Alkhurma hemorrhagic fever in travelers returning from Egypt, 2010

Two travelers returning to Italy from southern Egypt were hospitalized with a fever of unknown origin. Test results showed infection with Alkhurma virus. The geographic distribution of this virus could be broader than previously thought.     

Coccidioidomycosis in travelers returning from Mexico--Pennsylvania, 2000

Coccidioidomycosis (CM), a fungal disease caused by Coccidioides immitis, is endemic in the southwestern United States and parts of Central and South America. The disease is acquired by inhaling the arthroconidia of C. immitis present in the soil. Outbreaks of CM occur when susceptible persons are exposed to airborne arthroconidia from dust storms, natural disasters, and earth excavation (1,2). Persons who travel to areas where the disease is endemic may become infected and develop symptoms after returning home (3,4). This report describes an outbreak of CM among travelers returning to Pennsylvania from a trip to Mexico.     

Murine typhus in travelers returning from Indonesia.

We report the first three documented cases of murine typhus imported into Europe from Indonesia, discuss clues for the diagnosis of the disease, and urge that murine fever be considered in the diagnosis of febrile disease in travelers.     

Emporiatrics: protecting travelers from malaria

Travelers to malarious areas of the world should take precautions against mosquito bites and take medications to prevent the disease. Chloroquine is the prophylactic agent of choice in areas where malaria remains sensitive. If no contraindications exist, mefloquine is recommended in areas where chloroquine resistance occurs. Alternative regimens would include doxycycline taken as the sole prophylactic agent, or weekly chloroquine with a treatment dose of Fansidar to be taken if symptoms compatible with malaria occur.     

Dengue virus infections among travelers returning from Haiti--Georgia and Nebraska, October 2010

In October 2010, a Nebraska clinician notified the state's Central District Health Department (CDHD) of a cluster of dengue-like illnesses in six of 28 missionary workers from Nebraska and Georgia who recently had returned after 7-11 days in Haiti. Infection with the mosquito-transmitted dengue virus (DENV) later was confirmed by laboratory testing in seven persons, five of whom were hospitalized. CDHD, the Nebraska Department of Health and Human Services (NDHHS), the Georgia Department of Public Health (GDPH), and CDC conducted a retrospective cohort study to assess the pretravel dengue knowledge and mosquito-avoidance practices of those with and without laboratory-confirmed infection. This report describes the results of that study, which indicated that 90% of those in the study had a pretravel health-care appointment, 57% sought travel advice on the Internet, and 24% used mosquito repellent several times a day; neither pretravel knowledge nor mosquito-avoidance practices were significantly associated with absence of DENV infection. Clinicians should be vigilant for dengue among travelers returning from Haiti and other areas where DENV is endemic or likely to be endemic and should report suspected cases of dengue to public health authorities.     

Chloroquine-resistant Plasmodium falciparum malaria in Kenya.

A case of chloroquine-resistant Plasmodium falciparum malaria in a non-immune male is reported. Primary attack came 19 days after return to a non-malarious country from a visit to Kenya. Recrudescences occurred three times with intervals of 30 to 33 days after standard chloroquine treatment. The WHO extended field test for sensitivity of falciparum malaria to chloroquine was followed by recrudescence 31 days later. Treatment with Fansidar terminated the infection. If continuous treatment of the patient with lithium does not interfere with the schizontocidal action of chloroquine, this strain shows a resistance pattern of R I delayed recrudescence.     

Chikungunya virus in US travelers returning from India, 2006

Chikungunya virus (CHIKV), a mosquito-borne alphavirus, is endemic in Africa and Asia. In 2005-2006, CHIKV epidemics were reported in islands in the Indian Ocean and in southern India. We present data on laboratory-confirmed CHIKV infections among travelers returning from India to the United States during 2006.     

Novel chikungunya virus variant in travelers returning from Indian Ocean islands

Chikungunya virus (CHIKV) emerged in Indian Ocean islands in 2005 and is causing an ongoing outbreak that involves >260,000 patients, including travelers returning home from these islands. We investigated cases in 4 patients returning from Mayotte and Reunion Islands with CHIKV infection and a nurse infected in metropolitan France after direct contact with the blood of a traveler. Four patients had tenosynovitis and pain at wrist pressure, and 1 had life-threatening manifestations. Four CHIKV strains were isolated, including 1 from the patient with the autochthonous case. The complete genomic sequence identified a new CHIKV variant emerging from the East/ central African evolutionary lineage. Aedes albopictus, the implicated vector of CHIKV in Indian Ocean islands, has dispersed worldwide in recent decades. High viral loads in patients returning from Indian Ocean islands to countries where Ae. albopictus is prevalent may be a source of epidemics.     

Monkey malaria in a European traveler returning from Malaysia

In 2007, a Finnish traveler was infected in Peninsular Malaysia with Plasmodium knowlesi, a parasite that usually causes malaria in monkeys. P. knowlesi has established itself as the fifth Plasmodium species that can cause human malaria. The disease is potentially life-threatening in humans; clinicians and laboratory personnel should become more aware of this pathogen in travelers.     

Reduced fluoroquinolone susceptibility in Salmonella enterica serotypes in travelers returning from Southeast Asia.

During 1995 to 1999, we collected 1,210 Salmonella isolates; 629 were from Finnish travelers returning from abroad. These isolates were tested for susceptibility by determining MICs to ciprofloxacin, nalidixic acid, and seven additional antimicrobial agents. From 1995 to 1999, the annual proportion of reduced ciprofloxacin susceptibility (MIC > 0.125 microg/mL) among all travelers' isolates increased from 3.9% to 23.5% (p<0.001). The increasing trend was outstanding among the isolates from Southeast Asia; isolates from Thailand alone increased from 5.6% to 50.0% (p<0.001). The reduced fluoroquinolone susceptibility was nonclonal in character and significantly associated with multidrug resistance. A point mutation in the quinolone resistance-determining region of gyrA was present in all isolates with reduced susceptibility. These data provide further evidence for the rapid spread of multidrug-resistant pathogens from one continent to another.     

African trypanosomiasis in travelers returning to the United Kingdom.

Two returning safari tourists with African trypanosomiasis were admitted to the Hospital for Tropical Diseases, London, in a 3-day period, compared with six cases in the previous 14 years. We describe the clinical features, diagnosis, and problems encountered in accessing appropriate therapy, and discuss the potential for emergence of this disease in increasingly adventurous international travelers.