Infectious diseases among travellers and migrants in Europe, EuroTravNet 2010.

To investigate trends in travel-associated morbidity with particular emphasis on emerging infections with the potential for introduction into Europe, diagnoses of 7,408 returning travellers presenting to 16 EuroTravNet sites in 2010 were compared with 2008 and 2009. A significant increase in reported Plasmodium falciparum malaria (n=361 (6% of all travel-related morbidity) vs. n=254 (4%) and 260 (5%); p<0.001), P. vivax malaria (n=51 (1%) vs. n=31 (0.5%) and 38 (1%); p=0.027) and dengue fever (n=299 (5%) vs. n=127 (2%) and 127 (2%); p<0.001) was observed. Giardia lamblia was identified in 16% of patients with acute diarrhoea, with no significant annual variation. The proportion of acute diarrhoea due to Campylobacter increased from 7% in 2008 to 12% in 2010 (p=0.001). We recorded 121 patients with pulmonary tuberculosis in 2010, a threefold increase in the proportionate morbidity from 2008 to 2010. In 2010, 60 (0.8%) cases of chronic Chagas disease, 151 (2%) cases of schistosomiasis and 112 (2%) cases of cutaneous larva migrans were reported. Illness patterns in sentinel travellers, captured by EuroTravnet, continue to highlight the potential role of travellers in the emergence of infectious diseases of public health concern in Europe and the relevance of offering medical travel advice and enforcing specific and adequate prophylaxis.

[Diseases transmitted by ticks locally and abroad]. / Maladies transmises par des tiques d'ici et d'ailleurs.

This article provides a brief overview of some diseases transmitted by ticks. These vectors do not transmit only Lyme disease and tickborne-encephalitis, even in Switzerland. Several tick-borne diseases cause nonspecific flu-like symptoms. Nevertheless sometimes severe, some of these diseases can be treated with specific treatments. Repellents, appropriate clothes impregnated with permethrine and prompt removal of the tick are effective preventive measures to limit the risk of infection. There is an effective vaccine which protects against tick-borne encephalitis.

[Rickettsial diseases in Switzerland, update for the general practitioner]. / Rickettsioses d'importation.

Rickettsial diseases are arthropod-borne zoonosis. They are still misdiagnosed in Switzerland. Since development in molecular genetics, number of pathogenic species increased dramatically. In recent years, the incidence rise worldwide. Climatic conditions and development of tropical travels could explain it. In a near future, the Swiss general practitioner may face an increase of cases. Clinical presentation is unspecified. The eschar is the key diagnostic element but can be easily overlooked. Serology, the indirect immunofluorescence assay is the reference method. PCR can give the diagnosis in acute phase. However empirical treatment should be prescribed as soon as diagnosis is suspected. No vaccine is currently available and use of repellent is still the best way of prevention.

[Pulmonary diseases among returning travelers]. / Pathologies pulmonaires au retour de voyage.

Respiratory tract infections are a frequent cause of travelers' health problems. Tropical diseases are relatively rare compared to common respiratory infections. Nevertheless, due to their potential gravity, they must be systematically considered. The differential diagnosis of tropical pathogens is wide. A targeted travel history taking into account specific epidemiological, geographical and behavioral risk factors helps focusing biological exams to identify the causative diagnosis. The chest radiography remains very helpful in this context; however, more specific exams, such as serologies are often necessary to reach a final diagnosis.

Travel-related imported infections in Europe, EuroTravNet 2009.

