S, Aoun K. [Knowledge of malaria and preventive attitudes of Tunisian travellers toward malaria endemic areas]. Pan Afr Med J 2022; 41:223. [PMID: 35721633 PMCID: PMC9167471 DOI: 10.11604/pamj.2022.41.223.28696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction travellers to endemic areas must know malaria, its risk factors and prophylactic measures. This can help to avoid severe cases of malaria and to prevent transmission in countries that are malaria-free. The purpose of this study is to assess Tunisian travellers´ knowledge about malaria, its transmission and prevention and their adherence to prophylactic measures. Methods we conducted a survey based on two anonymous questionnaires (pre- and post-trip) among adults travelling to endemic countries. The 1st questionnaire was followed by a medical interview focusing on level of risk and recommended prophylactic measures. Results two hundred and eighty-nine travellers were recruited. They mainly moved within sub-Saharan Africa (99%) for professional reasons (84,4%). The average age of subjects was 42.3 years and sex ratio (male/female) was 3.1. Prior to departure, only 53.3% of subjects were aware of the risk of malaria, and only 28% gave correct answers about modes of transmission. Recommendations for chemoprophylaxis were only known by 62.3% of subjects and only 43.6% intended to use chemoprophylaxis (p < 0.01). Better adherence to protective measures, including chemoprophylaxis, was reported after the trip, with attitudes qualified as good or excellent by 64.2% on return against 23.7% before the interview (<0.001). Conclusion Tunisian travellers knowledge of malaria is insufficient. Strengthening information through specialized consultations (whose usefulness has been demonstrated) is required.
Collapse
Affiliation(s)
- Sonia Kechaou-Cherif
- Service des Vaccinations Internationales et Antirabiques, Institut Pasteur de Tunis, 13, place Pasteur, BP 74,1002 Tunis Belvédère, Tunisie
- Laboratoire de BioInformatique, bioMathématiques, bioStatistique, LR 16-IPT-09, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisie
| | - Mohamed Hsairi
- Service d´Epidémiologie, Institut Salah Azaiez de Carcinologie, Université Tunis El Manar, Tunis, Tunisie
| | - Aida Bouratbine
- Laboratoire de Parasitologie Médicale, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisie
| | - Alia Benkahla
- Laboratoire de BioInformatique, bioMathématiques, bioStatistique, LR 16-IPT-09, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisie
| | - Samy Khoufi
- Service des Vaccinations Internationales et Antirabiques, Institut Pasteur de Tunis, 13, place Pasteur, BP 74,1002 Tunis Belvédère, Tunisie
| | - Karim Aoun
- Laboratoire de Parasitologie Médicale, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El Manar, Tunis, Tunisie
- Laboratoire d´Epidémiologie et d´Ecologie Parasitaires, Institut Pasteur de Tunis, Tunis, Tunisie
| |
Collapse
|
13
|
Ginten C, Eberhard-Kuhn N, Braun D, Kälin M. [CME: Fever in Travelers Returning from the Tropics]. PRAXIS 2022; 110:63-74. [PMID: 35105209 DOI: 10.1024/1661-8157/a003819] [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: 06/14/2023]
Abstract
CME: Fever in Travelers Returning from the Tropics Abstract. With rising numbers of travelers to tropic countries consultations for suspected tropical infections are on the rise in primary care and emergency units. The aim is to identify potentially life-threatening and highly contagious infectious diseases. In addition, counseling on the prevention of tropical diseases is taking on an important role. This article intends to provide an overview of the most important infections acquired in the tropics and support for clinical practice.
