{"title":"Multiple nodules and pustules in a traveler","authors":"Luca Pipitò , Marcello Trizzino , Fasciana Teresa , Donatella Ferraro , Antonio Cascio","doi":"10.1016/j.tmaid.2025.102880","DOIUrl":"10.1016/j.tmaid.2025.102880","url":null,"abstract":"","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"67 ","pages":"Article 102880"},"PeriodicalIF":6.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-16DOI: 10.1016/j.tmaid.2025.102875
Qingchun Li , Zike Cheng , Qinglin Cheng , Ruoqi Dai , Yifei Wu , Liyun Ai , Yinyan Huang , Qingjun Jia , Nan jiang , Xuexin Bai , Zijian Fang , Xu Song , Xin Lv
Background
Tuberculosis (TB) remains a critical public health challenge in China, particularly amid rapid urbanization and internal migration. This retrospective study analyzed the epidemiology and transmission dynamics of TB among internal migrants (IMTB) versus local residents (LRTB) in Hangzhou, China, from 2013 to 2022.
Methods
Data from 47,659 pulmonary TB cases were extracted from the national Tuberculosis Information Management System.
Results
IMTB accounted for 21.88 % of cases, with patients significantly younger (mean age 33.45 vs. 51.50 years, P < 0.0001) and fewer bacteriologically confirmed diagnoses (34.9 % vs. 41.8 %, P < 0.0001) compared to LRTB. Treatment success rates were higher among IMTB (95.0 % vs. 89.7 %, P < 0.0001). Spatial clustering of IMTB occurred in industrial districts, primarily originating from Anhui, Guizhou, and Jiangxi provinces.
Conclusion
Migration-driven TB transmission highlights the need for adaptive control strategies in urbanizing settings.
结核病（TB）在中国仍然是一个重大的公共卫生挑战，特别是在快速城市化和内部移民的背景下。本回顾性研究分析了2013年至2022年中国杭州内部流动人口（IMTB）与当地居民（LRTB）之间结核病的流行病学和传播动态。方法从国家结核病信息管理系统中提取47,659例肺结核病例的数据。结果simtb占21.88%，患者年龄明显年轻化（平均年龄33.45岁vs. 51.50岁）；0.0001)和较少的细菌学确诊(34.9%比41.8%,P <；0.0001)与LRTB相比。IMTB的治疗成功率更高(95.0% vs 89.7%, P <；0.0001)。IMTB的空间集聚主要集中在工业区域，主要分布在安徽、贵州和江西等省。结论移民驱动的结核病传播突出了城市化环境下自适应控制策略的必要性。
{"title":"Epidemiology and transmission dynamics of tuberculosis among internal migrants in Hangzhou: A retrospective analysis from 2013 to 2022","authors":"Qingchun Li , Zike Cheng , Qinglin Cheng , Ruoqi Dai , Yifei Wu , Liyun Ai , Yinyan Huang , Qingjun Jia , Nan jiang , Xuexin Bai , Zijian Fang , Xu Song , Xin Lv","doi":"10.1016/j.tmaid.2025.102875","DOIUrl":"10.1016/j.tmaid.2025.102875","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a critical public health challenge in China, particularly amid rapid urbanization and internal migration. This retrospective study analyzed the epidemiology and transmission dynamics of TB among internal migrants (IMTB) versus local residents (LRTB) in Hangzhou, China, from 2013 to 2022.</div></div><div><h3>Methods</h3><div>Data from 47,659 pulmonary TB cases were extracted from the national Tuberculosis Information Management System.</div></div><div><h3>Results</h3><div>IMTB accounted for 21.88 % of cases, with patients significantly younger (mean age 33.45 vs. 51.50 years, P < 0.0001) and fewer bacteriologically confirmed diagnoses (34.9 % vs. 41.8 %, P < 0.0001) compared to LRTB. Treatment success rates were higher among IMTB (95.0 % vs. 89.7 %, P < 0.0001). Spatial clustering of IMTB occurred in industrial districts, primarily originating from Anhui, Guizhou, and Jiangxi provinces.</div></div><div><h3>Conclusion</h3><div>Migration-driven TB transmission highlights the need for adaptive control strategies in urbanizing settings.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"67 ","pages":"Article 102875"},"PeriodicalIF":6.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.tmaid.2025.102872
Taha Maatoug , Farah Seedat , Eman Elafef , Anissa Ouahchi , Ali Mtiraoui , Stella Evangelidou , Wejdene Mansour , Ana Requena-Méndez , Dominik Zenner
Introduction
Migrants in the Middle East and North Africa (MENA) region face an increased tuberculosis (TB) risk due to socioeconomic and structural barriers. This systematic review synthesises evidence on TB burden, clinical outcomes, and epidemiological characteristics among migrants in MENA.
