Sickle cell disease in the Zanzibar Archipelago, the Republic of Tanzania

BACKGROUND

Sickle cell disease (SCD) is one of the most severe haemoglobinopathies, a group of blood disorders, typically inherited. The condition affects over 7.7 million people globally and results in more than 370,000 deaths per year. The highest morbidity and mortality rates are seen in Africa and most children with SCD are born in Tanzania. The available literature on SCD morbidity in Tanzania focus primarily on the residents of the mainland, while there is little data available on SCD morbidity among residents of the Tanzanian islands in the Indian Ocean. The aim of the present study was to confirm the presence of sickle cell disease among residents of the Zanzibar Archipelago.

MATERIAL AND METHODS

The study group consisted of 27 people, residents of Pemba Island in the Zanzibar Archipelago, aged between 2 months and 26 years old, whose at least one parent has been diagnosed with sickle cell anaemia. Blood samples collected from the study participants were tested using HemoTypeSCTM, a rapid, point-of-care diagnostic test. The tests were performed at the Amal Hospital (Chake Chake town, Pemba Island) in June 2023.

RESULTS

Sickle cell disease was diagnosed in 11 study subjects (40.7%); their haemoglobin concentration ranged between 6.6 and 8.5 g/dL. The presence of the sickle cell trait (HbAS phenotype) was confirmed in 14 patients (51.9%). Only two of the tested patients had normal haemoglobin phenotype.

CONCLUSIONS

The results of the present study support the necessity to introduce large-scale population- -based screening for SCD in the Zanzibar Archipelago, especially in infants whose family members have sickle cell anaemia. The introduction of such a programme will help monitor the number of new SCD cases in the region and may potentially reduce infant mortality due to SCD as well as minimize complications from SCD in older children through the adoption of effective disease prevention measures.

Characteristics of Polish travellers admitted at the University Centre of Maritime and Tropical Medicine in Poland, 2023

BACKGROUND

After COVID-19 restrictions were lifted, people started to travel again. Each year, thousands of Poles travel internationally, and many travel to tropical or subtropical destinations in Asia, Africa or South America. The aim of this article was to describe the characteristics of Polish travellers based on the information from a retrospective 12-month review of the medical records of Polish patients seeking pre-travel advice at the largest diagnostic and treatment travel medicine centre in Poland in 2023.

MATERIAL AND METHODS

The retrospective study was based on the analysis of medical records of 2,147 patients seeking pre-travel advice at the University Centre of Maritime and Tropical Medicine in Gdynia, Poland, between January and December 2023. The study focused on the analysis of the following patients' variables: age, sex, travel details (purpose of travel, length of travel, departure month, continents and countries to be visited). It also aimed to evaluate the range of prevention measures which were either recommended or administered to patients seeking pre-travel advice at the clinic (preventive vaccinations, chemoprophylaxis). In addition, it assessed the health status of the patients presenting at the travel medicine clinic; retrospective health assessments were based on the information from the interviews with the patients.

RESULTS

Patients who sought pre-travel advice were mostly aged 36-65 years (49.5%), they were travelling for tourism purposes (78.3%), for a maximum period of 4 weeks (79.0%), mostly in November (15.2%) or in January (14.9%). Most travellers planned to visit Asia (55.5%) or Africa (29.0%); mainly Thailand (21.5%), Vietnam (8.5%), Kenya (8.3%) or India (8.2%). The most frequently administered immunoprophylaxis included vaccinations against typhoid fever and hepatitis A. Other commonly recommended/prescribed prevention measures included: insect repellents (69.3%), sunscreen (58.3%), antimalarials (35.8%), antithrombotic drugs (32.6%), and antidiarrheal drugs (25.6%). The analysis of patient interviews demonstrated that 61.8% of the travellers consulted at the clinic had no pre-existing medical conditions, while 38.2% required the use of chronic medications, mainly for allergies (14.3%), thyroid disorders (13.6%), cardiovascular diseases (9.3%), or psychiatric disorders (5.5%).

CONCLUSIONS

A large number of Polish travellers visit destinations where the risk of infectious and non-infectious diseases is high. Providing patients with professional advice during a pre-travel consultation will help protect against travel-associated health problems.

High risk of intestinal colonization with ESBL-producing Escherichia coli among soldiers of military contingents in specific geographic regions

One-hundred Polish soldiers of a contingent in Afghanistan in 2019 were screened for Enterobacterales resistant to newer-generation β-lactams at their departure and return. Seventeen percent were colonized in the gut at the departure, whereas 70% acquired carriage in Afghanistan. The commonest organisms were extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-Ec; 96.6%). All isolates were sequenced and were clonally diverse overall, even within the same sequence type, indicating that independent acquisitions mainly. ESBL-Ec were often multi-drug-resistant. Soldiers stationing in certain regions are at high risk of acquiring resistant bacteria that may cause endogenous infection, be transmitted to vulnerable individuals, and spread resistance genes.

Leprosy - neglected tropical disease in Pygmies inhabiting Central African Republic

Leprosy is a neglected tropical disease that is still present worldwide despite efforts aimed at elimination of the disease. The BaAka Pygmy community inhabiting rural areas in the Central African Republic is one of the most leprosy-vulnerable populations. The aim of the study was to assess the prevalence of leprosy in the BaAka Pygmy population. People living in the Dzanga Sangha protected area were regularly visited by a mobile clinic in 2019/2020. The diagnosis was based on the clinical manifestation of the disease. Deformations of skin and extremities were assessed. In a 12-month period 26 cases of leprosy were diagnosed and 25 patients received treatment. 24 of those patients were BaAka Pygmies, 10 were women, 7 were children under 15 years old and 8 were diagnosed with grade 2 disability. Presented data shows that leprosy in Dzanga Sangha region is not well controlled due to the high transmission rate. Efforts to diagnose and report new leprosy cases should be intensified.

Detection and Molecular Characterization of Blastocystis Species in Polish Soldiers Stationed in the Republic of Kosovo

Blastocystis species (sp.) is one of the less well-understood water- and foodborne protozoa of medical and veterinary importance linked to different gastrointestinal disorders. Soldiers participating in military missions are particularly vulnerable to infection with this protozoa. The present study used molecular methods to detect, identify, and subtype (ST) Blastocystis sp. in Polish soldiers stationed in the Republic of Kosovo. Fecal samples were collected from 192 soldiers on arrival and after four months of stay. After DNA extraction, the barcoding region of the small subunit ribosomal RNA (SSU-rRNA) gene was amplified and sequenced. The DNA of Blastocystis sp. was detected in six (3.13%) and thirty (15.16%) samples in the first and second batch, respectively. Sequencing analysis revealed infections with ST 2, 3, 4, and 7. There was no statistical association between Blastocystis sp. infection and the parasite's ST or the age or rank of soldiers. The results indicate that the visit to a new environment and prolonged stay in the area of military operation in Kosovo resulted in a significant increase in both Blastocystis sp. infections and ST diversity among surveyed soldiers. This shows the need to undertake appropriate countermeasures to reduce Blastocystis infections in the military environment abroad.