Collapse
Affiliation(s)
- Christina Ginten
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
| | - Nadia Eberhard-Kuhn
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
| | - Dominique Braun
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
| | - Marisa Kälin
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Zürich, Zürich
| |
Collapse
|
14
|
Ngamprasertchai T, Hanboonkunupakarn B, Piyaphanee W. Rickettsiosis in Southeast Asia: Summary for International Travellers during the COVID-19 Pandemic. Trop Med Infect Dis 2022; 7:tropicalmed7020018. [PMID: 35202213 PMCID: PMC8879928 DOI: 10.3390/tropicalmed7020018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Rickettsiosis is an important cause of febrile illness among travellers visiting Southeast Asia (SEA). The true incidence of rickettsiosis is underestimated; however, murine typhus and scrub typhus are widely distributed across SEA. Among travellers visiting SEA, scrub typhus was mostly reported from Thailand, whereas murine typhus was frequently found in Indonesia. Although most cases are self-limited or present with mild symptoms, a few cases with severe clinical manifestations have been reported. Doxycycline remains the key treatment of rickettsiosis. Some travellers, such as backpackers, trekkers, or cave explorers, are at a higher risk for rickettsiosis than others. Therefore, in resource-limited conditions, empirical treatment should be considered in these travellers. The coronavirus disease 2019 (COVID-19) pandemic has contributed to difficulty in the diagnosis of rickettsiosis because of the clinical similarities between these diseases. In addition, physical distancing mandated by COVID-19 management guidelines limits accurate physical examination, resulting in misdiagnosis and delayed treatment of rickettsiosis. This review summarises the characteristics of murine typhus and scrub typhus, describes travel-associated rickettsiosis, and discusses the impact of the COVID-19 pandemic on rickettsiosis.
Collapse
|
15
|
Alkhaldy I, Barnett R. Explaining Neighbourhood Variations in the Incidence of Dengue Fever in Jeddah City, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13220. [PMID: 34948849 PMCID: PMC8706944 DOI: 10.3390/ijerph182413220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
The rapid growth and development of cities is a contributing factor to the rise and persistence of dengue fever (DF) in many areas around the world. Many studies have examined how neighbourhood environmental conditions contribute to dengue fever and its spread, but have not paid enough attention to links between socio-economic conditions and other factors, including population composition, population density, the presence of migrant groups, and neighbourhood environmental conditions. This study examines DF and its distribution across 56 neighbourhoods of Jeddah City, Saudi Arabia, where the incidence of dengue remains high. Using stepwise multiple regression analysis it focuses on the key ecological correlates of DF from 2006-2009, the years of the initial outbreak. Neighbourhood variations in average case rates per 10,000 population (2006-2009) were largely predicted by the Saudi gender ratio and socio-economic status (SES), the respective beta coefficients being 0.56 and 0.32 (p < 0.001). Overall, 77.1% of cases occurred in the poorest neighbourhoods. SES effects, however, are complex and were partly mediated by neighbourhood population density and the presence of migrant groups. SES effects persisted after controls for both factors, suggesting the effect of other structural factors and reflecting a lack of DF awareness and the lack of vector control strategies in poorer neighbourhoods. Neighbourhood environmental conditions, as measured by the presence of surface water, were not significant. It is suggested that future research pay more attention to the different pathways that link neighbourhood social status to dengue and wider health outcomes.
Collapse
Affiliation(s)
- Ibrahim Alkhaldy
- Department of Administrative and Human Research, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Ross Barnett
- School of Earth and Environment, University of Canterbury, Christchurch 8140, New Zealand;
| |
Collapse
|
16
|
Garcia-Ruiz de Morales A, Morcate C, Isaba-Ares E, Perez-Tanoira R, Perez-Molina JA. High prevalence of malaria in a non-endemic setting among febrile episodes in travellers and migrants coming from endemic areas: a retrospective analysis of a 2013-2018 cohort. Malar J 2021; 20:449. [PMID: 34838010 PMCID: PMC8627073 DOI: 10.1186/s12936-021-03984-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background The study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain. Methods Observational retrospective study that consisted of a review of all medical files of patients with any malaria test registered at Móstoles University Hospital between April 2013 and April 2018. All suspected malaria cases were confirmed by Plasmodium spp. polymerase chain reaction (PCR). Results Of the 328 patients with suspected malaria (53.7% migrant-travellers; 38.7% visitors; 7.6% travellers), 108 cases were confirmed (101 by Plasmodium falciparum), accounting for a 33% positive sample rate. Sixteen cases were diagnosed only by PCR. Patients with malaria, compared to those without, presented predominantly with fever (84% vs. 65%), were older (34 vs. 24 years), sought medical attention earlier (17d vs. 32d), had a greater number of previous malaria episodes (74% vs. 60%), lower levels of platelets (110,500µL vs. 250,000µL), and higher of bilirubin (0.6 mg/dL vs. 0.5 mg/dL). Severe malaria was present in 13 cases; no deaths were recorded. Malaria diagnosis showed a bimodal distribution with two peaks: June to September and November to January. Conclusions Malaria is still a common diagnosis among febrile patients coming from the tropics specially among migrant travellers. Fever, thrombocytopenia, and/or high bilirubin levels should raise suspicion for this parasitic infection. Prompt diagnosis is crucial to avoid severe cases and deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03984-9.