Methods
We searched six electronic databases and grey literature sources for studies published between 2000 and September 2024 in any language. Eligible studies reported primary data on TB prevalence, incidence, treatment outcomes, and clinical or epidemiological features in migrants. Pooled estimates were calculated using DerSimonian & Laird's random-effects model where applicable or narratively synthesised.
Results
Of the 779 records identified, we included 57 studies, comprising 95,190 TB cases and 3,532,359 migrants across 12 MENA countries. TB incidence was consistently higher in migrants than non-migrants (26.7–69.8/100,000 vs. 11.5–16.8/100,000). Migrants had lower TB-related mortality (pooled OR 0.8, 95 % CI 0.7–0.9; I2 = 2.9 %), however, treatment success rates were consistently below the WHO-recommended 90 % threshold. Migrant TB patients were younger (mean age difference: 12.8 years; 95 % CI 8.8–16.0; I2 = 86.5 %) and predominantly male (sex ratio: 1:5). Drug-resistant TB was more common among migrants, though this was not always statistically significant (multi-drug-resistant TB: pooled OR 1.2; 95 % CI 0.9–1.6; I2 = 40.2 %), while extrapulmonary TB was more prevalent among non-migrants (33.4–83.4 % vs. 16.6–72.9 %).
Conclusion
Migrants in MENA region experience disproportionate TB burden and poorer treatment outcomes, underscoring the need for targeted interventions. Enhanced data, especially from North Africa, is essential to support regional TB elimination aligned with World Health Organization and Sustainable Development Goals.
{"title":"Burden, clinical outcomes, and characteristics of tuberculosis in migrant populations in the middle East and North African region: A systematic review and meta-analyses","authors":"Taha Maatoug , Farah Seedat , Eman Elafef , Anissa Ouahchi , Ali Mtiraoui , Stella Evangelidou , Wejdene Mansour , Ana Requena-Méndez , Dominik Zenner","doi":"10.1016/j.tmaid.2025.102872","DOIUrl":"10.1016/j.tmaid.2025.102872","url":null,"abstract":"<div><h3>Introduction</h3><div>Migrants in the Middle East and North Africa (MENA) region face an increased tuberculosis (TB) risk due to socioeconomic and structural barriers. This systematic review synthesises evidence on TB burden, clinical outcomes, and epidemiological characteristics among migrants in MENA.</div></div><div><h3>Methods</h3><div>We searched six electronic databases and grey literature sources for studies published between 2000 and September 2024 in any language. Eligible studies reported primary data on TB prevalence, incidence, treatment outcomes, and clinical or epidemiological features in migrants. Pooled estimates were calculated using DerSimonian & Laird's random-effects model where applicable or narratively synthesised.</div></div><div><h3>Results</h3><div>Of the 779 records identified, we included 57 studies, comprising 95,190 TB cases and 3,532,359 migrants across 12 MENA countries. TB incidence was consistently higher in migrants than non-migrants (26.7–69.8/100,000 vs. 11.5–16.8/100,000). Migrants had lower TB-related mortality (pooled OR 0.8, 95 % CI 0.7–0.9; I<sup>2</sup> = 2.9 %), however, treatment success rates were consistently below the WHO-recommended 90 % threshold. Migrant TB patients were younger (mean age difference: 12.8 years; 95 % CI 8.8–16.0; I<sup>2</sup> = 86.5 %) and predominantly male (sex ratio: 1:5). Drug-resistant TB was more common among migrants, though this was not always statistically significant (multi-drug-resistant TB: pooled OR 1.2; 95 % CI 0.9–1.6; I<sup>2</sup> = 40.2 %), while extrapulmonary TB was more prevalent among non-migrants (33.4–83.4 % vs. 16.6–72.9 %).</div></div><div><h3>Conclusion</h3><div>Migrants in MENA region experience disproportionate TB burden and poorer treatment outcomes, underscoring the need for targeted interventions. Enhanced data, especially from North Africa, is essential to support regional TB elimination aligned with World Health Organization and Sustainable Development Goals.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"66 ","pages":"Article 102872"},"PeriodicalIF":6.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Here we report the acute and post-acute virological findings in a OROV infected traveller returning to Italy from Cuba. Testing multiple specimen types and the prolonged detection of OROV RNA in whole blood and urine samples extend the possibility of cases confirmation through direct diagnosis even in convalescence-phase of infection.
