Viral hepatitis, A though E, complicating pregnancy.

Jaundice during pregnancy may be the result either of disease uniquely associated with the pregnant state or disease totally unrelated to the pregnancy. In the United States, the most common cause of jaundice in pregnant women is viral hepatitis. With the exception of hepatitis E virus infection, the clinical course and histologic findings do not differ between pregnant and nonpregnant patients.     

Severe dengue virus infection in travelers: risk factors and laboratory indicators

BACKGROUND: Dengue fever is the most common arboviral disease in travelers. In countries where dengue virus is endemic, sequential (secondary) infections with different dengue virus serotypes are associated with disease severity. Data on severity and secondary infection rates in a population of travelers are lacking. METHODS: Intensified surveillance of dengue fever in travelers was performed within the European Network on Surveillance of Imported Infectious Diseases. Data were collected at 14 European clinical referral centers between 2003 and 2005. RESULTS: A total of 219 dengue virus infections imported from various regions of endemicity were reported. Serological analysis revealed a secondary immune response in 17%. Spontaneous bleeding was observed in 17 (8%) patients and was associated with increased serum alanine and aspartate aminotransferase levels and lower median platelet counts. Two (0.9%) patients fulfilled the World Health Organization (WHO) case definition for dengue hemorrhagic fever. However, 23 (11%) travelers had severe clinical manifestations (internal hemorrhage, plasma leakage, shock, or marked thrombocytopenia). A secondary immune response was significantly associated with both spontaneous bleeding and other severe clinical manifestations. CONCLUSIONS: In travelers, severe dengue virus infections are not uncommon but may be missed if the WHO classification is strictly applied. High liver enzyme levels and low platelet counts could serve as indicators of disease severity.     

Tropical skin infections among Israeli travelers

Infectious skin disorders are common dermatologic illnesses in travelers. Knowledge of post-travel-related infectious skin disorders will allow for effective pre- and post-travel counseling. All cases of returning travelers seen in our center seeking care for infectious skin diseases were included in this study. For a comparison, data on returned travelers with non-infectious skin diseases and healthy travelers who had pre-travel consultations in our institution were also analyzed. Altogether, skin-related diagnosis was reported in 540 ill travelers, and among them, 286 (53%) had infectious skin diseases. Tropical skin infection was diagnosed in 64% of the infectious cases. Travelers returning from Latin America were significantly more ill with tropical skin infections than those traveling to Asia and Africa, The most common diagnoses were cutaneous leishmaniasis, myiasis, and cutaneous larva migrans. In conclusion, tropical skin infections are common among Israeli travelers, especially among those who visited Latin America.     

Amebic liver abscess

Amebiasis is a widespread parasitic disease caused by Entamoeba histolytica. This protozoan organism is the third leading parasitic cause of death in the developing world and is an important health risk to travelers in endemic areas. Amebiasis most commonly results in asymptomatic colonization of the gastrointestinal tract, but some patients may develop intestinal invasive disease or extraintestinal disease-amebic liver abscess being the most common extraintestinal manifestation. This article reviews epidemiologic features, pathophysiology, clinical features, diagnostic tests, imaging studies, treatment of amebic liver abscess, and prevention measures.     

旅行者腹泻患者寄生虫感染研究进展

随着全球旅游业的飞速发展,旅行日渐成为日常生活的重要组成部分,旅行者健康问题也越来越引起重视.旅行者腹泻为跨国或跨地区旅行者中最常见的疾病之一,造成了极大的疾病和经济负担.目前,我国仍缺乏寄生虫病相关病原体与旅行者腹泻关系的系统性研究.本文主要就旅行者腹泻患者肠道原虫及蠕虫等寄生虫感染情况作一综述,以期为制定与旅行者腹...     