Collapse
Affiliation(s)
- Alejandro Garcia-Ruiz de Morales
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.,Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Covadonga Morcate
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Elena Isaba-Ares
- Internal Medicine Department, Móstoles University Hospital, Móstoles, Spain
| | - Ramon Perez-Tanoira
- Clinical Microbiology Department, Príncipe de Asturias University Hospital, Madrid, Spain.,Biomedicine and Biotechnology Department, Faculty of Medicine, Alcalá de Henares University, Alcalá de Henares, Spain
| | - Jose A Perez-Molina
- Infectious Diseases Department, National Referral Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Enfermedades Infecciosas, 28034, Madrid, Spain.
| |
Collapse
|
17
|
Lu G, Cao Y, Chai L, Li Y, Li S, Heuschen AK, Chen Q, Müller O, Cao J, Zhu G. Barriers to seeking health care among returning travellers with malaria: A systematic review. Trop Med Int Health 2021; 27:28-37. [PMID: 34748264 DOI: 10.1111/tmi.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify barriers to seeking health care among returning travellers with malaria with the aim of developing targeted interventions that improve early health care-seeking behaviour, diagnosis and treatment. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of published medical literature, selecting studies that investigated and reported barriers to seeking health care among returning travellers and migrants with malaria. In total, 633 articles were screened, of which four studies met the inclusion criteria after a full-text review. RESULTS The four studies reported barriers to seeking healthcare among returning travellers in China, the United States, Thailand and the Dominican Republic. Three studies had an observational design. The identified barriers were summarised based on the appraisal delay, illness delay and utilisation delay stages. During appraisal delays, low awareness of malaria was the most significant factor. Once the patient assessed that he or she was ill, belonging to a specific minority ethnicity, being infected with P. vivax and receiving a low level of social support were predictors of delayed health care-seeking. Finally, the most significant factor associated with utilisation delays was the monetary cost. CONCLUSION The health care-seeking behaviour of returning travellers with malaria should be further investigated and improved. Addressing the identified barriers and gaps in health care-seeking behaviour among returning travellers with malaria, particularly among groups at high risk of travel-associated infections, is important to prevent severe disease and deaths as well as secondary transmission and epidemics.
Collapse
Affiliation(s)
- Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yuanyuan Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Liying Chai
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Jiangsu North People's Hospital, Medical College of Yangzhou University, Yangzhou, China
| | - Shuying Li
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | | | - Qi Chen
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Olaf Müller
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Guoding Zhu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| |
Collapse
|
18
|
Abstract
Global travel is increasingly a fact of modern life, and the rapid spread of severe acute respiratory syndrome coronavirus 2 leading to lockdown across the world has demonstrated the interconnectedness of the world's population. Illness in the returning traveller can range from trivial to life-threatening, and the concept of imported infection can be an intimidating diagnostic and management challenge. An important caveat is that even if your patient has returned from cuddling multimammate rats in Guinea 1 week ago, they could be febrile from a distinctly non-tropical urinary tract infection. That said, antimicrobial resistance is an established concern among returned travellers, which has further infection control implications. Infection control issues regarding isolation, personal protective equipment and notification to public health should always be considered for returning travellers on presentation often before diagnostic confirmation has been made. Always consider the risk of high-consequence infectious diseases.