{"title":"Virological findings in a case of travel-associated Oropouche virus (OROV) infection imported to Italy, June 2024","authors":"Giada Rossini , Beatrice Mola , Alessandra Rampini , Margherita Ortalli , Giovanna Mattei , Tiziana Lazzarotto","doi":"10.1016/j.tmaid.2025.102874","DOIUrl":"10.1016/j.tmaid.2025.102874","url":null,"abstract":"<div><div>Here we report the acute and post-acute virological findings in a OROV infected traveller returning to Italy from Cuba. Testing multiple specimen types and the prolonged detection of OROV RNA in whole blood and urine samples extend the possibility of cases confirmation through direct diagnosis even in convalescence-phase of infection.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"66 ","pages":"Article 102874"},"PeriodicalIF":6.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rabies remains a significant global health concern. The aim of this study was to identify risk factors associated with delayed and incomplete post-exposure prophylaxis (PEP) for rabies among international travelers in eastern Thailand.
Methods
A retrospective study was conducted using the medical records of 528 international patients from January 2016 to December 2022. Logistic regression was used to analyze factors associated with delayed and incomplete PEP.
Results
PEP was delayed in 10.1 % of the patients and incomplete in 45.6 % of the patients. The factors associated with delayed PEP included an age of 35–60 years (AOR: 3.08, 95 % CI: [1.07, 8.86]), superficial wounds (2.86, 95 % CI: [1.38, 5.92]), and a single wound (1.88, 95 % CI: [1.01, 3.49]). Incomplete PEP was associated with ages 18–34 and 35–60 years (2.04, 95 % CI: [1.25, 3.32]; 2.28, 95 % CI: [1.27, 4.09]) and exposure to a non-dog mammal (2.05, 95 % CI: [1.29, 3.25]). Previous rabies immunization (0.19, 95 % CI: [0.10, 0.36]) and an intradermal vaccination regimen (0.58, 95 % CI: [0.39, 0.84]) were associated with a lower risk of incomplete PEP. There was no difference in delayed and incomplete PEP for rabies between Southeast Asian and non-Southeast Asian travelers.
Conclusion
In this study, a large proportion of international travelers had delayed or incomplete PEP for rabies. The patient's age and wound characteristics and the animal type were key factors that influenced PEP adherence. These findings highlight the need for targeted interventions to improve adherence to rabies PEP among international travelers in regions where rabies is endemic.
{"title":"Delayed and incomplete rabies post-exposure prophylaxis among international travelers: A seven-year retrospective study at an emergency center in eastern Thailand","authors":"Nipon Singkam , Vorapot Sapsirisavat , Jirayu Chanduan , Panichanok Piyabenjarad , Pimpattra Limpitigranon , Siraprapa Wisitthipakdeekul , Wiriya Mahikul","doi":"10.1016/j.tmaid.2025.102873","DOIUrl":"10.1016/j.tmaid.2025.102873","url":null,"abstract":"<div><h3>Background</h3><div>Rabies remains a significant global health concern. The aim of this study was to identify risk factors associated with delayed and incomplete post-exposure prophylaxis (PEP) for rabies among international travelers in eastern Thailand.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted using the medical records of 528 international patients from January 2016 to December 2022. Logistic regression was used to analyze factors associated with delayed and incomplete PEP.</div></div><div><h3>Results</h3><div>PEP was delayed in 10.1 % of the patients and incomplete in 45.6 % of the patients. The factors associated with delayed PEP included an age of 35–60 years (AOR: 3.08, 95 % CI: [1.07, 8.86]), superficial wounds (2.86, 95 % CI: [1.38, 5.92]), and a single wound (1.88, 95 % CI: [1.01, 3.49]). Incomplete PEP was associated with ages 18–34 and 35–60 years (2.04, 95 % CI: [1.25, 3.32]; 2.28, 95 % CI: [1.27, 4.09]) and exposure to a non-dog mammal (2.05, 95 % CI: [1.29, 3.25]). Previous rabies immunization (0.19, 95 % CI: [0.10, 0.36]) and an intradermal vaccination regimen (0.58, 95 % CI: [0.39, 0.84]) were associated with a lower risk of incomplete PEP. There was no difference in delayed and incomplete PEP for rabies between Southeast Asian and non-Southeast Asian travelers.