Retrospective Study of the Clinical Profile and Prognostic Indicators in Patients of Alcoholic Liver Disease Admitted to a Tertiary Care Teaching Hospital in Western Nepal

Background/Aim:

Alcohol is the most common substance abused in Nepal. Liver disease caused by alcohol abuse, including its end stage, cirrhosis, is a major health care problem, which is difficult to treat.

Objectives:

To study the demographic profile, laboratory parameters, complications and their prognostic implications among patients of alcoholic liver disease (ALD).

Materials and Methods:

Records of all patients of ALD admitted from January 1'' 2005 to December 31'' 2006 were studied and followed up to December 31, 2007. A total of 181 patients were analyzed. Their clinical profile and laboratory parameters were noted and analyzed using SPSS-10.0 software.

Results:

Among the 181 patients, 80.7% were male, 30.9% were army/ex-army and 65.2% were documented smokers. The mean age of presentation was 52.08 years. Jaundice (57.5%) was the most common presentation followed by hepatomegaly (51.4%). Hypoalbuminemia (50.3) followed by ascites (48.1) were common complications. Death occurred in 19.1% of the patients, the most common cause being hepatic encephalopathy (72.2%) followed by variceal bleeding and hepatorenal syndrome. Jaundice, ascites and hepatic encephalopathy at presentation and female sex were significantly associated with increased mortality along with discriminant score >32, aspartate aminotransferase (AST): Alanine aminotranferase (ALT) ≥ 2, ultrasonography (USG)-proven cirrhosis, rise in prothrombin time ≥5 s, total bilirubin ≥ 4mg/dL and ESR ≥34.

Conclusion:

ALD was predominantly seen among the productive age group with a high morbidity and mortality. Jaundice, ascites, hepatic encephalopathy at presentation and female sex are poor prognostic indicators along with discriminant score > 32, AST:ALT ≥ 2, USG-proven cirrhosis, coagulopathy, hyperbilirubenemia and high ESR.     

Infections in HIV-infected travelers: risks and prevention

OBJECTIVE: To review risks for infection and to outline strategies to protect the health of travelers infected with human immunodeficiency virus (HIV). DATA SOURCES: Original reports and summaries of the geographic distribution and frequency of infections as well as of special risks these infections impose on HIV-infected persons. The recommendations incorporate guidelines published by the Centers for Disease Control (CDC) and the World Health Organization. STUDY SELECTION: Sources containing the most recent, pertinent information. DATA SYNTHESIS: Infections of the gastrointestinal tract are common in all travelers to developing countries and are likely to be more frequent, severe, and difficult to treat in HIV-infected persons. Prominent among the respiratory tract infections that pose special risks to HIV-infected travelers are influenza, measles, and fungal infections with geographically focal distributions. The most common vector-borne infection, malaria, appears to present relatively little, if any, incremental risk to the HIV-infected traveler. Persons with HIV infection respond less vigorously to vaccines and have a higher frequency of adverse reactions to antimicrobial agents. Nevertheless, immunizations and chemoprophylaxis can reduce the risk for many travel-related infections. Additionally, there are protective measures that travelers can take to minimize exposure to pathogens. CONCLUSIONS: By understanding the risks for disease in different destinations, assessing patients' HIV status, counseling patients about travel plans and personal protective measures, appropriately using vaccines and chemoprophylaxis, as well as instituting early treatment of infection, physicians can help HIV-infected patients to preserve their health during travel.     

African trypanosomiasis in two travelers from the United States.

African trypanosomiasis is a rare but well-documented cause of fever in United States travelers returning from areas where it is endemic. We report two recently diagnosed cases that involved tourists who went on safari in Tanzania. Review of these and 29 other published cases indicates that disease in returning United States travelers is nearly always of the East African form, a fulminant illness for which prompt diagnosis is necessary. In the United States, timely and appropriate therapy for this disease has resulted in favorable outcomes for most patients. Chemoprophylaxis for East African trypanosomiasis is not recommended, but travelers visiting areas of endemicity should practice appropriate preventive measures to prevent tsetse fly bites.     

