Journal of travel medicine最新文献

Rationale for review: Travel-related skin problems are a common reason for healthcare consultations. We present a clinical approach to diagnosing skin diseases in travellers, emphasizing clinical examination and epidemiological clues such as travel history, incubation time and at-risk behaviors.

Key findings: Skin problems or manifestations of systemic infections are the third most common health issue encountered by travellers, though their causes and frequency may vary based on the season and destination. The four most frequent skin conditions affecting travellers include arthropod bites, sunburns, hookworm-related cutaneous larva migrans, and bacterial skin and soft tissue infections. Dengue fever is the leading cause of febrile exanthema in travellers returning from Asia, Latin America, and the Caribbean, while hookworm-related cutaneous larva migrans is the most common cause of creeping dermatitis. Notable travel-related infections associated with pruritus include cercarial dermatitis, scabies, creeping dermatitis, and urticaria. Acute schistosomiasis is the most common parasitic cause of acute urticaria in travellers. African tick-bite fever is the most frequently encountered rickettsiosis, typically presenting with single or multiple eschars.

Conclusions: Diagnostic approaches emphasize the importance of travel history, at-risk activities during travel, and lesion distribution. At-risk activities include sun exposure, walking barefoot, exposure to sea and fresh water, hiking in forested or jungle areas, exposure frequency to mosquitoes and sandflies, poor hygiene and food intake, drug history, and sexual behaviour. Morphological characteristics (vesicula, bullae, pustule, papule, nodule, plaque, oedema, and ulcer), distinguishing between single and multiple skin lesions, localized or generalized, and whether mucosa, scalp, palmar or plantar surfaces are affected, provide further clinical clues. Systemic signs and symptoms such as fever and pruritus will aid in the differential diagnosis algorithms. With a thorough clinical assessment and knowledge of geographic and exposure-related risk factors, the differential diagnosis of travel-associated skin conditions can be narrowed down allowing for timely clinical management.

Atovaquone/proguanil is frequently prescribed among travellers to malaria-endemic areas. Side effects most commonly include headaches and gastrointestinal symptoms. Nevertheless, physicians should be aware of possible rare severe cutaneous adverse reactions, in order to facilitate the diagnosis and interrupt the drug rapidly if suspected.

We described the case of a Guinea-Conakry patient presented with a pulmonary Schistosoma mansoni infection. Hypereosinophilia, positive serology and multiple lung nodules led us to suspect the diagnosis. However, parasitic examination of stool and urine were negative. The diagnosis was obtained thanks to specific serum PCR.

Background: Travellers frequently visit popular destinations like Brazil, India, Peru, Thailand, and Tanzania, each presenting varying malaria risks. The extent to which travellers enter high-risk malaria-endemic areas in destinations with heterogeneous malaria risk remains unclear. We used geo-location via smartphone application to (i) describe where travellers go within countries with heterogeneous malaria risk (Brazil, India, Peru, Thailand), and (ii) compare mosquito bite prevention behaviours between these destinations and Tanzania, considered entirely high-risk for malaria.

Methods: This analysis is a sub-study of the TOURIST2 cohort, which prospectively recruited 1000 travellers (≥ 18 years, travelling ≤ 4 weeks) from Swiss travel clinics (Zurich and Basel) between 09/2017-04/2019. We included 734 travellers to Brazil, India, Peru, Thailand, and Tanzania who provided geo-location data. Daily health and geo-location data were collected using a smartphone application. Malaria risk was categorised using 2022 malaria maps from the Swiss Expert Committee for Travel Medicine.

Results: Of the 734 travellers, 525 travelled to Brazil, India, Peru, and Thailand, and 225 to Tanzania. In Brazil, India, Peru, and Thailand, only 2% (n = 13) visited high-risk malaria areas. In Peru, 4% (n = 4) visited a high-risk area; in Brazil, 3% (n = 6); in Thailand, 2% when crossing the border into Myanmar (n = 3); and in India, 0%. Travellers to high-risk areas were more often male (62%), slightly older (median age 42.0), and planned longer trips (median 23.0 days) than other travellers. No participants were diagnosed with malaria. Travellers to Brazil, India, Peru and Thailand used mosquito bite prevention measures less frequently than travellers to Tanzania. Those in Tanzania had higher, but still suboptimal, use of insect spray (65% of travel-days).

Conclusions: Travellers to Brazil, India, Peru, and Thailand rarely visited high-risk malaria areas, and their adherence to mosquito bite prevention measures was generally low. In Tanzania, adherence was higher but still suboptimal.

Background: Typhoid and paratyphoid fever, collectively known as enteric fever, are systemic infections caused by Salmonella enterica and are highly prevalent in children. We aimed to describe the global burden, trends, and inequalities of enteric fever among children under 15 years from 1990 to 2019 based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019).

Methods: In this secondary analysis of GBD 2019, we extracted data for incident cases, deaths, disability-adjusted life-years (DALYs) as measures of enteric fever burden. We estimated the average annual percentage changes (AAPC) in enteric fever incidence, mortality, and DALYs rate to quantify trends over time. Cross-country inequalities in enteric fever incidence were measured using the slope index of inequality and concentration index.

Results: In 2019, the global cases of typhoid and paratyphoid were 4 833 282 and 1 793 172, respectively, both lower than those in 1990. On secondary analysis, paratyphoid incidence decreased at a faster rate than typhoid from 1990 to 2009, whereas the incidence of paratyphoid (AAPC = -3.78, 95% CI: -4.07, -3.49) declined slower than that of typhoid (AAPC = -4.32, 95% CI: -4.50, -4.13) from 2010-2019 (P < 0.05) at the global level. The incidence burden of enteric fever increased in Australasia (AAPC = 1.28, 95% CI: 0.77, 1.78) and Western Europe (AAPC = 0.77, 95% CI: 0.44, 1.11). Death and DALYs burden in low socio-demographic index (SDI) region showed an stable trend. A significant reduction in SDI-related inequality occurred, with the concentration index falling from -0.31 in 1990 to -0.22 in 2019.

Conclusions: The global disease burden of enteric fever and the magnitude of inequalities across countries have declined since 1990, but low SDI countries remain a region of concern. Travellers from Oceania and Western Europe to endemic regions should be particularly aware of the risk of enteric fever.