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Schawaller M, Wiemer D, Hagen RM, Frickmann H. Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years. BMJ Mil Health 2023; 169:146-151. [PMID: 33257519 DOI: 10.1136/bmjmilitary-2020-001575] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Military deployments to the tropics are associated with specific infection risks. To add to the available epidemiological information, infectious disease risks in German military personnel returning from predominantly tropical deployments were assessed. METHODS Since 2006, German soldiers returning from predominantly tropical deployments have been offered the opportunity of returnee screenings at the Department of Tropical Medicine and Infectious Diseases of the Bundeswehr Hospital Hamburg. Case files and diagnostic results recorded between 2006 and 2018 were retrospectively assessed to identify deployment-associated infectious disease risks. RESULTS Along with high enteric colonisation rates with apathogenic protozoa and resistant Enterobacteriaceae, direct or indirect proof of infections among the 764 assessed cases comprised Plasmodium spp (n=37), Giardia duodenalis (n=21), Schistosoma spp (n=14), Yersinia enterocolitica (n=5), Strongyloides stercoralis (n=3), Campylobacter jejuni (n=1), Leishmania spp (n=1) and Salmonella enterica (n=1), as well as latent infections with Mycobacterium tuberculosis complex (n=8). The infections were mainly imported from the African region and Eastern Mediterranean region and high proportions of cases lacked typical symptoms. Reported side effect rates of antimalarial chemoprophylaxis for mefloquine (n=121), atovaquone/proguanil (n=49) and doxycycline (n=6) were 36.3%, 19.3% and 11.8%, respectively, while non-compliance rates were 12.9%, 13.0% and 5.9%, respectively. CONCLUSIONS Considerable rates of infections with sometimes atypical or absent symptoms confirm a need for returnee screenings after tropical deployments. High reported side effect rates for mefloquine support its replacement by atovaquone/proguanil or doxycycline for antimalarial chemoprophylaxis.
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Affiliation(s)
- Marius Schawaller
- Department of Tropical Medicine and Infectious Diseases, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - D Wiemer
- Department of Tropical Medicine and Infectious Diseases, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - R M Hagen
- Department of Microbiology and Hospital Hygiene, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - H Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsmedizin Rostock, Rostock, Germany
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Burns DS, Riley MR, Mason A, Bailey MS. UK Role 4 military infectious diseases and tropical medicine cases in 2005-2013. J ROY ARMY MED CORPS 2017; 164:77-82. [PMID: 29279320 DOI: 10.1136/jramc-2017-000815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Infectious diseases are a frequent cause of morbidity among British troops. The aim of this paper is to describe the spectrum of infectious diseases seen when UK service personnel are evacuated for definitive care to the Role 4 Medical Treatment Facility based at Birmingham Heartlands Hospital. METHOD A retrospective analysis of all military patients presenting with infectious diseases and treated at Birmingham Heartlands Hospital between 14 April 2005 and 31 December 2013 was undertaken. RESULTS During this period, 502 patients were identified. Infections originated in 49 countries, most commonly Afghanistan (46% cases), the UK (10% cases) and Belize (9% of cases). The most common presentations were dermatological conditions, gastroenterological illnesses and undifferentiated fevers. CONCLUSION UK service personnel in significant numbers continue to suffer a wide range of infectious diseases, acquired throughout the globe, which often require specialist tertiary infection services to diagnose and manage. Future prospective data collection is recommended to identify trends, which in turn will inform military training needs and future research priorities in the Defence Medical Services (DMS) and allows development of appropriate policies and clinical guidelines for management of DMS personnel with infectious diseases.
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Affiliation(s)
- Daniel S Burns
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK.,Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - M R Riley
- Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - A Mason
- Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - M S Bailey
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Smith AM, Smouse SL, Tau NP, Bamford C, Moodley VM, Jacobs C, McCarthy KM, Lourens A, Keddy KH. Laboratory-acquired infections of Salmonella enterica serotype Typhi in South Africa: phenotypic and genotypic analysis of isolates. BMC Infect Dis 2017; 17:656. [PMID: 28962627 PMCID: PMC5622435 DOI: 10.1186/s12879-017-2757-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Workers in clinical microbiology laboratories are exposed to a variety of pathogenic microorganisms. Salmonella species is among the most commonly reported bacterial causes of laboratory-acquired infections. We report on three cases of laboratory-acquired Salmonella enterica serotype Typhi (Salmonella Typhi) infection which occurred over the period 2012 to 2016 in South Africa. METHODS Laboratory investigation included phenotypic and genotypic characterization of isolates. Phenotypic analysis included standard microbiological identification techniques, serotyping and antimicrobial susceptibility testing. Genotypic analysis included the molecular subtyping methodologies of pulsed-field gel electrophoresis analysis, multilocus sequence typing and whole-genome sequencing (WGS); with WGS data analysis including phylogenetic analysis based upon comparison of single nucleotide polymorphism profiles of isolates. RESULTS All cases of laboratory-acquired infection were most likely the result of lapses in good laboratory practice and laboratory safety. The following critical issues were highlighted. There was misdiagnosis and misreporting of Salmonella Typhi as nontyphoidal Salmonella by a diagnostic laboratory, with associated public health implications. We highlight issues concerning the importance of accurate fluoroquinolone susceptibility testing and interpretation of results according to updated guidelines. We describe potential shortcomings of a single disk susceptibility screening test for fluoroquinolone susceptibility and suggest that confirmatory minimum inhibitory concentration testing should always be performed in cases of invasive Salmonella infections. These antimicrobial susceptibility testing issues resulted in inappropriate ciprofloxacin therapy which may have been responsible for failure in clearance of pathogen from patients. Salmonella Typhi capsular polysaccharide vaccine was not protective in one case, possibly secondarily to a faulty vaccine. CONCLUSIONS Molecular subtyping of isolates proved effective to investigate the genetic relatedness of isolates. Molecular subtyping data interpreted together with epidemiological data allowed us to pinpoint the most likely sources for our cases of laboratory-acquired infection.
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Affiliation(s)
- Anthony Marius Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Private Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa. .,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shannon Lucrecia Smouse
- Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Private Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa
| | - Nomsa Pauline Tau
- Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Private Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Colleen Bamford
- National Health Laboratory Service (Groote Schuur Hospital), Cape Town, South Africa.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | | | - Charlene Jacobs
- Department of Health, Communicable Disease Control, Cape Town, South Africa
| | - Kerrigan Mary McCarthy
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Adré Lourens
- National Health Laboratory Service (Tygerberg Hospital), Cape Town, South Africa
| | - Karen Helena Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Private Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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