Therapy of tropical diseases after returning from travel

Most tropical diseases imported by travelers can be treated quite effectively. Human endoparasites belong to the protozoa and worms. Protozoa can be seen as microparasites, characterized by short generation periods and high rates of reproduction within a host--consequently the diseases mainly are of short duration. Effective drugs are available for malaria, amebiasis and other intestinal protozoa as well as for leishmaniasis. Resistance, however, sometimes is a problem. Worms are macroparasites that generally do not reproduce within a host--teleologically speaking because otherwise they would rapidly damage their own basis of living. Accordingly, severe worm disease is rarely found in travelers. Levels of anthelminthic resistances so far are low. The most important worm disease in travelers is schistosomiasis, a disease that also can be treated effectively if diagnosed early.     

Ciguatera fish poisoning in Brazilian traveler to Caribbean

Ciguatera poisoning is the most common form of non-bacterial food-poisoning from fish worldwide. The incidence among Brazilians returning from high-risk regions is unclear because it is not a mandatory reportable disease. We describe a previously healthy 53-year-old Brazilian woman developed Ciguatera fish poisoning while traveling to Havana, Cuba. Physicians and health care professionals should advise travelers to avoid eating ciguatoxic fish species and potentially toxic fish species in the Caribbean islands. Despite the prognosis for most cases is good with a short duration of self-limited symptoms, early recognition of the identifying clinical features of ciguatera can result in improved patient care.     

Dermatologic Presentations of Tropical Diseases in Travelers

Dermatoses are one of the three most common presenting health care problems in returning travelers. The spectrum of travel-related dermatoses is broad, and includes tropical, cosmopolitan, and environmental skin diseases. Bacterial infections are the main cause of skin consultations in returning travelers. Most of these infections are not specific to the tropics and are the consequences of arthropod bites. Conversely, tropical skin infections are less commonly observed. Knowledge of imported dermatoses among Western physicians is limited, even though it is becoming increasingly important that doctors be able to recognize and differentiate between the diverse varieties of diseases. This review highlights the most recent developments regarding dermatologic presentations of tropical diseases in travelers in order to provide more effective pre-travel counseling and an up-to-date aid to post-travel diagnosis and treatment.     

Travel vaccines

Travel-related infectious diseases are exceedingly common, difficult to diagnose, and sometimes preventable. Vaccination is one tool for reducing the risk of infectious disease for some travelers. Both healthcare providers and travelers need to be aware of the new travel vaccines, and new formulations of older vaccines that now are available. This article presents an update on vaccines for cholera, Japanese encephalitis, rabies, rotavirus, typhoid, and malaria.     

Fever in travelers returning from tropical areas: prospective observational study of 613 cases hospitalised in Marseilles, France, 1999-2003

BACKGROUND: Febrile travelers may pose a diagnostic challenge for Western physicians who are frequently involved in the assessment of these patients but unfamiliar with tropical diseases. Evaluation of this situation requires an understanding of the common etiologies, which are associated with the demographics of travelers and the destinations. METHODS: We conducted a 5-year prospective observational study on the etiologies of fever in travelers returning from the tropics admitted to the infectious and tropical diseases unit of a university teaching hospital in Marseilles, France. RESULTS: A total of 613 patients were enrolled, including 364 migrants (59.4%), 126 travelers (20.6%), 37 visitors (6%), 24 expatriates (3.9%), and 62 patients (10.1%) who could not be classified. Malaria was the most common diagnosis (75.2%), with most cases (62%) acquired by migrants from the Comoros archipelago and who had traveled to these islands to visit friends and relatives. Agents of food-borne and water-borne infections (3.9%) and respiratory tract infections (3.4%) were also frequently identified as the cause of fever. Other infections included emerging diseases such as gnathostomiasis, hepatitis E infection and rickettsial diseases, as well as common infections or exotic diseases. CONCLUSIONS: Although we have identified here various causes of imported fever, 8.2% of the fevers remained unexplained. An improved approach to diagnosis may allow for the discovery of new diseases in travelers in the future.     

