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Bauer IL. Healthy, safe and responsible: the modern female traveller. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2021; 7:14. [PMID: 34090539 PMCID: PMC8180038 DOI: 10.1186/s40794-021-00141-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
One-half of all travellers are women; yet, there is a distinct lack of detailed travel health knowledge on topics of unique relevance to women. While there is medical advice relating to stages in the female lifecycle, it neglects women-specific practical aspects despite their ability to harm travellers’ health and cause inconvenience. This paper discusses comprehensively three major aspects of travel as they relate to women. First, it suggests the management of personal hygiene, bodily functions, menstruation and sexual behaviour, and alerts to the limited knowledge on travel mental health issues. Second, apart from travelling in a female body with its specific demands, being a woman requires special attention to safety and security. Within various travel contexts, women have many opportunities for minimising potential risks. Finally, guided by travel medicine’s acknowledgment of its role in the concept of responsible travel, this article goes beyond the usual general statements and broad advice and offers detailed and practical suggestions on how the female traveller can contribute to the overall goal of minimising any potential harm to fellow humans and the natural environment. Recognising the scarcity of women-specific travel information, pathways to better education, and a range of suggestions for urgent research facilitate the provision of high-quality travel health care tailored specifically to women’s needs.
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Affiliation(s)
- Irmgard L Bauer
- College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, 4811, Australia.
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Contou D, Colin G, Travert B, Jochmans S, Conrad M, Lascarrou JB, Painvin B, Ferré A, Schnell D, La Combe B, Coudroy R, Ehrmann S, Rambaud J, Wiedemann A, Asfar P, Kalfon P, Guérot E, Préau S, Argaud L, Daviet F, Dellamonica J, Dupont A, Fartoukh M, Kamel T, Béduneau G, Canouï-Poitrine F, Boutin E, Lina G, Dessap AM, Tristant A, de Prost N. Menstrual toxic shock syndrome: a French nationwide multicenter retrospective study. Clin Infect Dis 2021; 74:246-253. [PMID: 33906228 DOI: 10.1093/cid/ciab378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. METHODS This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between January 1, 2005 and December 31, 2020 in 43 French pediatric (n=7) or adult (n=36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, of critically ill patients with m-TSS. RESULTS In total, 102 patients with m-TSS (median age: 18 [16-24] years) were admitted to one of the participating ICUs. All blood cultures (n=102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for super-antigenic toxin gene sequences was performed for 76 of the 92 (83%) vaginal samples positive for Staphylococcus aureus and TSST-1 isolated from 66 (87%) strains. At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with anti-toxin antibiotic therapy and eight (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. CONCLUSIONS In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.
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Affiliation(s)
- Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - Gwenhaël Colin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, Les Oudairies, Boulevard Stéphane Moreau, 85925 La Roche-sur-Yon, France
| | - Brendan Travert
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Nantes, 9 Quai Moncousu, 44036 Nantes, France
| | - Sébastien Jochmans
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun-Sénart, 270 avenue Marc Jacquet, 77000 Melun, France
| | - Marie Conrad
- Service de Réanimation, Centre Hospitalier Universitaire de Nancy, 25 Rue Lionnois, 54000 Nancy, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 9 Quai Moncousu, 44036 Nantes, France
| | - Benoit Painvin
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Alexis Ferré
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier André Mignot de Versailles, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - David Schnell
- Service de Médecine Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Rond point de Girac, 16959 Angoulême, France
| | - Beatrice La Combe
- Service de Réanimation Médico-Chirurgicale, Hôpital du Scorff - Groupe Hospitalier Bretagne Sud Lorient, 5 Avenue Choiseul, 56322 Lorient, France
| | - Rémi Coudroy
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France, INSERM CIC1402, ALIVE group, Université de Poitiers, France
| | - Stephan Ehrmann
- Service de Médecine Intensive et Réanimation, CHRU de Tours, CIC 1415, CRICS-TriggerSEP, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Jérôme Rambaud