Intestinal parasitic infections in officers of the Border Guard in East Poland

BACKGROUND

Poland has experienced increased economic migration since 2021. Large waves of migrants, mostly from Asian and African countries, are trying to get into the European Union by crossing Poland's eastern border illegally. The influx of illegal migrants into Poland is the result of a policy adopted by the Belarusian and Russian regimes that are trying to provoke another migrant crisis in Europe. In the opinion of some Polish politicians illegal migration contributes to the spread of parasitic diseases in our country as many migrants arriving into Poland carry intestinal parasites. The aim of this study was to assess the prevalence of infections with intestinal parasites in the Polish Border Guard officers safeguarding Poland's eastern borders.

MATERIALS AND METHODS

Parasitological diagnostics was carried out between April and May 2023. The study involved 218 Polish Border Guard officers from the Podlaski Border Guard Unit (PBGU) and 209 officers from the Bug Border Guard Unit (BBGU), whose task is to patrol and safeguard Poland's border with Ukraine and Belarus. Faecal examinations were performed using three different light microscopy testing methods (direct smear, decantation, flotation) at the Department of Epidemiology and Tropical Medicine at the Military Institute of Medicine - National Research Institute, Warsaw, Poland.

RESULTS

Considered to be potentially pathogenic intestinal parasites were diagnosed in 20 out of 218 officers serving in the PBGU (8.7% infected with Blastocystis spp., 0.5% with Dientamoeba fragilis) and in 9 out of 209 officers serving in the BBGU (3.8% infected with Blastocystis spp., 0.5% with Dientamoeba fragilis). There were no infections with nematodes, cestodes or trematodes in the study participants. No correlation was found between a parasitic infection and the presence of diarrhoea or other gastrointestinal symptoms within 6 months prior to the study in both groups.

CONCLUSIONS

Although Polish Border Guard officers deployed to the eastern border are exposed to difficult environmental conditions and have frequent contacts (either directly or indirectly) with migrants arriving from countries which report high incidence of parasitic infections, the rates of infections with potentially pathogenic protozoa in officers from the PBGU and BBGU are low and mainly attributable to pathogens which are widespread in the general Polish population. Low rates of parasitic infections in officers serving in the border zone suggest that the epidemiological situation of parasitic diseases in East Poland is satisfactory and that the disease prevention strategies (including the use of personal protection gear) implemented by the Polish medical services are effective.

The risk of an epidemic outbreak in southern Ukraine

The humanitarian crisis that followed the military aggression against Ukraine is getting worse. The war which has continued since February 2022 has already caused irreparable health damage in the local community, which is affected by such acts of Russian terror as the destruction of the Kakhovka dam on the Dnieper River. As a result of the explosion and destruction of the dam, which occurred on 6 June 2023, over 2,500 square kilometres of land were flooded and around 17,000 residents had to be evacuated.

Characteristics of Polish travellers: six-month experience from the University Centre of Maritime and Tropical Medicine in Gdynia, Poland

BACKGROUND

The number of international travels has grown substantially over the last decade, both globally and in Poland. Thousands of Poles travel to tropical or subtropical countries in Asia, Africa or South America each year. The aim of this paper was to discuss the characteristics of Polish travellers seeking pre-travel consultation at the largest diagnostic and treatment travel medicine clinic in Poland.

MATERIALS AND METHODS

This retrospective study was based on the analysis of medical records of 1291 patients seeking pre-travel advice at the University Centre of Maritime and Tropical Medicine in Gdynia, Poland, between 1 July and 31 December 2022. The study comprised the analysis of the following patient variables: age, sex, travel details (purpose and length of travel, continents and countries to be visited, activities planned). The study also aimed to evaluate the range of prevention measures which were recommended/ administered (preventive vaccinations, chemoprophylaxis). In addition, it assessed the health status of the patients presenting at the travel medicine clinic.

RESULTS

Patients who sought pre-travel advice were mostly people aged 18-35 years old (50.1%), travelling for tourism (72.2%), for a maximum period of 4 weeks (85.0%), travelling in December (24.3%) or in November (22.2%). Most of the Polish travellers consulted at the clinic travelled to Asia (56.2%), mainly to Thailand (27.3%), Vietnam (10.8%) or India (8.7%). Most travellers were planning a beach holiday (56.4%). As regards extreme activities, scuba diving was the most popular among the patients involved in the study (22.5%). The most frequently administered immunoprophylaxis were vaccines against typhoid fever (76.3%) and hepatitis A (56.2%). Other commonly recommended/prescribed prevention measures included: probiotics (75.9%), repellents (73.6%), antimalarial drugs (60.9%), and antidiarrheal antibiotics (51.9%). The analysis of patient interviews demonstrated that 42.4% of Polish travellers consulted at the clinic complained of no medical problems while 36.0% were taking chronic medications, mainly for allergies (17.1%) or thyroid disorders (12.2%).

CONCLUSIONS

A growing number of people from Poland travel to destinations where the risk of infectious disease exposure or transmission is high. Providing a patient with appropriate advice during a pre-travel consultation will help protect the traveller against travel-associated risks at their intended destinations.

Intestinal parasite infections among internal war refugees and inhabitants of the Ternopil region, Western Ukraine

BACKGROUND

The armed aggression of the Russian Federation against Ukraine resulted in the destruction of the country's infrastructure and a decline in the standard of living for many citizens (e.g. shortages of electricity and safe drinking water, limited access to healthcare, living in unsuitable cold basements). A lot of Ukrainians living in the eastern, southern and central parts of the country were forced to flee their homes. The aim of this study was to assess the prevalence of intestinal parasite infections among internal war refugees and residents of Ternopil, a city in Western Ukraine, in response to the worsening of the epidemiological situation in the country.

MATERIALS AND METHODS

Parasitological diagnostics was carried out in June 2023 and involved 127 adult Ukrainian citizens aged 19-80 years old, including 80 internal war refugees (most of the participants came from Donetsk, Luhansk, Dnipro, Kherson regions) and 47 residents of Ternopil region, Western Ukraine. Surveys and parasitological examination of stool samples by three different light microscopy testing methods (direct smear, decantation, flotation) were performed. The samples were then tested for the presence of Giardia intestinalis intestinal protozoa by molecular tests (reverse transcription polymerase chain reaction [RT-PCR]) and immunochromatographic rapid diagnostic tests (RDTs).

RESULTS

All RT-PCR and RDT tests to detect Giardia intestinalis were found to be negative. The examination of faecal samples taken from 127 patients showed no infections with nematodes, cestodes or trematodes. The examinations only revealed infections with potentially pathogenic Blastocystis spp.: 18/80 infections in the population of internal war refugees (22.5%) and 7/47 infections among residents of the Ternopil region (14.9%). Survey results demonstrated frequent use of antibiotics and antiparasitic drugs without physician advise or prescription: 43.9% of the study participants (n = 127) were taking antibiotics, and 25.2% were taking antiparasitic drugs during the period of 3 months prior to the study.