Hepatitis E virus infection in travelers.

Hepatitis E virus (HEV) is a major cause of clinical hepatitis in regions of endemicity, affecting primarily young adults and travelers to these areas. We present 5 cases of acute HEV infection in travelers and review 143 cases of HEV infection found by a literature search that were contracted in areas of endemicity. Fulminant hepatitis occurred in 2.7% of the reported cases; 2 of these were fatal. The destination of most of the travelers with acute HEV infection was the Indian subcontinent. The overall risk of contracting HEV infection for travelers appears to be lower than the risk for hepatitis A virus infection. Pregnant women and individuals with underlying liver disease may be a risk for severe infection.     

Giardiasis: association with homosexuality

Giardiasis is a common gastrointestinal illness among travelers. Recently an increased prevalence of giardiasis in men who had not traveled outside New York City was seen at The New York Hospital and was found to be due to transmission of this disease among homosexuals. Cases of giardiasis for a 5-year period were then reviewed, and it was discovered that 19 male patients who had not traveled or had an immunodeficiency disease were homosexuals. This accounted for 22% of the adult men with giardiasis during that period. Adult women with giardiasis usually were either travelers or had an immunodeficiency disease (96%). It is important to obtain a sexual history in these patients and treat sexual contacts to prevent recurrent infection. Our findings are consistent with venereal transmission of giardiasis.     

Traveler's diarrhea due to intestinal protozoa.

Intestinal protozoa account for a minority of cases of acute traveler's diarrhea, but they are common pathogens in travelers who experience protracted diarrhea during or after travel. Evaluation of the traveler with chronic diarrhea should include a careful examination for typical infecting organisms, such as Giardia and Entamoeba species, as well as for emerging parasites, such as Cryptosporidium species, Cyclospora species, and microsporidia. The microbiology, epidemiology, clinical presentation, and treatment of the most common intestinal parasites found in travelers are presented in this minireview.     

Blastocystis hominis and travelers

B. hominis is a unicellular protozoan commonly identified in stool specimens of travelers who have returned from tropical countries. It has a world-wide distribution, and infection is more common in developing countries compared to industrialized nations. Clinical features of illness which have been attributed to Blastocystis include nausea, anorexia, abdominal pain, flatulence and acute or chronic diarrhea. The preferred method of diagnosis is a permanently stained smear of an unconcentrated stool specimen. The presence of B. hominis in stool specimens of symptomatic travelers should prompt clinicians to search for other unrecognized co-pathogens. Due to controversy regarding the pathogenicity of B. hominis in humans, clinicians are often faced with the dilemma of whether or not they should offer treatment for B. hominis infection in returned travelers. The most commonly used drugs for treatment include metronidazole and trimethoprim-sulfamethoxazole (TMP-SMX), when treatment is deemed necessary. Prevention in travelers should focus on food and water precautions as the organism is transmitted by the fecal-oral route.     

Typhoid fever in travelers: Time for reassessment

Enteric fever (EF) is the most common bacteremic disease affecting travelers to the tropics. For more than a decade, fluoroquinolones have been considered the drugs of choice for EF. However, recent reports have raised concern about fluoroquinolone resistance. Treatment with ciprofloxacin failed in a traveler with Salmonella paratyphi EF who had recently returned from India. Treatment failed despite minimum inhibitory concentrations of fluoroquinolones within the susceptible range. Further in vitro investigations revealed very low serum bactericidal activity with ciprofloxacin. Clinicians should be aware of the recent changes in the interpretation of Salmonellae sensitivity.     

Penicillium marneffei infection in HIV-infected travelers

Disseminated Penicillium marneffei infection is the third most common AIDS-defining illness in parts of Southeast Asia. A review of the literature now shows that penicilliosis may represent an emergent opportunistic infection in HIV-positive travelers to endemic regions as well.