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traveller - Top 30 Publications

Kikuchi-Fujimoto disease: an unusual presentation of meningitis in a returning traveller.

A 19-year-old, previously healthy woman developed a pruritic erythematous maculopapular rash on her bilateral palms and wrists, right-sided tender cervical lymphadenopathy and nightly fevers and headaches 5 days after returning from a 1-month trip to Cambodia. She presented 2 weeks after her trip due to ongoing nightly fevers to a maximum of 38.8°C. She was given empiric doxycycline for possible rickettsial disease, though an extensive infectious workup returned without positive findings. Lumbar puncture was performed on hospital day 4, and spinal fluid analysis was consistent with aseptic meningitis. On hospital day 5, core biopsy and fine-needle aspiration were performed on the largest anterior cervical lymph node. Her fever curve gradually improved, and she was discharged on hospital day 6. Results of the lymph node biopsy were finalized 5 days after discharge and were compatible with Kikuchi's lymphadenitis. Symptoms had completely resolved on follow-up with infectious disease and rheumatology.

Gastroenteritis outbreaks on cruise ships: contributing factors and thresholds for early outbreak detection.

When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013 by five seagoing cruise ships were analysed to identify attack rate thresholds for early outbreak detection. The overall incidence rate of AG was 2.81 cases per 10,000 traveller-days (95% confidence interval (CI): 0.00-17.60), while the attack rate was 19.37 cases per 10,000 travellers (95% CI: 0.00-127.69). The probability of an outbreak occurring was 11% if 4 per 1,000 passengers reported symptoms within the first 2 days of the voyage, and this increased to 23 % if 5 per 1,000 passengers reported such within the first 3 days. The risk ratio (RR) for outbreak occurrence was 2.35, 5.66 and 8.63 for 1, 2 and 3 days' delay of symptoms reporting respectively, suggesting a dose-response relationship. Shipping companies' policies and health authorities' efforts may consider these thresholds for initiating outbreak response measures based on the number of cases according to day of cruise. Efforts should focus on ensuring travellers report symptoms immediately and comply with isolation measures.

Severe delayed haemolytic anaemia associated with artemether-lumefantrine treatment of malaria in a Japanese traveller.

Delayed haemolytic anaemia has been reported in association with intravenous artesunate treatment in patients with severe Plasmodium falciparum malaria, and furthermore, oral artemisinin-based combination therapies including artemether-lumefantrine (AL) have also been incriminated. However, definite cases of delayed haemolytic anaemia associated with AL appear to be scarce, as reported cases were often treated concomitantly with other anti-malarials. In this study, we report a severe case of delayed haemolytic anaemia following AL alone in a Japanese traveller with severe parasitaemia caused by numerous P. falciparum parasites and a few P. vivax parasites. We also stress the need by further studies to differentiate between delayed haemolytic anaemia and blackwater fever, the latter being another malaria-related haemolytic condition, more clearly than they are now.

Unusual case of splenomegaly and pancytopenia in a returned traveller.

A returning traveller with epilepsy.

Encephalitis in a traveller with typhoid fever: efficacy of corticosteroids.

Typhoid fever is a bacterial infection caused by Salmonella typhi or S. paratyphi, recognized as a classical cause of fever in returning travellers. However, neuropsychiatric presentations are rarely reported in travellers diagnosed in western countries, whereas they are more commonly described in patients treated in endemic areas. We describe such a case and discuss the pathophysiologic mechanisms of this complication.

Self-diagnosis of malaria by travellers: a cohort study on the use of malaria rapid diagnostic tests provided by a Swiss travel clinic.

The WHO recommends that all suspect malaria cases be tested before receiving treatment. Rapid diagnostic tests (RDT) for malaria can be performed reliably by community health workers with no formal medical background and thus, RDTs could also be provided to travellers for self-diagnosis during visits to endemic regions.

How practices can facilitate access for the gypsy traveller community.

Gypsy travellers have poor health in comparison to the UK average. They may struggle to access emergency and routine dental care because of social, educational and cultural barriers. General dental practitioners can facilitate better oral health within the community by improving access, which may require some adaptation to conventional practice. This paper discusses the experiences of a practice within West Oxfordshire and highlights areas in which the authors have found small modifications to aid appointment attendance and patient motivation. Primary care dental practitioners come across a wide variety of patients from very diverse backgrounds. Following a year working in West Oxfordshire, one group of patients has particularly stood out - the travelling community. The term 'traveller' or 'gypsy' refers to 'persons who wander or travel for the purpose of making or seeking their livelihood (not persons who move from place to place without any connection between their movements and their means of livelihood)' and includes those who live permanently or temporarily in settled housing. There are many different socio-cultural groups within this broad definition, including Romany Gypsies, Irish Travellers, Scottish Travellers and Eastern European Roma Communities.

Sushi, ceviche and gnathostomiasis - A case report and review of imported infections.