Collapse
|
19
|
Aoki Y, Terakawa I. Disease profiles created by the experience of imported febrile cases in resource-limited settings. J Travel Med 2021; 28:6173865. [PMID: 33724430 DOI: 10.1093/jtm/taab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshihiro Aoki
- Department of Emergency and Critical Care Medicine, Aizawa Hospital, Nagano, Japan
| | - Ion Terakawa
- Department of General Internal Medicine, Aizawa Hospital, Nagano, Japan
| |
Collapse
|
20
|
Antinori S, Bonazzetti C, Giacomelli A, Corbellino M, Galli M, Parravicini C, Ridolfo AL. Non-human primate and human malaria: past, present and future. J Travel Med 2021; 28:6162451. [PMID: 33693917 DOI: 10.1093/jtm/taab036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies of the malaria parasites infecting various non-human primates (NHPs) have increased our understanding of the origin, biology and pathogenesis of human Plasmodium parasites.This review considers the major discoveries concerning NHP malaria parasites, highlights their relationships with human malaria and considers the impact that this may have on attempts to eradicate the disease. RESULTS The first description of NHP malaria parasites dates back to the early 20th century. Subsequently, experimental and fortuitous findings indicating that some NHP malaria parasites can be transmitted to humans have raised concerns about the possible impact of a zoonotic malaria reservoir on efforts to control human malaria.Advances in molecular techniques over the last 15 years have contributed greatly to our knowledge of the existence and geographical distribution of numerous Plasmodium species infecting NHPs, and extended our understanding of their close phylogenetic relationships with human malaria parasites. The clinical application of such techniques has also made it possible to document ongoing spillovers of NHP malaria parasites (Plasmodium knowlesi, P. cynomolgi, P. simium, P. brasilianum) in humans living in or near the forests of Asia and South America, thus confirming that zoonotic malaria can undermine efforts to eradicate human malaria. CONCLUSIONS Increasing molecular research supports the prophetic intuition of the pioneers of modern malariology who saw zoonotic malaria as a potential obstacle to the full success of malaria eradication programmes. It is, therefore, important to continue surveillance and research based on one-health approaches in order to improve our understanding of the complex interactions between NHPs, mosquito vectors and humans during a period of ongoing changes in the climate and the use of land, monitor the evolution of zoonotic malaria, identify the populations most at risk and implement appropriate preventive strategies.
Collapse
Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Cecilia Bonazzetti
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Galli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Carlo Parravicini
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| |
Collapse
|
21
|
Camprubí-Ferrer D, Portillo A, Santibáñez S, Almuedo-Riera A, Rodriguez-Valero N, Subirà C, Martinez MJ, Navero-Castillejos J, Fernandez-Pardos M, Genton B, Cobuccio L, Van Den Broucke S, Bottieau E, Muñoz J, Oteo JA. Incidence of human granulocytic anaplasmosis in returning travellers with fever. J Travel Med 2021; 28:6218787. [PMID: 33839778 DOI: 10.1093/jtm/taab056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/23/2021] [Accepted: 03/31/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although tick-borne pathogens have been reported as an important cause of imported fever, the incidence of Anaplasma phagocytophilum, the causative agent of human granulocytic anaplasmosis (HGA), in travellers is unknown. METHODS We conducted a prospective cohort study to investigate the aetiologies of fever in returning travellers (November 2017-July 2019). Polymerase chain reaction for msp2 gene amplification and indirect immunofluorescence assay for A. phagocitophilum were performed in all returning travellers with undifferentiated non-malarial fever. RESULTS Among 141 travellers included, 8 patients were diagnosed with probable or confirmed HGA. The overall incidence rate of HGA was 19.9 cases/1000 person-week of travel. The main destination of travel was Asia, accounting for 62.5% patients with HGA. Co-infections were found in 37.5% of patients with HGA. CONCLUSIONS Diagnosis of HGA and empirical treatment with doxycycline should be considered in travellers with fever.