- Service de Réanimation Pédiatrique, Hôpital Trousseau, AP-HP, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Arnaud Wiedemann
- INSERM u1256 N-GERE et Réanimation Pédiatrique Spécialisée - C.H.R.U. Nancy - 5 rue du Morvan 54500 Vandœuvre-lès-Nancy, France
| | - Pierre Asfar
- SDépartement de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100 Angers, France
| | - Pierre Kalfon
- Service de Réanimation, Centre Hospitalier de Chartres, 4 Rue Claude Bernard, 28630 Le Coudray, France
| | - Emmanuel Guérot
- Service de Médecine Intensive Réanimation, Hôpital européen Georges Pompidou AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Sébastien Préau
- Service de Réanimation, Centre Hospitalier Universitaire de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, hôpital Édouard-Herriot, 5, place d'Arsonval, F-69437 Lyon, France
| | - Florence Daviet
- Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13015 Marseille, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, 151 route de Saint-Antoine CS23079, UR2CA Université Cote d'Azur, 06000 Nice, France
| | - Audrey Dupont
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Nice, 30 Voie Romaine, 06000 Nice, France
| | - Muriel Fartoukh
- Sorbonne Université, AP-HP, Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Toufik Kamel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans Hôpital de La Source, 14 Avenue de l'Hôpital, 45100 Orléans, France
| | - Gaëtan Béduneau
- Universite de Normandie, UNIROUEN, EA3830, Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Florence Canouï-Poitrine
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Emmanuelle Boutin
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Gérard Lina
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Anne Tristant
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Abstract
BACKGROUND Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined. CASE A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise. She was found to be tachycardic and hypotensive. Investigations revealed thrombocytopenia, an elevated white count and lactate, and acute kidney injury, consistent with septic shock. Recent tampon usage with menstruation was reported, and a pelvic examination revealed purulent vaginal discharge. The patient was transferred to a pediatric intensive care unit for antibiotic and vasopressor therapy. Vaginal swabs later tested positive for Staphylococcus aureus and TSS toxin-1. CONCLUSIONS Although the incidence of TSS has decreased in recent years, it is crucial that clinicians rapidly recognize and treat this life-threatening condition. Emergency physicians should always have a high index of suspicion for TSS in young females presenting without another obvious cause of shock. A pelvic examination should always be completed in these cases.
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Berger S, Kunerl A, Wasmuth S, Tierno P, Wagner K, Brügger J. Menstrual toxic shock syndrome: case report and systematic review of the literature. THE LANCET. INFECTIOUS DISEASES 2019; 19:e313-e321. [PMID: 31151811 DOI: 10.1016/s1473-3099(19)30041-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 01/20/2023]
Abstract
Menstrual toxic shock syndrome (mTSS) is a life-threatening disease caused by superantigen-producing Staphylococcus aureus. Incidence ranges from 0·03 to 0·50 cases per 100 000 people, with overall mortality around 8%. In this Grand Round, we present the case of a previously healthy 23-year-old menstruating woman who was diagnosed with mTSS after she presented at our hospital with a septic condition for the second time. The diagnosis was confirmed by fulfilment of the clinical criteria outlined by the US Centers for Disease Control and Prevention (CDC; fever, rash, desquamation, hypotension, and multi-system involvement) as well as a nasal swab positive for the S aureus strain and presence of the gene encoding for toxic shock syndrome toxin 1 (TSST-1). In the early 1980s, when mTSS was first described, use of tampons was considered the main risk factor. Today, the complex interplay between pathogenic factors of S aureus, immunological mechanisms of the host, and changes in the vaginal ecosystem during menstruation has broadened current understanding of the disease, and the CDC criteria have appreciable limitations in everyday clinical practice.
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Affiliation(s)
- Selina Berger
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Anika Kunerl
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Stefan Wasmuth
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Philip Tierno
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Karoline Wagner
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Jan Brügger
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland; University of Zurich, Zurich, Switzerland.
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