CONCLUSIONS

An absence of intestinal parasite pathogens was detected in the studied population. The authors may explain it by the fact, that many Ukrainian patients have unlimited access to antimicrobial drugs (drugs sold without a valid prescription and taken without consultation with a physician), which could have contributed to the low incidence of intestinal parasite infections.

Asymptomatic Malaria Infections in the Time of COVID-19 Pandemic: Experience from the Central African Republic

According to the latest World Health Organization malaria report, 95% of 241 million global malaria cases and 96% of 627,000 malaria deaths that were recorded in 2020 occurred in Africa. Compared to 2019, 14 million more cases and 69,000 more malaria deaths were recorded, mainly because of disruptions to medical services during the COVID-19 pandemic. The aim of this study was to assess the prevalence of asymptomatic malaria cases in children and adults living in the Dzanga Sangha region in the Central African Republic (CAR) during the COVID-19 pandemic. Rapid immunochromatographic assays for the qualitative detection of Plasmodium species (P. falciparum, P. vivax, P. ovale/P. malariae) circulating in whole blood samples were used. A screening was performed in the group of 515 patients, 162 seemingly healthy children (aged 1–15) and 353 adults, all inhabiting the villages in the Dzanga Sangha region (southwest CAR) between August and September 2021. As much as 51.2% of asymptomatic children and 12.2% of adults had a positive result in malaria rapid diagnostic tests (mRDTs). Our findings demonstrated a very high prevalence of asymptomatic malaria infections in the child population. Limited access to diagnostics, treatment and prevention of malaria during the global COVID-19 pandemic and less medical assistance from developed countries may be one of the factors contributing to the increase in the prevalence of disease in Africa.

Marine creatures dangerous for divers in tropical waters

Diving has been gaining in popularity in recent years with spectacular dive sites in tropical waters. Before anyone goes diving, they should learn about the risk factors associated with the exposure to hyperbaric conditions and also the risks from exposure to marine life. Apart from amazing views of the coral reefs, divers may be astonished by the magnitude of marine species diversity in local waters, ranging from predators (sharks, barracuda, moray eels) to venomous or stinging fish (jellyfish, anemones) and sea snakes. If travelers are unprepared and know little about the existing risk factors, a diving trip that was much looked forward to may turn out to have some very unpleasant consequences. The article describes the most common marine species which divers can come across in tropical waters. It also discusses the management of injuries caused by dangerous marine creatures.

Travelers with thyroid disorders

Thyroid disorders account for a majority of endocrine diseases. The most frequent among them are Hashimoto's thyroiditis, thyroid nodules and cancer with hyperthyroidism or hypothyroidism. Many thyroid patients travel a lot and therefore require appropriate guidance from their doctor. The aim of the review article is to discuss various aspects of travel in order to determine the optimal travel conditions for thyroid patients. Thyroid travelers must be well prepared for their journey. They should put particular emphasis on the choice of destination, the season and iodine resources at the planned place of stay. Before going on a journey, they are advised to check their health insurance, buy enough medications, prepare a copy of prescriptions and all other necessary documents. Depending on the means of transport, a few precautions should be taken to avoid infections or worsening of thyroid symptoms during travel. To deal with unpredictable events which might occur at the place of stay, travelers are recommended to take a first-aid kit containing basic medications. It needs to be stressed that many drugs are responsible for thyroid function disruptions and should only be used after consultation with a healthcare professional. Avoiding stress, maintaining good night's rest, as well as following a healthy diet, are all of great importance in managing thyroid diseases. Observing a few simple rules can minimize the frequency of flare-ups and the occurrence of the life-threatening thyroid storm. Traveling is an inseparable element of life for many people. Therefore, ensuring that patients are well informed about how to travel safely may prevent unwanted health events during travel.

A cluster of cutaneous larva migrans in travellers returning from Zanzibar

Beaches of East Africa are the place to relax, but when contaminated with animal faeces, they are a likely source of health problems, such as cutaneous larva migrans. Cases of CLM were diagnosed in Polish travellers returned from holidays in Zanzibar.

Medical assessment of fitness to dive after COVID-19

Since the global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of a coronavirus disease 2019 (COVID-19) infection started, millions of people globally have become infected. It must not be forgotten that thousands of those affected are commercial or recreational divers. A severe COVID-19 seriously affects the respiratory system and the pulmonary parenchyma but it may also involve the cardiovascular and the blood coagulation system. For this reason, many divers and hyperbaric medicine specialists are becoming increasingly concerned about a diver's ability to safely return to diving after a SARS-CoV-2 infection. The article presents current guidelines for diving fitness health assessment after a COVID-19 both for active and prospective divers, with particular emphasis on the types of diagnostic procedures and tests to be performed in cases of asymptomatic infection with SARS-CoV-2 as well as in patients who have recovered from a symptomatic COVID-19.

Prevalence of Plasmodium spp. in symptomatic BaAka Pygmies inhabiting the rural Dzanga Sangha region of the Central African Republic

INTRODUCTION

Malaria remains a diagnostic and therapeutic challenge in many endemic regions of sub-Saharan Africa. It is one of the most important causes of morbidity and mortality, especially in children <5 years. Plasmodium falciparum is responsible for the majority of severe malaria cases in sub-Saharan Africa, but is not the exclusive one.

OBJECTIVE

The objective of the study was to assess the prevalence of Plasmodium spp. in BaAka Pygmies with clinical symptoms of malaria, and define the percentage distribution of infections caused by species other than P. falciparum in order to assess the need for diversification of malaria treatment protocols.

MATERIAL AND METHODS

The study was conducted during the dry and rainy seasons in 2018 and involved a group of 540 symptomatic BaAka Pygmies, patients of both genders, aged 1-75-years-old. Two diagnostic methods for detecting Plasmodium in the bloodstream were used: RDTs targeting HRP2-protein specific for P. falciparum, and PCR assays aimed at detecting P. falciparum, P. vivax, P. ovale, P. malariae species.

RESULTS

Only 40.5% of symptomatic patients tested with RDTs for P. falciparum infections were positive. Molecular tests (PCR) confirmed P. falciparum in 94.8% of the samples and also revealed the genetic material of P. malariae (11.1%), P. ovale (9.8%), and P. vivax (0.7%). BaAka Pygmies aged <5 years of age dominated in patients with positive results; the common clinical symptoms reported by the sick individuals were fever, shivers and fatigue.

CONCLUSIONS

The study suggests the need for introducing accurate diagnostic methods for the diagnosis of malaria and the revision of malaria treatment protocols. Assessment of the Pfhrp2/Pfhrp3 deletions is necessary for evaluating malaria epidemiology in Central Africa.

Medical assessment of fitness to dive. Part II

Good physical and mental health is a prerequisite for anyone planning to scuba dive. A certificate of fitness to dive for those willing to enter a scuba diving course as well as for active divers, either amateur or occupational, can only be issued if there are no medical contraindications to dive. It is usually within the competence of a diving instructor, a manager of underwater work or a physician to assess a person's mental and physical health and grant them permission to stay under hyperbaric conditions. The legal requirements for issuing a certificate of fitness to dive are different for recreational and occupational divers. The part II of this article discusses the issues concerning medical assessment of fitness to dive for professionals, and divers in uniformed services. It also discusses contraindications to scuba diving and guidelines for medical assessment of fitness to dive in divers with a history of a diving-related condition.