</div></div><div><h3>Conclusion</h3><div>In this study, a large proportion of international travelers had delayed or incomplete PEP for rabies. The patient's age and wound characteristics and the animal type were key factors that influenced PEP adherence. These findings highlight the need for targeted interventions to improve adherence to rabies PEP among international travelers in regions where rabies is endemic.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"67 ","pages":"Article 102873"},"PeriodicalIF":6.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-27DOI: 10.1016/j.tmaid.2025.102871
Alfonso J. Rodriguez-Morales , Abdulaziz H. Alhazmi , Abraham Katime , Ahneez Abdul Hameed , Alejandra Morales , Alejandro Claudio Lepetic , Alejandro Risquez , Alex Julián Forero-Delgadillo , Alexis Holguin , Álvaro A. Faccini-Martínez , Amanda Guerrero , Ana Ribeiro , Asma Al Balushi , Aysegul Taylan Ozkan , Balram Rathish , Baruch Diaz , Beatriz Elena Porras-Pedroza , Bhanasut Hunsajarupan , Botond Lakatos , Carlos Álvarez-Moreno , Zitta Barrella Harboe
{"title":"Yellow fever in South America – A plea for action and call for prevention also in travelers from SLAMVI, ESGITM, EVASG, ALEIMC, GEPI-SEIMC, SEMEVI, and CMTZMV-ACIN","authors":"Alfonso J. Rodriguez-Morales , Abdulaziz H. Alhazmi , Abraham Katime , Ahneez Abdul Hameed , Alejandra Morales , Alejandro Claudio Lepetic , Alejandro Risquez , Alex Julián Forero-Delgadillo , Alexis Holguin , Álvaro A. Faccini-Martínez , Amanda Guerrero , Ana Ribeiro , Asma Al Balushi , Aysegul Taylan Ozkan , Balram Rathish , Baruch Diaz , Beatriz Elena Porras-Pedroza , Bhanasut Hunsajarupan , Botond Lakatos , Carlos Álvarez-Moreno , Zitta Barrella Harboe","doi":"10.1016/j.tmaid.2025.102871","DOIUrl":"10.1016/j.tmaid.2025.102871","url":null,"abstract":"","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"67 ","pages":"Article 102871"},"PeriodicalIF":6.3,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rabies exposure remains a significant public health concern in South and Southeast Asia. Despite the disease being vaccine-preventable, international travelers remain at risk of rabies infection due to the limited access to vaccines and immunoglobulin. This retrospective review aims to analyze post-exposure rabies consultations at the Thai Travel Clinic providing insights into epidemiology, risk factors, and post-exposure management for international travelers.
Methods
A retrospective study included international travelers of all ages who visited the Thai Travel Clinic at the Hospital for Tropical Diseases in Bangkok, Thailand for potential rabid animal post-exposure management between January 1, 2019, and March 31, 2024.
Results
Among 306 international travelers, 91.5 % were healthy with no underlying medical conditions. Approximately 30.9 % traveled in Southeast Asia for less than one month, 46.6 % for one to six months, and 20.8 % for over six months. The majority of bites were from dogs (46.3 %), followed by monkeys (23.9 %) and cat (23.5 %). Common exposure locations included streets (40.1 %), followed by islands or beaches (20.5 %). The median time from arrival in Thailand to animal exposure was 30 days, with 14.7 % bitten within the first week. World Health Organization (WHO) category III rabies wounds accounted for 59.8 % (176/294) of cases. Only 47.5 % (144/303) received the first dose of the rabies vaccine on the day of exposure, and 57.9 % (70/121) experienced delays in receiving rabies immunoglobulin. Additionally, two travelers (2/149; 1.3 %) refused rabies immunoglobulin despite it being clinically indicated. Only 35.3 % (108/306) had pre-travel consultations, and 9.5 % (29/306) of all travelers completed rabies pre-exposure vaccination.