We describe a case of imported cutaneous gnathostomiasis in a Thai patient living in France. Gnathostomiasis is a zoonosis of food origin. The disease is endemic in Southeast Asia and Latin America. However, over the past 30 years, an increasing number of imported cases has been described in Europe and America. The disease is rare in Western Europe and the majority of cases described had a cutaneous clinical presentation. The disease may sometimes be confused with allergy, leading to a delay in diagnosis. Visceral symptoms are rare but may follow severe attacks. A definitive diagnosis can be obtained by the isolation of larvae from skin biopsies, but these are rarely performed. The diagnosis is usually presumptive, based on a combination of anamnestic, clinical, and biological factors. Several courses of the anti-helminths, albendazole or ivermectin, are often necessary. Although rare, the diagnosis should be evoked systematically in a migrant or traveller returning from an endemic area with cutaneous lesions.

A Tale of Black Eschar in a Returning Traveller.

African tick-bite fever is an increasingly common cause for fever in the returning traveller. It needs to be considered in the febrile returning traveller with a characteristic rash: a black eschar.

Crusted Nodules on the Lower Left Arm in a Traveller Returning from South America: A Quiz.

Relationship of altitude mountain sickness and smoking: a Catalan traveller's cohort study.

The aim of this study is to analyse the relationship between smoking and altitude mountain sickness in a cohort of travellers to 2500 metres above sea level (masl) or higher.

Epstein-Barr virus and cytomegalovirus mononucleosis: Important causes of febrile illness in returned travellers.

Diagnosing the cause of fever in the returned traveller is challenging. Efforts often focus on identifying 'exotic' pathogens. Primary Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections cause clinical features that overlap with many exotic pathogens. The age-matched seroprevalence of both EBV and CMV is greater in tropical than temperate areas. We describe the clinical and laboratory features of returned travellers diagnosed with primary CMV and EBV syndromes.

Malaria prevention recommendations for risk groups visiting sub-Saharan Africa: A survey of European expert opinion and international recommendations.

Malaria prevention can be complex due to the individual characteristics of the traveller, travel destination, duration of stay and type of travel. Our aim in this study was to document malaria chemoprophylaxis recommendations provided by travel-medicine experts in Europe for specific risk groups of travellers visiting malaria-endemic areas of sub-Saharan Africa.

Can a galacto-oligosaccharide reduce the risk of traveller's diarrhoea? A placebo-controlled, randomized, double-blind study.

Diarrhoea is a common medical problem affecting travellers to Asia, Africa and Latin America. The use of prophylactic antimicrobial agents may increase the risk of contracting resistant bacteria. Findings indicate that oligosaccharides, i.e. carbohydrate chains of 3-10 monosaccharides, reduce the risk of diarrhoea.

The quantified self during travel: mapping health in a prospective cohort of travellers.

Travel medicine research has remained relatively unchanged in the face of rapid expansion of international travel and is unlikely to meet health challenges beyond infectious diseases. Our aim was to identify the range of health outcomes during travel using real-time monitoring and daily reporting of health behaviours and outcomes and identify traveller subgroups who may benefit from more targeted advice before and during travel.

A rare case of subcutaneous abscess with intercostal muscles involvement by pleural tuberculosis in a Malagasy young traveller.

Lyme disease vs Baggio-Yoshinari syndrome in a returned traveller from Brazil.

What proportion of international travellers acquire a travel-related illness? A review of the literature.

As international travel increases, travellers may be at increased risk of acquiring infectious diseases not endemic in their home countries. Many journal articles and reference books related to travel medicine cite that between 22-64% of international travellers become ill during or after travel; however, this information is minimal, outdated and limited by poor generalizability. We aim to provide a current and more accurate estimate of the proportion of international travellers who acquire a travel-related illness.

Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia.

Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia.

6-year review of +Redivi: a prospective registry of imported infectious diseases in Spain.

Understanding and detecting imported diseases is a priority in the prevention and management of prevalent and emergent infectious diseases acquired abroad. The +Redivi network measures the burden of imported infections in Spain and is essential for closing the gap in travel medicine.

Cutaneous Mycobacterium gordonae infection in an elderly diabetic returned traveller.

Mycobacterium gordonae, a low pathogenicity organism, is rarely implicated in skin and soft tissue infections. We present a 77-year-old returned diabetic traveler from rural Sudan with cutaneous M. gordonae infection. Several months of ciprofloxacin, rifampin and ethambutol led to resolution of his plaque, without signs of recurrence at 6-month follow-up.

Individual traveller health priorities and the pre-travel health consultation.

The purpose of this study was to examine the principal travel health priorities of travellers. The most frequently selected travel health concerns were accessing medical care abroad, dying abroad, insect bites, malaria, personal safety and travel security threats. The travel health risks of least concern were culture shock, fear of flying, jet lag and sexually transmitted infections. This study is the first to develop a hierarchy of self-declared travel health risk priorities among travellers.