Sexually transmitted infections in the military environment

Sexually transmitted infections (STIs) have always been a major health issue affecting military personnel in all types of services and in all armed forces around the world, especially during deployments and in operational settings. Although the research shows that STIs are still reported in the military, the epidemiological risk for contracting a sexually transmitted infection is much lower nowadays than it was in the past. It is important, however, that service members are routinely screened for sexually transmitted diseases. Because of a high prevalence of STIs in the general population as well as the asymptomatic nature of some infections (e.g. HIV, Chlamydia trachomatis), screening of the sexually active service personnel is recommended as a practical method of preventing the spread of STIs and their sequelae, such as pelvic inflammatory disease, ectopic pregnancy, infertility in women or epididymitis, prostatitis, infertility in men. The rates of STIs in service members have been on the increase in recent years, which may be associated with the fact that more and more women are now seeking a career in the armed forces. Currently, STIs do not only affect male soldiers or their civilian sexual partners (either long-term or casual), but both male and female soldiers alike, especially if they are serving together. The article focuses on the prevalence of STIs in the military in the past and at present, the common STI risk factors and prevention measures.

Medical assessment of fitness to dive. Part I

Good physical and mental health is a prerequisite for anyone planning to scuba dive. A fitness to dive certificate for those willing to enter a scuba diving course as well as for active divers, either amateur or occupational, can only be issued if there are no medical contraindications to dive. It is usually within the competence of a diving instructor, a manager of underwater work or a physician to assess a person's mental and physical health and grant them permission to stay under hyperbaric conditions. The legal requirements for issuing a fitness to dive certificate are different for recreational and occupational divers. The part I of this article discusses the issues concerning medical assessment of fitness to dive for amateurs.

Intestinal parasitic infections in a population of BaAka Pygmies inhabiting the Congo Basin in the Central African Republic

INTRODUCTION

Pygmy tribes inhabit tropical environment of Central Africa. After expulsion from their original habitat by the Bantu people, they settled in a local forest ecosystem where they live with very low sanitary standards. Their actual morbidity remains unknown.

OBJECTIVE

The aim of the study was to analyze the prevalence of intestinal parasitic infections in BaAka Pygmies inhabiting the Congo Basin in the Central African Republic.

MATERIAL AND METHODS

The study was conducted in 2015, and involved a group of 950 Pygmies living inthe Sangha-Mbaere and Lobaye prefectures. Single stool samples were collected from study participants, fixed in 10% formalin, transported from Africa to Europe, and analyzed by light microscopy using 5 different diagnostic methods (direct smear, decantation with distilled water, Fülleborne's flotation, Kato-Miura thick smear, DiaSyS/PARASYS system sedimentation) at the Military Institute of Medicine in Warsaw, Poland.

RESULTS

Microscopic examination revealed infections with 14 different species of intestinal nematodes, cestodes, trematodes and protozoa. According to the study findings, 90.5% of BaAka Pygmies were found to be infected with intestinal parasites, and 70.8% had mixed infections. Most of the pathogenic intestinal parasites were nematodes (85.0%), with Asrcaris lumbricoides (29.8%), hookworm (29.4%) and Trichuris trichiura (10.7%) being predominant.

CONCLUSIONS

Poor sanitation, limited the high prevalence of intestinal parasitic infections in the community of Pygmies. The negative test results may prove the effectiveness of periodic deworming campaigns chich, implemented by non-governmental organizations, are voluntary with respect to the informed consent principle.

Prevalence of Asymptomatic Malaria Infections in Seemingly Healthy Children, the Rural Dzanga Sangha Region, Central African Republic

According to the World Health Organization 94% of global malaria cases and 94% of global malaria deaths have been reported from Africa. Unfortunately, it is difficult to determine the exact prevalence of disease in some African countries due to a large number of asymptomatic cases. The aim of this study was to assess the prevalence of malaria infections in seemingly healthy children living in the Central African Republic (CAR). CareStart^TM Malaria HRP2 rapid diagnostic test (RDT) targeting Plasmodium falciparum was used to test a group of 500 asymptomatic children aged 1-15 years old (330 settled Bantu and 170 semi-nomadic BaAka Pygmies) inhabiting the villages in the Dzanga Sangha region (south-west CAR) in March 2020. In total, 32.4% of asymptomatic Bantu and 40.6% of asymptomatic Pygmy children had a positive result of malaria RDT. Our findings allowed us to demonstrate the high prevalence of asymptomatic malaria infections in south-west CAR. RDTs seem to be a useful tool for the detection of Plasmodium falciparum in areas with limited possibilities of using other diagnostic methods, such as light microscopy and molecular biology.

Extreme traveler

Although they may pose a serious health risk or may even turn out to be life-threatening, extreme sports, i.e. high-risk physical activities of varied difficulty, are growing in popularity among international travelers in recent years. Extreme sports encompass a wide range of activities such as scuba diving, rafting, surfing, bungee jumping and mountaineering. It is not unusual for travelers to engage in extreme sports far off the beaten path, in destinations where environmental conditions are difficult and specialist healthcare is not easily available. Therefore, before taking the decision to engage in any form of adventurous activity, travelers should be encouraged to take certain precautionary measures. The most important are: identification of potential health risk factors related to travel or the activity itself, physical conditioning and fitness training prior to travel (depending on the type of activity) and prophylaxis (a travel health kit, mandatory and recommended vaccinations, a pre-travel consultation to assess a person's fitness to travel and identify any potential contraindications for certain types of adventure sports, a comprehensive travel insurance policy). The article focuses on popular extreme sports, common risk factors associated with extreme activities as well as the recommended prophylaxis and precautionary measures.

Post-travel screening of symptomatic and asymptomatic travelers

Until last year, terrorism, economic instability, poverty and natural disasters were considered the major threats to humans globally. Infectious diseases were seen as a minor problem. This, however, changed in 2020 when the global COVID-19 pandemic broke out and a new danger emerged. The latest events generated a lot of discussion on health hazards associated with international tourism and uncontrolled spread of pathogens across the borders. The major health problems of travelers to developing countries with harsh environmental conditions and endemic infectious diseases include gastrointestinal disorders, dermatoses, respiratory infections and fevers of unknown origin. A medical interview by an experienced physician is the foundation of the post-travel screening process both in symptomatic and asymptomatic travelers; the interview should focus on identifying exposure to risk factors (endemic infectious diseases, failure to adopt disease prevention measures, consumption of food or water from unsafe sources, insect bites, animal bites, travelling in large groups, unsafe sex with casual partners). While physical examination (identification of abnormalities) and diagnostic tests (identification of pathogens) can be useful for detecting illnesses and asymptomatic infections as well as assessing the general health condition of a patient, including his immune system. The aim of the article is to provide information on the post-travel screening process in symptomatic and asymptomatic travelers who have returned from areas with harsh climate conditions and low sanitation standards.

