Current Infectious Disease Reports最新文献

Purpose of review: With climate change being the single biggest health threat facing humanity, this review aims to identify the climate-sensitive health risks to the traveler and to recognize the role that travel plays in contributing to the detrimental effects of climate change. With this understanding, adaptations for transformational action can be made.

Recent findings: Travel and tourism, including transportation, food consumption, and accommodation, is responsible for a large percentage of the world's carbon emissions which is contributing to the climate change crisis at an alarming rate. Climate change is a health emergency that is resulting in a rise of significant health impacts to the traveler including increased heat illnesses; food-, water-, and vector-borne diseases; and increasing risk of exposure to emerging infectious diseases. Patterns of future travel and destination choices are likely to change due to climactic factors such as temperature and extreme weather events, forced migration, degradation, and disappearance of popular and natural tourist destinations.

Summary: Global warming is and will continue to alter the landscape of travel medicine with expansion of transmission seasons and geographic ranges of disease, increased risk of infections and harmful marine toxins, and introduction of emerging infections to naïve populations. This will have implications for pre-travel counseling in assessing risk and discussing the environmental influences on travel. Travelers and stakeholders should be engaged in a dialogue to understand their "climate footprint," to innovate sustainable solutions, and be empowered to make immediate, conscientious, and responsible choices to abate the impact of breaching critical temperature thresholds.

Purpose of review: Bacterial vaginosis (BV) is the most common vaginal infection worldwide, but most research has been conducted in premenopausal women. After menopause, endogenous estrogen production decreases, often leading to the genitourinary syndrome of menopause (GSM), characterized by vulvovaginal dryness and irritation. The estrogen-deficient postmenopausal state results in an elevated vaginal pH and depletion of vaginal lactobacilli. Use of traditional BV diagnostics (Amsel criteria, Nugent score) is difficult in post-menopausal women, especially those not on estrogen replacement therapy, as these methods were originally developed in premenopausal women. In this review, we discuss recent clinical data on BV in postmenopausal women, difficulties in diagnosis using traditional methods, the role of BV molecular diagnostics, and our current expert opinion for managing BV in this population.

Recent findings: BV prevalence has been found to range between 2%-57% among postmenopausal women per Amsel and Nugent criteria. This is likely an over-estimate of the true prevalence due to limitations in these criteria which were only validated in pre-menopausal women. Despite increasing diagnostic options for BV in recent years, including highly sensitive and specific BV nucleic acid amplification tests (NAATs), the physiologic changes of menopause and limited inclusion of postmenopausal women in clinical studies, diagnosis is difficult in this population. Recent studies utilizing 16s rRNA gene sequencing suggest that the vaginal microbiota of premenopausal and postmenopausal women is quite different, even if BV is not present. Data also suggest that obese postmenopausal women have significantly lower rates of BV compared to non-obese postmenopausal women, although further research is needed in this area. Multiple treatment options exist for vaginal atrophy and BV in this population.

Summary: Data are limited regarding optimal diagnostic approaches for BV in postmenopausal women; BV NAATs and 16s rRNA gene sequencing may have a role for diagnosing BV in symptomatic women although further studies are needed. Menopausal women with characteristic vaginal symptoms and an elevated vaginal pH should be initially treated for estrogen deficiency prior to considering a diagnosis of BV; subsequent treatment for BV should be driven by symptoms.