Cutaneous leishmaniasis in the returning traveler

Infection with protozoan parasites of the genus Leishmania leads to a wide variety of clinical disease syndromes called leishmaniasis, or more appropriately the leishmaniases. The three major clinical syndromes are cutaneous leishmaniasis, mucosal leishmaniasis, and visceral leishmaniasis. All three of these syndromes have been documented in returning travelers. This article focuses on cutaneous leishmaniasis with some comment on mucosal leishmaniasis.     

Case report: Successful treatment of cutaneous leishmaniasis caused by Leishmania aethiopica with liposomal amphothericin B in an immunocompromised traveler returning from Eritrea

Cutaneous leishmaniasis caused by Leishmania aethiopica is rarely encountered outside disease-endemic areas and there have been no clinical trials evaluating its pharmacotherapy. We describe the treatment of cutaneous leishmaniasis caused by L. aethiopica using liposomal amphothericin B in an immunocompromised traveler returning from Eritrea.     

Lactococcus garvieae multi-valve infective endocarditis in a traveler returning from South Korea

Lactococcus garvieae is a rare but emerging human pathogen causing a variety of infections with only ten cases of infective endocarditis reported in the literature. We present the only case of Lactococcus garvieae infective endocarditis affecting both a native and a bioprosthetic valve in a traveler returning from rural South Korea.     

Ceftazidime monotherapy for pulmonary melioidosis in a traveler returning from Thailand.

A patient with deteriorating pulmonary melioidosis rapidly recovered after treatment with ceftazidime. To prevent possible relapses, an oral maintenance regimen of amoxicillin and clavulanic acid was prescribed for a period of three months. Melioidosis is caused by Pseudomonas pseudomallei. It is an insidious disease because of its variable clinical presentation, possible long-term asymptomatic carriage, broad-spectrum resistance to first-line antibiotics, and high mortality rate. As in our patient, the diagnosis should be particularly considered when there is reduced immunologic resistance and previous exposure in endemic areas, such as Southeast Asia.     

Imported Plasmodium knowlesi malaria in a French tourist returning from Thailand

We report a case of imported Plasmodium knowlesi malaria in a French tourist following a vacation in Thailand. This case shows, first, tourists may contract knowlesi malaria even only staying on the beach and second, the diagnosis remains difficult, even with polymerase chain reaction methods.     

Furuncular myiasis caused by Dermatobia hominis in a returning traveler

Furuncular myiasis caused by Dermatobia hominis is endemic throughout Central and South America. We report a case of furuncular myiasis in a traveler returned from Costa Rica. The case is unique because the primary care physician obtained magnetic resonance images. The images, however, do not show any characteristic features that assist in diagnosis.     

Fever of unknown origin in the returning traveler

The returning traveler with fever presents a diagnostic challenge for the health care provider. When evaluating such a patient, the highest priority should be given to diseases that are potentially fatal or may represent public health threats. A good history is paramount and needs to include destination, time and duration of travel, type of activity, onset of fever in relation to travel, associated comorbidities, and any associated symptoms. Pretravel immunizations and chemoprophylaxis may alter the natural course of disease and should be inquired about specifically. The fever pattern, presence of a rash or eschar, organomegaly, or neurologic findings are helpful physical findings. Laboratory abnormalities are nonspecific but when corroborated with clinical and epidemiologic data may offer a clue to diagnosis.     

Evaluation of diarrhea in the returning traveler.

Diarrhea in the returned traveler raises the possibility of a wide range of infectious, post-infectious, and idiopathic (e.g., inflammatory bowel disease) disorders that require a thoughtful evaluation. Specific clues in the history and clinical presentation are helpful in distinguishing inflammatory from noninflammatory processes and in suggesting persistent parasitic or other syndromes. The authors describe a practical approach to the diagnosis and management of diarrhea in the returned traveler.     

Ivermectin treatment of a traveler who returned from Peru with cutaneous gnathostomiasis.

We describe a 21-year-old patient who experienced a relapse of cutaneous gnathostomiasis after receiving initial treatment with albendazole and who had a successful outcome after receiving a short course of ivermectin for the relapse. This is the first reported case of gnathostomiasis acquired by a human in Peru.     

Failure of atovaquone/proguanil to prevent Plasmodium ovale malaria in traveler returning from Cameroon

We report a case of a patient returning from Cameroon who developed Plasmodium ovale malaria, despite atovaquone/proguanil (AP, Malarone) prophylaxis, which is widely used for the prevention of chloroquine-resistant malaria. AP is indeed active only on schizont blood forms of P. ovale but not against liver-stage hypnozoites and does not realize effective prophylaxis against delayed onset of P. ovale malaria. Hence, this case illustrates the risk of failure with Malarone for the prophylaxis of P. ovale infection for travelers in endemic regions. Travelers returned from risk areas with symptoms suggestive of malaria, should not have the diagnosis of P. ovale (or P. vivax) infection discounted, despite a history of compliance with a standard chemoprophylactic regimen.     

Case report: Severe typhus group rickettsiosis complicated by pulmonary edema in a returning traveler from Indonesia

We report a severe case of typhus group rickettsiosis in a returning traveler from Indonesia. This typically mild illness was characterized by progressive pulmonary edema and prolonged fever, with defervescence 4 days after the commencement of doxycycline.