Gastrointestinal infections in returned travelers

Gastrointestinal infections are one of the most frequent medical conditions diagnosed in patients who travel to tropical or subtropical destinations. The most common disorder occurring in up to 60% travelling people is travelers' diarrhea (TD). The illness is defined as a minimum of three loose stools within 24 hours; in most cases TD is caused by the enterotoxigenic Escherichia coli. Its symptoms usually persist for 4-5 days and resolve spontaneously or on self-administered empirical antimicrobial therapy, but in case of an invasive infection, it is necessary to seek medical care. As most tourists travel for 1-2 weeks, the disease often persists or develops upon return; therefore, it is important to raise awareness of TD's clinical features and treatment options among physicians from travelers' home countries unaccustomed to this health problem. Another issue, which is gaining more and more importance in recent years, is post-infectious irritable bowel syndrome, a chronic disturbance affecting up to 17% of patients, who have had travelers' diarrhea. This review aims to promote prophylaxis of gastrointestinal disorders and to extend knowledge about their after-effects in returned travelers.

Immunoprophylaxis for travellers

When planning a journey to a destinations where infectious diseases are endemic one needs to undertake appropriate prophylactic measures in order to reduce the risk of developing a travel-related health problem. It is important that a traveller undergoes a medical examination before travel, makes sure that his travel first-aid kit includes all the necessary medicines and receives all the required and recommended travel vaccinations. There are currently two vaccination requirements and more than ten vaccination recommendations for international travellers according to the World Health Organization guidelines. The article discusses the major issues concerning immunoprophylaxis for travellers, in particular the epidemiology of infectious diseases and the vaccination schedules (the primary course and booster doses).

First detection of Echinococcus multilocularis in environmental water sources in endemic areas using capsule filtration and molecular detection methods

Water is one of the possible transmission routes for water- and foodborne parasites to humans. Echinococcus multilocularis is a parasite, which causes alveolar echinococcosis (AE). Nevertheless, no environmental studies have been performed as yet to confirm the occurrence of E. multilocularis in water supplies. Accordingly, 105 water samples of 50 L volume were collected from surface waters (lakes, rivers, canals) and wells in the Warmia-Masuria Province (Echinococcus endemic area) and Pomerania Province (Echinococcus non-endemic area), Poland. The water was filtered and subsequently analysed with nested PCR and real-time PCR. E. multilocularis DNA was found in two (1.9%) samples, which originated from two lakes localised in the Warmia-Masuria Province. Sequencing of the positive samples confirmed that the PCR products were fragments of the E. multilocularis mitochondrial 12S rRNA gene. This is the first investigation describing E. multilocularis detection in environmental water samples, using molecular diagnostic tools. The results indicate that water could be considered as a potential source of E. multilocularis infections in humans and animals, in endemic areas.

Evaluation of Neisseria meningitidis Carriage with the Analysis of Serogroups, Genogroups and Clonal Complexes among Polish Soldiers

Neisseria meningitidis is an etiological factor of invasive meningococcal disease (IMD). This Gram-negative diplococcus is transmitted from person to person via droplets or through a direct physical contact with secretions of infected patients or asymptomatic carriers. The latter account for 5–10% of the general population. The aim of the study was to estimate the actual N. meningitidis carriage rate in the military environment with identification of serogroups, genogroups, sequence types and clonal complexes of the isolates detected among Polish soldiers. The study was conducted during winter seasons of 2015 and 2016 and involved 883 professional soldiers from the Armoured Brigade in Świętoszów, Poland. The material for testing were nasopharyngeal swabs obtained from study participants. The samples were tested using standard microbiological methods (culture, incubation, microscopy, biochemical and automated identification). N. meningitidis isolates were subjected to slide agglutination test (identification of serogroups), the bacterial DNA was extracted and allowed to determine genogroups, clonal complexes and sequence types. 76 soldiers were found to be carriers of N. meningitidis, they accounted for 8.6% of the study group. The meningococcal isolates mostly belonged to serogroup B. Sequence types ST-11439, ST-136, ST-1136 and the clonal complex 41/44CC were found to be predominant. Clonal complexes responsible for IMD were detected in 15.8% of carriers and 1.4% of the whole study participants. Carriage rates of N. meningitidis among Polish soldiers were found to be similar to those reported in the general population.

The older traveller

All over the world there has been a sudden increase in the number of international travels, mostly for touristic purposes. According to the World Tourism Organisation, the number of international journeys exceeded 1.323 billion in 2017 and it continues to grow. Of the growing number of travellers more and more are the elderly (> 65 years), this fact can be attributed to longer life expectancy and a better quality of life, especially in the developed countries. The article lists the main destinations chosen by senior tourists and their reasons for travel, it also discusses physiological changes in organs and systems affecting the elderly, which are the result of travelling across time zones and to areas with different environment. The article looks at various groups of patients affected by chronic diseases and examines health-related consequences of travel, including the most common complications. The general health prevention measures, with emphasis on vaccinations and antimalarial chemoprophylaxis, have also been discussed.

Does winter supplementary feeding affect deer damage in a forest ecosystem? A field test in areas with different levels of deer pressure

BACKGROUND

Supplementary feeding is a widespread but controversial practice in game management. While many studies have been conducted on this issue, there is limited empirical evidence on how feeding affects damage caused by wildlife. In this context, the present study focused on the effect of artificial winter feeding on tree damage in three mountain regions in Poland.

RESULTS

The presence of additional winter food did not increase tree damage caused by deer in any region, as expected. Moreover, we observed that additional feeding mitigated forest damage in one region, where the highest level of deer impact had occurred. However, in this mountain region, the most important factor was elevation, which was used to classify additional feeding practice as efficient or inefficient. In the two other study regions, we did not observe any effect of supplementary feeding.

CONCLUSIONS

Additional winter supplementary feeding can reduce damage caused by deer in forest stands, but only in areas with high deer pressure. Moreover, feeders should be situated in locations > 600 m above sea level in our study area. © 2018 Society of Chemical Industry.

Urogenital Chlamydia trachomatis in the environment of soldiers from the Polish Special Forces

INTRODUCTION AND OBJECTIVE

Urogenital Chlamydia trachomatis is one of the most common sexually transmitted bacterial pathogens. The aim of the study was to present the current occurrence of chlamydial infections among Polish soldiers, sexually-active men and women at reproductive age.

MATERIAL AND METHODS

The research involved 253 active duty soldiers from the Polish Special Forces, 237 men and 16 women aged 26-57, stationed in Warsaw between October - November 2016. The study participants were asked to fill a socio-demographic questionnaire and then subjected to diagnostic tests. These included a urine test for the presence of Chlamydia trachomatis DNA using the Real-Time PCR assay with fluorescently labeled markers and probes, complementary to plasmid DNA of the bacteria (DNA isolated from urine samples was used as matrix).