The aim of this study was to investigate travel-associated morbidity in European travellers in 2009 in comparison with 2008, with a particular emphasis on emerging infectious diseases with the potential for introduction into Europe. Diagnoses with demographic, clinical and travel-related predictors of disease from ill returning travelers presenting to 12 core EuroTravNet sites from January to December 2009 were analysed. A total of 6392 patients were seen at EuroTravNet core sites in 2009, as compared with 6957 in 2008. As compared with 2008, there was a marked increase in the number of travellers exposed in North America and western Europe. Respiratory illnesses, in particular pandemic A(H1N1) influenza, influenza-like syndromes, and tuberculosis, were also observed more frequently. A significant increase in reported dengue cases in 2009 as compared with 2008 was observed (n = 172, 2.7% vs. n = 131, 1.90%) (p 0.002). The numbers of malaria and chikungunya cases were also increasing, although not significantly. Two deaths were recorded: visceral leishmaniasis and sepsis in a Sudanese migrant, and Acinetobacter sp. pneumonia in a patient who had visited Spain. This is the most comprehensive study of travel-related illness in Europe in 2009 as compared with 2008. A significant increase in travel-related respiratory and vector-borne infections was observed, highlighting the potential risk for introduction of these diseases into Europe, where competent vectors are present. The number of traveller deaths is probably underestimated. The possible role of the travellers in the emergence of infectious diseases of public health concern is highlighted.

[Melioidosis: a poorly known tropical disease]. / Mélioïdose: une pathologie tropicale méconnue.

A 35 year-old man was admitted to the hospital for fever upon returning from the Caribbean area. He died 48 hours later, after developing pulmonary lesions that were complicated by multi-organ failure, despite rapid diagnosis of melioidosis by mass spectrometry on blood cultures. Melioidosis is a rare bacterial disease in the traveller that is caused by Burkholderia pseudomallei. Although the clinical presentation is variable, pneumonia is the most frequent finding. Diagnosis may be considered in travellers returning from tropical and subtropical regions, especially during rainy seasons. Accordingly, when confronted with a patient who presents with fever after travelling, it is important to carefully specify the regions visited, potential expositions, and rapidly offer adequate laboratory testing.

Fatal acute melioidosis in a tourist returning from Martinique Island, November 2010.

We report the fatal case of acute melioidosis in a patient returning from Martinique with fever in November 2010. Gram-negative rods were isolated from a blood culture and Burkholderia pseudomallei identified within 24 hours after first medical contact. The patient died two days after admission to hospital despite intravenous therapy with high doses of imipenem/cilastatin and intensive care. Clinicians seeing travellers returning from the subtropics or tropics with severe pneumonia or septicaemia should consider the possibility of acute melioidosis.

[Japanese encephalitis: risk for endemic populations and for travellers]. / Encéphalite japonaise: risque pour les populations vivant en zones d'endémie et pour les voyageurs.

The importance of Japanese encephalitis (JE) in endemic populations and in travellers requires a balanced assessment. This disease represents an important public health problem in some endemic areas, which contrasts with the minimal risk for travellers to endemic areas. This is reflected by high numbers of infections mainly among children in endemic countries and by few case reports among tourists and even expatriates. The total number of case reports between 1978 and 2008 amounts to a risk of one to two cases per year. Nevertheless, some travelling groups may be at higher risk when visiting or working in high risk areas. A new vaccine against Japanese encephalitis will soon be registered in Switzerland. This paper contributes to the scarce data available for decision making whether or not to recommend the vaccination to tourists and expatriates.

Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal.

Drug-related factors and parasite resistance have been implicated in the failure of pentavalent antimonials (Sb(v)) in the Indian subcontinent; however, little information is available on host-related factors. Parasitologically confirmed kala-azar patients, treatment naïve to Sb(v), were prospectively recruited at a referral hospital in Nepal and were treated under supervision with 30 doses of quality-assured sodium stibogluconate (SSG) 20mg/kg/day and followed for 12 months to assess cure. Analysis of risk factors for treatment failure was assessed in those receiving >or=25 doses and completing 12 months of follow-up. One hundred and ninety-eight cases were treated with SSG and the overall cure rate was 77.3% (153/198). Of the 181 cases who received >or=25 doses, 12-month follow-up data were obtained in 169, comprising 153 patients (90.5%) with definite cure and 16 (9.5%) treatment failures. In the final logistic regression model, increased failure to SSG was significantly associated with fever for >or=12 weeks [odds ratio (OR)=7.4], living in districts bordering the high SSG resistance zone in Bihar (OR=6.1), interruption of treatment (OR=4.3) and ambulatory treatment (OR=10.2). Early diagnosis and supervised treatment is of paramount importance to prevent treatment failures within the control programme.

