[Travel vaccinations]. / Reiseimpfungen.

Vaccinations are an integral part of pre-travel care. Gaps in routine vaccination should be closed. In particular, measles and influenza are important in the context of travel medicine. Vaccinations against yellow fever and meningococcal disease may be required for international travel. This article provides information on these and other travel vaccinations against hepatitis A, typhoid fever, rabies, Japanese encephalitis and cholera.Yellow fever endemic areas are located in Africa and in South America; there is no yellow fever in Asia. The meningococcal vaccine (A, C, W, Y) is required for pilgrims to Saudi Arabia. Additionally, it is recommended for travellers visiting the African "meningitis belt" during the dry season. A polio booster is required for countries with endemic wild-type polio virus (WPV) or circulating vaccine derived poliovirus (cVDPV).Hepatitis A is a common vaccine-preventable infection in travellers. The hepatitis A vaccination should therefore be recommended to all travellers going to endemic areas. South Asia is the most important region where travel-associated typhoid fever is acquired and where at the same time antimicrobial resistance is emerging. Two different vaccines against typhoid fever are available in Germany. The vaccine efficacy is 50-70% for both vaccines. Contacts with potentially rabid animals are a common travel-related problem. At the same time, vaccines for state of the art postexposure care are not provided in many countries. According to recent WHO recommendations, two vaccinations are sufficient for pre-travel priming against rabies. Japanese encephalitis is rare in travellers. Vaccination should be offered in case of travel to rural and peri-urban areas. Cholera is extremely rare in travellers going to endemic areas. Cholera vaccination is therefore usually not indicated in the context of travel medicine.

[Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany]. / S1-Leitlinie--Revision November 2010 Diagnostik und Therapie der kutanen und mukokutanen Leishmaniasis in Deutschland.

The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is increasing globally, also in Germany, although the cases are imported and still low in number. The current evidence for the different therapies has many limitations due to lack of sufficient studies on the different Leishmania species with differing virulence. So far there is no international gold standard for the optimal management. The aim of the German joint working group on Leishmaniasis, formed by the societies of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology (DDG), was to establish a guideline for the diagnosis and treatment of CL and MCL in Germany, based on evidence (Medline search yielded 400 articles) and, where lacking, on consensus of the experts. As the clinical features do not necessarily reflect the involved Leishmania species and, as different parasite species and even geographically distinct strains of the same species may require different treatments or varying dosages or durations of therapy, the guidelines suggest for Germany to identify the underlying parasite prior to treatment. Because of relevant differences in prognosis and ensuing therapy species should be identified in i) New World CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subgenus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic algorithm is presented. For recommendations on localized and systemic drug treatment and physical procedures, data from the accessible literature were adjusted according to the involved parasite species and a clinical differentiation into uncomplicated or complex lesions. Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3 infected lesions, infections in functionally or cosmetically critical areas such as face or hands, presence of lymphangitis), ii) lesions refractory to therapy, iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with L. major it encompasses miltefosine, fluconazole and ketoconazole, while antimony or allopurinol were here considered second choice. Local therapy was considered appropriate for i) uncomplicated lesions of OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with L. major it encompasses perilesional antimony, combined with cryotherapy, paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy. The group also stated that there is an urgent need for improving the design and the way of publishing of clinical trials in leishmaniasis.

Pathogenesis and management of a late manifestation of vivax malaria after deployment to Afghanistan: conclusions for NATO Armed Forces Medical Services.

Because of the worldwide engagement of the German armed forces, tropical diseases may come to the attention of their medical services. In particular, acquired malarial infections, which sometimes become symptomatic only months or even years after soldiers return from military operations, need to be addressed. Other forces, such as the British, U.S., Australian, and Italian armed forces, reported cases of vivax malaria up to approximately 20 months after soldiers returned from military operations. The importance of a sound history and rapid diagnosis, leading to appropriate treatment, is emphasized in this case report of a 27-year-old German soldier who reported for sick call in his unit complaining of a flu-like illness, which later proved to be vivax malaria. The special parasitological features of Plasmodium vivax infection are discussed.