RESULTS

Chlamydia trachomatis infection was detected in two male soldiers, non-commissioned officers, at mean age 40.5 years (total: 38.0 years); reporting sexual contacts with 2-3 partners in the last 12 months (total: 141 soldiers - 1 partner, 66 - 2-3 partners, 46 - >4 partners), with no UTI symptoms.

CONCLUSIONS

Among all the study participants, of whom more than 40% reported sexual contacts with 2-4 or more partners within the last 12 months, only 0.8% were found to be infected. The low prevalence of Chlamydia trachomatis infection can be associated with a regular or frequent use of STI prevention measures during casual sex, or having a single sexual partner.

The pregnant traveller

Travelling during pregnancy has become increasingly common. Many pregnant women travel for pleasureand recreation and a lot of them continue to work and therefore often travel on business, sometimes to areas with poor standards of sanitation and limited access to health care providers. During pregnancy, it is extremely important that a woman has a regular access to maternal health care, also in temporary destinations, especially in areas characterised by harsh environmental conditions, and places where the prevalence of infectious diseases is high. It must be remembered that the course of contagious or parasitic illnesses, such as hepatitis E and malaria, is generally more severe in pregnant travellers, due to pregnancy-related immunosuppression. The assessment of indications and contraindications for the use of mandatory/recommended vaccinations and antimalarial drugs is also very important in pregnant travellers. When pregnant women travel for long term, it is absolutely necessary that they receive prenatal care in a new place of residence. Scheduled maternity care usually begins in week 10-12 of pregnancy, and continues once a month until the 7 month of pregnancy, next every second week until week 36 and then once a week until the delivery.

The paediatric traveller

International travel with children, which is the opportunity for the family to see the world together, has become commonplace. If you are travelling with children the journey needs to be carefully planned, especially in cases of visiting a region with harsh environment or poor sanitation. It is particularly important in terms of thermoregulation (hot climate) and the immune system (protection against pathogens causing infectious and invasive diseases) as these are not fully developed in small children. In addition, it is important to maintain appropriate safety and security measures in the destination area (e.g. using child car seats during drive, supervising children during recreational activities in water and on land, avoiding contact with undomesticated animals). Moreover, it is essential to prepare a travel health kit containing drugs appropriate for young travellers - matched for their age and body weight, and to purchase personal prevention products for everyday use (sunscreen with a high sun protection factor, insect repellents, etc.).

Immunocompromised travellers

Given a better quality of life and extended life expectancy in patients with immune suppression, the number of immunocompromised travellers is constantly growing. The aim of the article is to discuss travel-related health problems in immunocompromised patients, their most common destinations and reasons to travel, as well as complications associated with travel to regions with harsh environmental conditions. The article focuses on selected groups of immunocompromised travellers (ICTs), i.e., cancer patients, transplant patients receiving immunosuppressant agents, splenectomised patients and HIV-infected individuals. The most common infections and complications, including traveller's diarrhoea, vector-borne diseases (yellow fever, malaria, leishmaniasis, dengue, chikungunya), respiratory infections (including tuberculosis), and dermatoses were taken into account. Preventive measures dedicated to ICTs (pre-travel consultation, vaccinations, malaria chemoprophylaxis, prevention during travelling) have been also characterised.

Hepatitis E virus seroprevalence in Polish soldiers serving in harsh environmental conditions

BACKGROUND

Hepatitis E virus (HEV) is an under-recognised aetiological factor of viral hepatitis; it is most commonly transmitted via the oral-faecal route, but can also be transmitted by blood or blood products, vertically from an infected mother to the foetus or by transplanted organs. The aim of the study was to present the current seroprevalence of HEV among soldiers from the Polish Special Forces deployed on military operations carried out in harsh environmental conditions.

MATERIALS AND METHODS

The research conducted between October and November 2016 involved 253 active duty soldiers, 237 men and 16 women, aged 26-57, without clinical symptoms of infection, participants in military operations in Asia and Africa. Accurate HEV diagnosis required the implementation of a two-phase diagnostic protocol. During the first phase, immunoenzymatic ELISA method was used to detect specific anti-HEV antibodies (IgM and IgG) in blood serum samples indicating contact with an infectious agent in the past. During the second phase, serum samples obtained from subjects with positive or inconclusive test results were tested again using confirmatory recomLine HEV IgM/IgG immunoassay.

RESULTS

Immunoenzymatic assay found anti-HEV antibodies (IgM and/or IgG) in blood serum samples obtained from 18 soldiers. Confirmatory tests were carried out among soldiers tested positive with ELISA or those with inconclusive test results; the confirmatory tests showed anti-HEV antibodies (IgM and/or IgG) in 16 of the studied soldiers, i.e. 6.3% of the study group.

CONCLUSIONS

The occurrence of HEV infections in Polish soldiers justifies the need for the introduction of screening tests for HEV in the military environment, especially among blood donors and in cases of whole blood or blood products transfusion.

Travel medicine for divers

Recreational diving is increasing in popularity globally, also among European travellers. Since a majority of popular diving sites are located in tropical or subtropical destinations commonly characterised by harsh climate and poor sanitation, travellers planning to engage in recreational diving are recommended to take certain health prevention measures to reduce travel-associated health risks. They need to be aware of the fact that diving can threaten their lives or even be fatal; however, if they are well prepared physically and mentally and follow all the recommended safety rules while underwater, diving is an unforgettable experience that cannot be compared to any other sports activity performed on land. Before going on a diving trip, it is important to make the necessary arrangements, bearing in mind they should not only concentrate on diving-related activities (the marine environment) but also on other aspects, e.g. contact with terrestrial flora and fauna. Therefore, the health prevention measures (a pre-travel consultation, vaccinations, antimalarial chemoprophylaxis, a properly prepared travel health kit and travel insurance) are to keep a traveller healthy during the entire travel and not just the moments of going underwater. The most important of the pre-travel arrangements include pre-travel medical evaluation, selecting and preparing medications for chronic conditions and assembling the first aid kit for personal use. Travellers are recommended to have a pre-travel consultation in medical facilities whose personnel have an appropriate level of knowledge and expertise on hyperbaric, tropical and travel medicine.

Detection of Giardia intestinalis in water samples collected from natural water reservoirs and wells in northern and north-eastern Poland using LAMP, real-time PCR and nested PCR

Giardia intestinalis is a protozoan parasite, transmitted to humans and animals by the faecal-oral route, mainly through contaminated water and food. Knowledge about the distribution of this parasite in surface water in Poland is fragmentary and incomplete. Accordingly, 36 environmental water samples taken from surface water reservoirs and wells were collected in Pomerania and Warmia-Masuria provinces, Poland. The 50 L samples were filtered and subsequently analysed with three molecular detection methods: loop-mediated isothermal amplification (LAMP), real-time polymerase chain reaction (real-time PCR) and nested PCR. Of the samples examined, Giardia DNA was found in 15 (42%) samples with the use of LAMP; in 12 (33%) of these samples, Giardia DNA from this parasite was also detected using real-time PCR; and in 9 (25%) using nested PCR. Sequencing of selected positive samples confirmed that the PCR products were fragments of the Giardia intestinalis small subunit rRNA gene. Genotyping using multiplex real-time PCR indicated the presence of assemblages A and B, with the latter predominating. The results indicate that surface water in Poland, as well as water taken from surface wells, may be a source of Giardia strains which are potentially pathogenic for humans. It was also demonstrated that LAMP assay is more sensitive than the other two molecular assays.