Conclusions
Over half of the international travelers delayed initiating rabies vaccine or immunoglobulin after potential rabid animal exposure. As rabies is a fatal yet preventable disease, this review underscores the urgent need to raise awareness about the importance of prompt post-exposure management. Strengthening traveler education and advocating for pre-exposure immunization are critical strategies to mitigate risks and improve outcomes.
{"title":"Travel-related potential rabid animal post-exposure consultation at the Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok, Thailand","authors":"Rachata Charoenwisedsil , Tanatorn Soravipukuntorn , Katawut Panyatanakun , Phimphan Pisutsan , Panita Looareesuwan , Punyisa Asawapaithulsert , Hisham Ahmed Imad , Sophie Schneitler , Watcharapong Piyaphanee , Wasin Matsee","doi":"10.1016/j.tmaid.2025.102870","DOIUrl":"10.1016/j.tmaid.2025.102870","url":null,"abstract":"<div><h3>Background</h3><div>Rabies exposure remains a significant public health concern in South and Southeast Asia. Despite the disease being vaccine-preventable, international travelers remain at risk of rabies infection due to the limited access to vaccines and immunoglobulin. This retrospective review aims to analyze post-exposure rabies consultations at the Thai Travel Clinic providing insights into epidemiology, risk factors, and post-exposure management for international travelers.</div></div><div><h3>Methods</h3><div>A retrospective study included international travelers of all ages who visited the Thai Travel Clinic at the Hospital for Tropical Diseases in Bangkok, Thailand for potential rabid animal post-exposure management between January 1, 2019, and March 31, 2024.</div></div><div><h3>Results</h3><div>Among 306 international travelers, 91.5 % were healthy with no underlying medical conditions. Approximately 30.9 % traveled in Southeast Asia for less than one month, 46.6 % for one to six months, and 20.8 % for over six months. The majority of bites were from dogs (46.3 %), followed by monkeys (23.9 %) and cat (23.5 %). Common exposure locations included streets (40.1 %), followed by islands or beaches (20.5 %). The median time from arrival in Thailand to animal exposure was 30 days, with 14.7 % bitten within the first week. World Health Organization (WHO) category III rabies wounds accounted for 59.8 % (176/294) of cases. Only 47.5 % (144/303) received the first dose of the rabies vaccine on the day of exposure, and 57.9 % (70/121) experienced delays in receiving rabies immunoglobulin. Additionally, two travelers (2/149; 1.3 %) refused rabies immunoglobulin despite it being clinically indicated. Only 35.3 % (108/306) had pre-travel consultations, and 9.5 % (29/306) of all travelers completed rabies pre-exposure vaccination.</div></div><div><h3>Conclusions</h3><div>Over half of the international travelers delayed initiating rabies vaccine or immunoglobulin after potential rabid animal exposure. As rabies is a fatal yet preventable disease, this review underscores the urgent need to raise awareness about the importance of prompt post-exposure management. Strengthening traveler education and advocating for pre-exposure immunization are critical strategies to mitigate risks and improve outcomes.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"66 ","pages":"Article 102870"},"PeriodicalIF":6.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-21DOI: 10.1016/j.tmaid.2025.102869
T. Mlangeni , C. Jian , H.K. Häkkinen , W.M. de Vos , A. Salonen , A. Kantele
Background
Visitors to low- and middle-income countries (LMICs) encounter numerous new intestinal microbes, including diarrhoeal pathogens and multidrug-resistant (MDR) bacteria, such as extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE). Consequently, many develop travellers’ diarrhoea (TD) and/or become colonised by ESBL-PE. We explored the impact of LMIC travel, TD, and ESBL-PE/diarrheal pathogen colonisation on gut microbiota.
Methods
The present study included 92 participants from the clinical vaccine trial OEV123, who spent 12 days in Benin, West Africa, and provided exploratory pre- and post-travel stool microbiota samples. The samples were subjected to quantitative polymerase chain reaction (qPCR) to detect diarrhoeal pathogens and 16S rRNA gene amplicon sequencing for microbiota profiling.
Results
Travel significantly altered gut microbiota, showing reduced richness, decreased α-diversity, and a 40-fold increase in Escherichia/Shigella. qPCR detected diarrhoeagenic Escherichia coli (DEC) in post-travel stools of 89 % of the 92 participants. No specific microbiota signatures were linked to TD or ESBL-PE acquisition. Participants acquiring multiple DEC pathotypes had higher pre-travel levels of Ruminococcaceae and Coprococcus spp., while their post-travel microbiota was enriched with oxygen-tolerant and oral and upper gastrointestinal tract-associated taxa.