Imported human African trypanosomiasis in Europe, 2005-2009.

Physicians in Europe are likely to see more African trypanosomiasis cases because of the increasing popularity of travel to Africa. In this paper the literature on imported cases in Europe, since 2005 is reviewed. Because of the high mortality risk associated with acute Rhodesian trypanosomiasis, travellers should be informed about preventive measures and the early disease manifestations.

[Prevention of non infectious health problems in expatriates and humanitarian workers]. / Prévention d'affections non infectieuses chez les expatriés et humanitaires.

Frequently, expatriates and humanitarian workers change their lifestyle during expatriation and take more risks. Exposure to sun and heat, alcohol abuse, unprotected sexual relationships, stress, accidents and security incidents are the main non infectious health risks. It is important to prevent them, as the consequences are more serious abroad. Their prevention lies on the responsibility of every individual to adapt their behaviour and lifestyle to the environment, as well as on institutional guidelines concerning risky behaviour.

[Security and travel]. / Sécurité et voyages.

Hijacking, crime, aggression and theaft when people travel abroad are regularly reported by the media. This increases travellers' fears. As there is little research that quantifies risks, subjectivity and preconceived ideas prevail. A survey done among travellers in Geneva, Lausanne and Lyon showed that the risk of incidents was lower in countries located outside of Europe, usually in cities. Most frequently it was baggage stealing, or stealing in the street, during the day. In Europe, stealing by breaking into cars was most frequent. Without becoming paranoid about aggression and burglary, some simple rules can be followed. Keep constant situational awareness, be respectful of the people in countries visited, avoid provocative attitudes and avoid insecure areas.

[Stress and mental health in expatriates]. / Stress et santé mentale chez les expatriés.

To be an expatriate can be a very rewarding experience. Nevertheless, it requires a great ability of adaptation to a new environment. The living and professional conditions may be very demanding. They can have an influence on the physical and mental health. The basic and cumulative stress should be prevented by a good preparation before departure, a thorough follow-up during the expatriation and upon return. The expatriate, the family doctor and the employer play an important role during the whole period of expatriation. Their close collaboration permits an ideal management of possible stress related problems.

Safety and effectiveness of amphotericin B deoxycholate for the treatment of visceral leishmaniasis in Uganda.

Between September 2003 and April 2004, the supply of antimonial drugs to Amudat Hospital, in north-eastern Uganda, was interrupted and all cases of visceral leishmaniasis presenting at the hospital could only be treated with amphotericin B deoxycholate (AmB). This allowed the safety and effectiveness of the AmB to be evaluated, in comparison with an historical cohort of patients treated, at the same hospital, with meglumine antimoniate (Sb(V)). Demographic and clinical data were collected before and after treatment. Adverse effects were recorded passively in all the subjects, and actively, using a standardized questionnaire, in a sub-group of the patients given AmB. The in hospital case-fatality 'rates' were 4.8% [95% confidence interval (CI) = 2.4%-8.8%] among the 210 patients treated with AmB and 3.7% (CI = 1.4%-7.9%) among the 161 patients treated with Sb(V) (P>0.20). Adverse effects requiring treatment interruption were rare in both cohorts. Treatment failures (i.e. non-responses or relapses) were observed in 2.9% (CI = 1.2%-6.4%) of the patients treated with AmB and 1.2% (CI = 0.1%-4.4%) of the patients treated with Sb(V) (P>0.20). For the treatment of visceral leishmaniasis in Uganda, AmB therefore had a similar effectiveness and safety profile to that of meglumine antimoniate.

[The management of travellers' diarrhoea]. / La prise en charge de la diarrhée des voyageurs.

Travellers' diarrhoea represents the most frequent health problem when travelling in developing countries. In most cases it is a self-limited disease. Nonetheless it can cause incapacitation and significant morbidity. It can become persistent in up to 3% of travellers who have suffered from acute diarrhoea in regions at high risk. This article discusses the investigations and the management of diarrhoea in returning travellers, preventive measures and its management during travel.