First detection and genotyping of Giardia intestinalis in stool samples collected from children in Ghazni Province, eastern Afghanistan and evaluation of the PCR assay in formalin-fixed specimens

It is estimated that faecal-orally transmitted diseases are common in Afghanistan, as a consequence of poor hygienic standards of life and widespread contamination of water and food with both human and animal faeces. However, there is little information in the literature concerning infections caused by intestinal parasites in the Afghan population. In this study, we report the occurrence of Giardia intestinalis assemblages (A and B) in formalin-fixed stool samples collected from 245 Afghan schoolchildren living in Ghazni Province in eastern Afghanistan. Detection of the parasite’s DNA and genotyping was performed using real-time PCR, specific to the β-giardin gene of G. intestinalis. Positive results were recorded in 52 (21.2%) samples. Genotyping was successful in 39 faecal samples and showed the predominance of assemblage B of G. intestinalis in this population (15 assemblage A and 24 assemblage B). Co-infection with both genotypes A and B was detected in four samples. Additionally, we evaluated the effect of 10% buffered formalin fixative on the detection of G. intestinalis DNA using real-time PCR and nested PCR characterised by different lengths of PCR products (74 and 479 bp, respectively). The human faeces containing the Giardia cysts were tested for 16 weeks. Amplification of G. intestinalis DNA with real-time PCR was possible up to 6 weeks of preservation of stool sample in formalin, compared to only 2 weeks with nested PCR. This suggests that real-time PCR is a more suitable tool in cases where stool samples have to be kept in formalin for longer periods of time.

Detection of Echinococcus multilocularis DNA in fruit, vegetable, and mushroom samples collected in the non-endemic territory of the Pomerania province and comparison of the results with data from rural areas of the neighbouring highly endemic Warmia-Masuria province, Poland

Echinococcus multilocularis is a tapeworm that may cause alveolar echinococcosis (AE), one of the most dangerous parasitic zoonoses. As in the case of some foodborne diseases, unwashed fruits and vegetables contaminated with eggs of E. multilocularis may serve as an important transmission route for this parasite. The aim of this study was to investigate the presence of E. multilocularis DNA in fruit, vegetables, and mushrooms in rural areas of the Pomerania province, Poland (non-endemic territory). In total, 104 environmental fruit, vegetable, and mushroom samples collected in forests, plantations, and kitchen gardens were analysed using nested PCR based on the mitochondrial 12S rRNA gene. E. multilocularis DNA was detected in 6.7 % of the samples tested, which indicated that the environment of the Pomerania province is contaminated with this parasite, creating a potential risk for humans. Therefore, fresh fruit, vegetables, and mushrooms should be washed before consumption. Additionally, the results showed that the level of contamination is significantly lower than in the highly endemic Warmia-Masuria province. The differences in the occurrence of E. multilocularis in the environment of these neighbouring provinces appears to be connected with the general epidemiological situation of these two regions, but further study is required for an exact explanation.

Detection of Giardia intestinalis infections in Polish soldiers deployed to Afghanistan

BACKGROUND

Members of the Polish Military Contingent (PMC) have been stationed in Afghanistan since 2002. They typically serve in areas characterised by low standards of sanitation which often leads to the development of food- and waterborne diseases. The aim of the study was to evaluate the prevalence of Giardia intestinalis infections among Polish soldiers deployed to Afghanistan. The research study was conducted as part of a programme for prevention of parasitic diseases of the gastrointestinal tract run by the Polish Armed Forces.

MATERIALS AND METHODS

The study was carried out in August 2011; it involved 630 asymptomatic Polish soldiers serving in the Forward Operational Base (FOB) Ghazni in eastern Afghanistan. Stool specimens obtained from members of the PMC were first tested in FOB Ghazni (detection of Giardia intestinalis by Rida Quick Giardia immunochromatographic tests and Ridascreen Giardia immunoenzymatic tests - single samples). Next, the same biological material and two other faecal specimens fixed in 10% formalin were transported to the Military Institute of Medicine in Poland, where they were tested for Giardia intestinalis under light microscopy (direct smear, decantation in distilled water).

RESULTS

Parasitological tests performed under light microscopy showed that 2.7% (17/630) of the study group were infected with Giardia intestinalis. Some of these results were confirmed by immunochromatographic tests (6/630). In contrast, immunoenzymatic tests (ELISA) demonstrated a significantly higher detection rate reaching 18.1% (114/630). Immunoenzymatic tests confirmed all the positive results given by light microscopy and by immunochromatographic tests.

CONCLUSIONS

The prevalence rate of Giardia intestinalis infections in Polish soldiers deployed to Afghanistan was found to be high. Microscopic methods exhibit low sensitivity and therefore may result in the underestimation of the true parasite prevalence. Immunoenzymatic tests (ELISA) showing a much higher sensitivity in comparison to light microscopy and immunochromatographic tests ought to be applied in screening for intestinal protozoan infections in areas characterised by harsh environmental conditions.

Diagnostics of intestinal parasites in light microscopy among the population of children in eastern Afghanistan

OBJECTIVES

The Afghans, living in poor socioeconomic conditions, are estimated to be a community with a high rate of intestinal parasitic infections. The aim of the study was to estimate the prevalence and species of intestinal parasites among children's population in eastern Afghanistan and to present the methods of optimizing the techniques for identification of pathogens in light microscopy. The research was carried out as a part of humanitarian project Capacity building of health care system in Ghazni Province.

MATERIALS AND METHOD

The study involved 500 children aged 7-18 attending the Share Kona and the Khuija Ali High Schools in Ghazni, eastern Afghanistan in the period November 2013-April 2014. Three stool samples were collected from each patient at 2-day intervals, the samples were fixed in 10% formalin, transported to the Military Institute of Medicine in Poland, where they were pooled and examined using five different diagnostic methods in light microscopy (direct smear in Lugol's solution, Fülleborne's flotation, decantation in distilled water, Kato-Miura thick smear, and DiaSys/PARASYS sedimentation system).

RESULTS

Pathogenic intestinal parasites were detected in 217 patients (43.4%), with the most common Ascaris lumbricoides (35.3%), Giardia intestinalis (31.1%), and Hymenolepis nana (15.7%). The use of direct smear method allowed for the detection of intestinal parasites in 161 individuals. The application of four following testing methods has improved the detection rates of infected patients by 11.2%.

CONCLUSIONS

The variety of detected intestinal pathogens in examined children's population has required the use of combination of multiple diagnostic methods in light microscopy, and finally improved the detection rates of intestinal parasites and helped eliminate infections with nematodes, cestodes, trematodes, and protozoa using appropriate treatment in the study population.