The Consul and the Beatnik: The Establishment, Youth Culture and the Beginnings of the Hippy Trail (1966-8).

This paper analyses the attitudes expressed by consular and embassy officials to a new type of traveller they encountered in the mid-1960s. Their observations are contextualised within wider debates concerning 'youth' in the late 1950s and 1960s. Officials distinguished sharply between 'overlanders' (who could be tolerated or accommodated) and 'beatniks' whose behaviour was characterized as illegal and/or unacceptable. Smoking cannabis was identified as a key marker of beatnik behaviour. Officials' observations are contrasted with four accounts by new travellers from the period. The paper concludes with a proposal for an 'anti-nominian' approach to the study of youth cultures: researchers should be more sensitive to the constructed nature of the labels used to identify the various strands of youth identity.

Toscana virus meningo-encephalitis: an important differential diagnosis for elderly travellers returning from Mediterranean countries.

Elderly patients have a long list of differentials for causes of acute confusion and altered consciousness levels, including infectious agents. In addition, elderly, retired patients often have more time to travel for tourism, particularly to exotic, warmer locations. Mediterranean countries such as Spain and Italy are popular holiday destinations for British and other tourists, especially during the winter months. However, these warm climates allow insect vectors to proliferate, increasing the risk of exposure to endemic vectorborne viral infections whilst on vacation. Such infections may not be routinely considered by geriatric medical teams.

Dalbavancin for outpatient parenteral antimicrobial therapy of skin and soft tissue infections in a returning traveller : Proposal for novel treatment indications.

Skin and soft tissue infections (SSTIs) are among the most common health problems in travellers returning from tropical and subtropical countries. Importantly, the prevalence of Staphylococcus aureus, the most common pathogen for purulent SSTIs, with specific drug resistance, such as methicillin resistant Staphylococcus aureus (MRSA) and those expressing virulence genes, such as Panton-Valentine-leukocidin is higher in tropical regions than in most high resource settings. This poses challenges for the empirical antimicrobial treatment of SSTIs in returning travellers. This short report describes a patient with a recent travel history to Hong Kong, Singapore and the Philippines who presented with multiple mosquito bites on both upper extremities and secondary bacterial superinfection. He had previously been prescribed oral beta-lactam antimicrobial therapy but lacked adherence to this treatment. Based on the risk for MRSA infection and problems with treatment adherence to oral therapy an outpatient parenteral antimicrobial therapy with dalbavancin was administered on days 0 and 7. Microbiological culture confirmed presence of MRSA and clinical follow-up demonstrated complete remission of the SSTI within 2 weeks. Dalbavancin is a promising treatment option for empirical parenteral treatment of SSTIs in returning travellers, a population at high risk for beta-lactam resistant S. aureus skin infections.

Prevalence and characteristics of paediatric Type 2 diabetes in the Republic of Ireland.

To establish the prevalence of paediatric Type 2 diabetes in the Republic of Ireland and describe patient demographics, initial presentation, management, outcomes, comorbidities and complications.

Pulmonary infections in the returned traveller.

Pulmonary infections in the returned traveller are a common presentation. A wide variety of infections may present with pulmonary symptoms. It is important for clinicians to differentiate the cause of these symptoms. The risk of contracting certain travel-related pulmonary diseases depends on travel destination, length of stay, activities undertaken and co-morbidities. Some pathogens are found worldwide, whilst others are related to specific locations. This review article will discuss the approach to diagnosing and treating pulmonary infections in the returned traveller.

Plasmodium knowlesi malaria in a traveller returning from the Philippines to Italy, 2016.

Plasmodium knowlesi is a simian parasite responsible for most human cases of malaria in Malaysian Borneo. A timely recognition of infection is crucial because of the risk of severe disease due to the rapid increase in parasitemia. We report a case of P. knowlesi infection in a traveller who developed fever and thrombocytopenia after returning from the Philippines in 2016. Rapid antigen test was negative, microscopy examination showed parasites similar to Plasmodium malariae, with a parasite count of 10,000 parasites per μL blood, while molecular testing identified P. knowlesi infection. Treatment with atovaquone-proguanil led to resolution of fever and restoration of platelet count in two days. P. knowlesi infection should be suspected in febrile travellers returning from South East Asia. Due to the low sensitivity of rapid antigen tests and the low specificity of microscopy, confirmation by molecular tests is recommended.

Dengue virus serotype 3 and Chikungunya virus co-infection in a traveller returning from India to Portugal, November 2016.

We report a case of a laboratory-confirmed Dengue and Chikungunya viruses co-infection imported from India to Portugal in early November 2016. The patient developed fever, retro-orbital pain and generalized myalgia after returning from Delhi, Jaipur, Agra, Rishikesh, Goa and Mumbai. This case highlights the importance of these arboviruses to public health in India where high rates of co-infection have been reported in the last few years, and demonstrates how challenging the laboratory diagnosis of imported co-infection cases can be in non-endemic areas.