Conclusion
Travel to an LMIC significantly impacted intestinal microbiota. Individuals with high pre-travel proportions of Ruminococcaceae and Coprococcus spp. acquired a greater DEC pathotype diversity. However, no specific pre-travel microbiota profile was identified as protective against or predisposing to TD or acquisition of MDR bacteria.
{"title":"Travel to the tropics: Impact on gut microbiota","authors":"T. Mlangeni , C. Jian , H.K. Häkkinen , W.M. de Vos , A. Salonen , A. Kantele","doi":"10.1016/j.tmaid.2025.102869","DOIUrl":"10.1016/j.tmaid.2025.102869","url":null,"abstract":"<div><h3>Background</h3><div>Visitors to low- and middle-income countries (LMICs) encounter numerous new intestinal microbes, including diarrhoeal pathogens and multidrug-resistant (MDR) bacteria, such as extended-spectrum β-lactamase-producing <em>Enterobacterales</em> (ESBL-PE). Consequently, many develop travellers’ diarrhoea (TD) and/or become colonised by ESBL-PE. We explored the impact of LMIC travel, TD, and ESBL-PE/diarrheal pathogen colonisation on gut microbiota.</div></div><div><h3>Methods</h3><div>The present study included 92 participants from the clinical vaccine trial OEV123, who spent 12 days in Benin, West Africa, and provided exploratory pre- and post-travel stool microbiota samples. The samples were subjected to quantitative polymerase chain reaction (qPCR) to detect diarrhoeal pathogens and 16S rRNA gene amplicon sequencing for microbiota profiling.</div></div><div><h3>Results</h3><div>Travel significantly altered gut microbiota, showing reduced richness, decreased α-diversity, and a 40-fold increase in <em>Escherichia/Shigella.</em> qPCR detected diarrhoeagenic <em>Escherichia coli</em> (DEC) in post-travel stools of 89 % of the 92 participants. No specific microbiota signatures were linked to TD or ESBL-PE acquisition. Participants acquiring multiple DEC pathotypes had higher pre-travel levels of <em>Ruminococcaceae</em> and <em>Coprococcus</em> spp., while their post-travel microbiota was enriched with oxygen-tolerant and oral and upper gastrointestinal tract-associated taxa.</div></div><div><h3>Conclusion</h3><div>Travel to an LMIC significantly impacted intestinal microbiota. Individuals with high pre-travel proportions of <em>Ruminococcaceae</em> and <em>Coprococcus</em> spp. acquired a greater DEC pathotype diversity. However, no specific pre-travel microbiota profile was identified as protective against or predisposing to TD or acquisition of MDR bacteria.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"66 ","pages":"Article 102869"},"PeriodicalIF":6.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-16DOI: 10.1016/j.tmaid.2025.102868
Junyan Wang , Nan Lian , Kuo Tang , Yan Deng , Tao Li
Background
Acute Mountain Sickness (AMS), the most prevalent high-altitude illness, necessitates effective preventive measures due to rising sudden high-altitude exposure from tourism and occupational activities. Current Pharmacological prophylaxis lack robust comparisons, dose optimization, and confounder-adjusted analysis.
Methods
This network meta-analysis (NMA) included 28 randomized controlled trials (RCTs), evaluated healthy individuals with a rapid ascent to >2500 m, compared 13 drugs for AMS incidence, severe AMS (SAMS) incidence, Lake Louise Score (LLS), peripheral oxygen saturation (SpO2), and pulmonary artery pressure (PAP). Quality was evaluated using Cochrane Risk of Bias tools and CINeMA (Confidence in Network Meta-Analysis) for evidence grading. Network meta-regression adjusted for ascent altitude and exposure duration to identify “time” windows or “height” windows.
Results
250 mg BID acetazolamide (OR = 0.31, 95 %CI: 0.20–0.47) demonstrated a 5-day preventive efficacy window, while 375 mg BID acetazolamide (OR = 0.31, 95 %CI: 0.18–0.54) showed a shorter 3-day window. 4 mg BID dexamethasone (OR = 0.29, 95 %CI: 0.16–0.54) and 600 mg TID ibuprofen (OR = 0.44, 95 %CI: 0.3–0.64) also significantly reduced AMS incidence. No pharmacological interventions reduced SAMS incidence. After altitude adjustment, sildenafil (40 mg TID; MD = −1.11, 95 %CI: 2.01–0.25) attenuated altitude-induced PAP elevation.