Collapse
Affiliation(s)
| | - Aránzazu Portillo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, 26006 Logroño, Spain
| | - Sonia Santibáñez
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, 26006 Logroño, Spain
| | | | | | - Carme Subirà
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - Miguel J Martinez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | | | | | - Blaise Genton
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, 1010, Switzerland
| | | | | | | | - Jose Muñoz
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - José Antonio Oteo
- Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, 26006 Logroño, Spain
| |
Collapse
|
22
|
Sonali Fernando E, Headley TY, Tissera H, Wilder-Smith A, De Silva A, Tozan Y. Household and Hospitalization Costs of Pediatric Dengue Illness in Colombo, Sri Lanka. Am J Trop Med Hyg 2021; 105:110-116. [PMID: 33999848 DOI: 10.4269/ajtmh.20-1179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/02/2021] [Indexed: 01/31/2023] Open
Abstract
Dengue, a mosquito-borne viral infection that affects millions around the world, poses a substantial economic burden in endemic countries. We conducted a prospective costing study in hospitalized pediatric dengue patients at the Lady Ridgeway Hospital for Children (LRHC), a public pediatric hospital in Colombo district, Sri Lanka, to assess household out-of-pocket and hospitalization costs of dengue in pediatric patients during peak dengue transmission season. Between August and October 2013, we recruited 216 hospitalized patients (aged 0-3 years, 27%; 4-7 years, 29%; 8-12 years, 42%) who were clinically or laboratory diagnosed with dengue. Using 2013 US dollars, household out-of-pocket spending, on average, was US$59 (SD 49) per episode and increased with disease severity (DF, US$52; DHF/DSS, US$78). Pediatric dengue patients received free-of-charge medical care during hospitalization at LRHC, and this places a high financial burden on hospitals. The direct medical cost of hospitalization was US$68.0 (SD 31.4) for DF episode, and US$122.7 (SD 65.2) for DHF/DSS episode. Yet a hospitalized dengue illness episode still accounted for 20% to 35% of household monthly income due to direct and indirect costs. Additionally, a majority of caregivers (70%) sought outpatient care before hospitalization, most of whom (81%) visited private health facilities. Our findings indicate that hospitalized pediatric dengue illness poses a nontrivial cost burden to households and healthcare systems, emphasizing the importance of preventing and controlling the transmission of dengue in endemic countries.
Collapse
Affiliation(s)
| | - Tyler Y Headley
- 2Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Annelies Wilder-Smith
- 4Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,5Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.,6Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Amala De Silva
- 7Department of Economics, University of Colombo, Colombo, Sri Lanka
| | - Yesim Tozan
- 2Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.,8School of Global Public Health, New York University, New York, New York
| |
Collapse
|
23
|
Ljubas D, Lalovac M, Vince A, Papic N. Brucellosis, a forgotten cause of hepatitis in travellers. J Travel Med 2021; 28:5999911. [PMID: 33236061 DOI: 10.1093/jtm/taaa218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022]
Abstract
A 43-year-old male patient developed fever after a trip to Balkans, which resolved on doxycycline treatment. However, abnormal liver function tests persisted, and 6 months later, he was diagnosed with non-viral chronic hepatitis. Clues to the diagnosis came from a thorough medical history. Blood cultures and molecular testing identified Brucella melitensis.
Collapse
Affiliation(s)
- Dominik Ljubas
- School of Medicine, University of Zagreb, Salata 3b, Zagreb 10000, Croatia
| | - Milos Lalovac
- University Hospital Merkur, Zajceva ulica 19, Zagreb 10000, Croatia
| | - Adriana Vince
- School of Medicine, University of Zagreb, Salata 3b, Zagreb 10000, Croatia.,University Hospital for Infectious Diseases Zagreb, Mirogojska cesta 16, Zagreb 10000, Croatia
| | - Neven Papic
- School of Medicine, University of Zagreb, Salata 3b, Zagreb 10000, Croatia.,University Hospital for Infectious Diseases Zagreb, Mirogojska cesta 16, Zagreb 10000, Croatia
| |
Collapse
|