Travel-related sexually transmitted infections

Sexually transmitted infections (STIs) are among the most common notifiable health problems worldwide, with particularly high rates in developing countries. Men and women with multiple sexual partners at home or a previous history of STIs are more likely to have casual sexual exposure (CSE) while travelling. Over the last several decades 5% to even 50% of short-term travellers engaged in CSE during foreign trips. It is estimated that only 50% of travellers use condoms during casual sex abroad. Sexual contact with commercial sex workers is an exceptionally high-risk behaviour. The common risk factor is also young age. Adolescents and young adults constitute 25% of the sexually active population, but represent almost 50% of all new acquired STIs. Many STIs are asymptomatic and therefore can be difficult to identify and control. The clinical manifestation of STIs can be grouped into a number of syndromes, such as genital ulcer or erosion, urethral or vaginal discharge, pelvic inflammatory disease. STIs are divided into curable infections caused by bacteria (gonorrhoea, chlamydiasis, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale) or protozoa (trichomoniasis) and incurable viral infections (genital herpes, genital warts, HIV). STIs are not only a cause of acute morbidity, but may result in complications including male and female infertility, ectopic pregnancy, cervical cancer, premature mortality or miscarriage. Monogamous sex with a stable, uninfected partner or sexual abstinence remains the only way to avoid the risk of becoming infected with STIs.

Fresh fruits, vegetables and mushrooms as transmission vehicles for Echinococcus multilocularis in highly endemic areas of Poland: reply to concerns

Echinococcus multilocularis is a tapeworm that may cause alveolar echinococcosis (AE), one of the most dangerous parasitic zoonoses. As in the case of other foodborne diseases, unwashed fruits and vegetables, contaminated with dispersed forms of E. multilocularis, may serve as an important transmission route for this parasite. In this article, we reply to the incorrect interpretation of results of our study concerning the detection of E. multilocularis DNA in fresh fruit, vegetable and mushroom samples collected from the highly endemic areas of the Warmia-Masuria Province, Poland, to dispel any doubts. The accusations formulated by the commentators concerning our paper are unfounded; moreover, these commentators demand information which was beyond the purview of our study. Making generalisations and drawing far-reaching conclusions from our work is also unjustified. The majority of positive samples were found in only a few hyperendemic communities; this information corresponds with the highest number of both infected foxes and AE cases in humans recorded in this area. Our findings indicate that E. multilocularis is present in the environment and may create a potential risk for the inhabitants. These people should simply be informed to wash fruits and vegetables before eating. No additional far-reaching conclusions should be drawn from our data. We believe these commentators needlessly misinterpreted our results and disseminated misleading information. Nevertheless, we would like to encourage any readers simply to contact us if any aspects of our study are unclear.

Skin lesions in returning travellers

Skin lesions, apart from diarrhoeas, fever of unknown origin, and respiratory tract infections belong to the most frequent medical problems in travellers returned from tropical and subtropical destinations, accounting more than 10% of reported cases. Most dermatoses have their clinical onset during travel, although some of them can occur after return. Travel-related dermatological problems can have a wide spectrum of clinical picture, from macular, popular or nodular rash, linear and migratory lesions, to plaques, vesicles, bullae, erosions or ulcers. Skin conditions in returning travellers may be of infectious and non-infectious aetiologies. Infectious lesions may be originally tropical (e.g. dengue, chikungunya, schistosomiasis, leishmaniasis, myiasis, tungiasis, loiasis), although the majority are cosmopolitan (arthropod bites, sunburns, allergic rashes). The evaluation of skin lesions depends on many factors, including immune status of patients, use of medicines, exposure on health hazards (fauna, flora, risky behaviours), as well as the time, duration and location of travel. As the number of travellers to tropical and subtropical destinations has been continuously rising, the number of skin illnesses has also been increasing. This means that specialists in travel medicine need to extend their knowledge of epidemiology, clinical features and diagnosis of travel-related health problems including skin lesions in returning travellers.

Fever of unknown origin in returning travellers

The aim of the article is to discuss issues associated with the occurrence of febrile illnesses in leisure and business travellers, with a particular emphasis on fevers of unknown origin (FUO). FUO, apart from diarrhoeas, respiratory tract infections and skin lesions, are one of the most common health problems in travellers to tropical and subtropical countries. FUO are manifestations of various diseases, typically of infectious or invasive aetiology. In one out of 3 cases, the cause of a fever in travellers returning from the hot climate zone is malaria, and therefore diagnostic tests should first aim at ruling out this specific disease entity. Other illnesses with persistent fever include dengue, enteric fever, viral hepatitis A, bacterial diarrhoeas and rickettsioses. Fever may also occur in travellers suffering from diseases of non-tropical origin, e.g. cosmopolitan respiratory tract or urinary tract infections, also, fever may coexist with other illnesses or injuries (skin rashes, bites, burns).

The characteristics of perpetrators of sexual offences with organic lesions in the central nervous system

Behaviour changes resulting from central nervous system (CNS) injury have been extensively presented in the scientific literature. Although the association between sexual violence and organic CNS lesions has been documented, the research on this subject is scarce.

AIM

The aim of this study was to explore the characteristics of perpetrators with organic lesions in CNS who committed sexual offences.

MATERIAL AND METHODS

The research material consisted of 180 court ordered psychiatric-sexuological assessments issued by forensic experts from the Mental Health Outpatient Unit in the 10th Military Clinic Hospital in Bydgoszcz (Poland) between 2004 and 2012. A specially designed questionnaire titled "Charter for Diagnosis of Factors Determining Criminal Sexual Activity" has been used.

RESULTS

Relevant statistically significant dependences have been observed between the examined variables.

CONCLUSIONS

The vast majority of perpetrators of sexual offences have been found to have organic lesions in the central nervous system (CNS). Perpetrators of sexual offences found to have organic lesions in CNS were more likely to overuse alcohol and had earlier onset of alcohol use. Among the perpetrators within the study group the most common clinical diagnosis was organic personality disorder.

Epidemiology of intestinal parasitic infections in school children in Ghazni Province, eastern Afghanistan

OBJECTIVE

To estimate the prevalence of intestinal parasites and their species in Afghan school children and to establish appropriate treatment methods for detected pathogens.

METHODS

Parasitological examination of stool samples collected from 1369 children aged 8-18, students of the Jahan Malika High School in Ghazni Province in eastern Afghanistan, was conducted in the period November 2013-April 2014. Three stool samples were collected from each patient every second day; the samples were fixed in 10% formalin and tested by light microscopy using the methods of direct smear in Lugol's solution, decantation in distilled water, and Fülleborn's flotation.

RESULTS

Of 535 examined children (39.1% of the study group) were infected with nematodes (n=324), cestodes (n=118), trematodes (n=12), and protozoa (n=228), 132 were diagnosed with co-infections (mainly ascariasis+giardiasis, ascariasis+hymenolepiasis) and received single or combined therapy.

CONCLUSIONS

The Afghan community is an example of population characterized by a high rate of parasitic infections. Owing to high prevalence of multiple infections among inhabitants of Afghanistan, it seems that a mass deworming campaign with a single-dose chemotherapy may prove ineffective in eradicating intestinal parasites in the local population.