Conclusion
Moderate-dose acetazolamide (125–250 mg BID) effectively prevents AMS with a longer prophylactic window compared to high-dose regimens (375 mg BID). There is no pharmacological intervention to prevent SAMS and no high-quality evidence to prevent high-altitude-induced PAP elevation. Our findings delineate the efficacy duration of acetazolamide across doses, while underscoring the imperative for robust clinical trials to advance the evidence base.
{"title":"Comparative effects of pharmacological interventions for the prevention of acute mountain sickness: A systematic review and Bayesian network meta-analysis","authors":"Junyan Wang , Nan Lian , Kuo Tang , Yan Deng , Tao Li","doi":"10.1016/j.tmaid.2025.102868","DOIUrl":"10.1016/j.tmaid.2025.102868","url":null,"abstract":"<div><h3>Background</h3><div>Acute Mountain Sickness (AMS), the most prevalent high-altitude illness, necessitates effective preventive measures due to rising sudden high-altitude exposure from tourism and occupational activities. Current Pharmacological prophylaxis lack robust comparisons, dose optimization, and confounder-adjusted analysis.</div></div><div><h3>Methods</h3><div>This network meta-analysis (NMA) included 28 randomized controlled trials (RCTs), evaluated healthy individuals with a rapid ascent to >2500 m, compared 13 drugs for AMS incidence, severe AMS (SAMS) incidence, Lake Louise Score (LLS), peripheral oxygen saturation (SpO2), and pulmonary artery pressure (PAP). Quality was evaluated using Cochrane Risk of Bias tools and CINeMA (Confidence in Network Meta-Analysis) for evidence grading. Network meta-regression adjusted for ascent altitude and exposure duration to identify “time” windows or “height” windows.</div></div><div><h3>Results</h3><div>250 mg BID acetazolamide (OR = 0.31, 95 %CI: 0.20–0.47) demonstrated a 5-day preventive efficacy window, while 375 mg BID acetazolamide (OR = 0.31, 95 %CI: 0.18–0.54) showed a shorter 3-day window. 4 mg BID dexamethasone (OR = 0.29, 95 %CI: 0.16–0.54) and 600 mg TID ibuprofen (OR = 0.44, 95 %CI: 0.3–0.64) also significantly reduced AMS incidence. No pharmacological interventions reduced SAMS incidence. After altitude adjustment, sildenafil (40 mg TID; MD = −1.11, 95 %CI: 2.01–0.25) attenuated altitude-induced PAP elevation.</div></div><div><h3>Conclusion</h3><div>Moderate-dose acetazolamide (125–250 mg BID) effectively prevents AMS with a longer prophylactic window compared to high-dose regimens (375 mg BID). There is no pharmacological intervention to prevent SAMS and no high-quality evidence to prevent high-altitude-induced PAP elevation. Our findings delineate the efficacy duration of acetazolamide across doses, while underscoring the imperative for robust clinical trials to advance the evidence base.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"66 ","pages":"Article 102868"},"PeriodicalIF":6.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-14DOI: 10.1016/j.tmaid.2025.102866
Sung-Hsi Huang , Yen-Lin Chen , Hao-Yu Lin , Aristine Cheng , Lih-Yu Chang , Yi-Chia Huang , Po-Hsien Kuo , Yueh-Feng Wen , Chia-Jung Liu , Chia-Hao Chang , Wei-Shun Yang , Kai-Hsiang Chen , Pin-Ru Chu , Chi-Wei Tseng , Yi-Ching Su , Li-Hsin Su , Li-Ta Keng , Chi-Ying Lin , Un-In Wu , Hsin-Yun Sun , Kua-Eyre Su
Background
When and how to screen for strongyloidiasis in high-income countries remain to be elucidated. This study aimed to investigate the prevalence, associated factors, and outcome of strongyloidiasis in Taiwan and proposed clinical criteria for serological screening.
Methods
Adults who were immunocompromised or about to undergo iatrogenic immunosuppression (proactive-screening cohort) and those with clinical presentations suggesting strongyloidiasis (diagnosis-driven cohort) were prospectively enrolled at five hospitals in Taiwan. Serum anti-Strongyloides IgG was determined by two enzyme-linked immunosorbent assays (ELISAs). Stool samples were obtained for microscopy and cultures. Prevalence of confirmed/probable strongyloidiasis, as defined by identification of characteristic larvae from stool or testing positive for both ELISAs, was calculated. Factors associated with strongyloidiasis were identified in multivariable analysis. Six-month mortality was compared between participants with and without strongyloidiasis using Cox proportional hazards model.
Results
From January 2021 to June 2024, confirmed/probable cases of strongyloidiasis were identified in 1.9 % and 4.8 % of the participants in proactive-screening and diagnosis-driven cohorts, respectively. Multivariable analysis revealed that skin and skin structure infection (adjusted odds ratio [aOR] 3.180), gastrointestinal bleeding of unknown causes (aOR 3.229), and hemoglobin <10 g/dl (aOR 4.300) were independently associated with strongyloidiasis. Six-month mortality was 33.3 % in participants with confirmed/probable strongyloidiasis, higher than that in those without strongyloidiasis (11.4 %), but not statistically significant after adjusting for age, sex, and clinical severity (p = 0.09).
Conclusions
Strongyloidiasis continued to occur among at-risk populations in Taiwan. Screening strategies are needed to improve the detection of this neglected parasitic infection in Taiwan and other high-income countries.
{"title":"Screening for strongyloidiasis among selected populations in Taiwan: Prevalence, associated factors, and outcomes","authors":"Sung-Hsi Huang , Yen-Lin Chen , Hao-Yu Lin , Aristine Cheng , Lih-Yu Chang , Yi-Chia Huang , Po-Hsien Kuo , Yueh-Feng Wen , Chia-Jung Liu , Chia-Hao Chang , Wei-Shun Yang , Kai-Hsiang Chen , Pin-Ru Chu , Chi-Wei Tseng , Yi-Ching Su , Li-Hsin Su , Li-Ta Keng , Chi-Ying Lin , Un-In Wu , Hsin-Yun Sun , Kua-Eyre Su","doi":"10.1016/j.tmaid.2025.102866","DOIUrl":"10.1016/j.tmaid.2025.102866","url":null,"abstract":"<div><h3>Background</h3><div>When and how to screen for strongyloidiasis in high-income countries remain to be elucidated. This study aimed to investigate the prevalence, associated factors, and outcome of strongyloidiasis in Taiwan and proposed clinical criteria for serological screening.</div></div><div><h3>Methods</h3><div>Adults who were immunocompromised or about to undergo iatrogenic immunosuppression (proactive-screening cohort) and those with clinical presentations suggesting strongyloidiasis (diagnosis-driven cohort) were prospectively enrolled at five hospitals in Taiwan. Serum anti-<em>Strongyloides</em> IgG was determined by two enzyme-linked immunosorbent assays (ELISAs). Stool samples were obtained for microscopy and cultures. Prevalence of confirmed/probable strongyloidiasis, as defined by identification of characteristic larvae from stool or testing positive for both ELISAs, was calculated. Factors associated with strongyloidiasis were identified in multivariable analysis. Six-month mortality was compared between participants with and without strongyloidiasis using Cox proportional hazards model.</div></div><div><h3>Results</h3><div>From January 2021 to June 2024, confirmed/probable cases of strongyloidiasis were identified in 1.9 % and 4.8 % of the participants in proactive-screening and diagnosis-driven cohorts, respectively. Multivariable analysis revealed that skin and skin structure infection (adjusted odds ratio [aOR] 3.180), gastrointestinal bleeding of unknown causes (aOR 3.229), and hemoglobin <10 g/dl (aOR 4.300) were independently associated with strongyloidiasis. Six-month mortality was 33.3 % in participants with confirmed/probable strongyloidiasis, higher than that in those without strongyloidiasis (11.4 %), but not statistically significant after adjusting for age, sex, and clinical severity (p = 0.09).</div></div><div><h3>Conclusions</h3><div>Strongyloidiasis continued to occur among at-risk populations in Taiwan. Screening strategies are needed to improve the detection of this neglected parasitic infection in Taiwan and other high-income countries.</div></div>","PeriodicalId":23312,"journal":{"name":"Travel Medicine and Infectious Disease","volume":"66 ","pages":"Article 102866"},"PeriodicalIF":6.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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