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Chagas Disease

Chagas disease, first described in , is endemic throughout Central and South America. An estimated 8 million people are infected with Trypanosoma cruzi , the etiologic agent of this disease. T. cruzi , a protozoan of the order Kinetoplastida, has a complex lifecycle passing between insects and mammals. Blood-sucking triatomine bugs serve as the principal transmission vector by depositing T. cruzi -infected feces onto the skin.…

Tuberculosis in Travelers and Immigrants

Approximately 2 billion people, one-third of the world's population, are infected with Mycobacterium tuberculosis , and the majority of burden is in developing countries. The World Health Organization (WHO) estimates that the annual incidence of active tuberculosis (TB) cases was 9 million worldwide with mortality of 1.5 million in 2013 ( ). In 2013, 65% of reported TB cases in the United States were foreign born;…

Lyme Disease

In 1977, Steere and co-workers reported on an epidemic of arthritis in the region of Old Lyme, Connecticut. This breakthrough work catalyzed a flurry of studies that soon described Ixodes ticks as the vector, identified the spirochete Borrelia burgdorferi as the causative infectious pathogen, and characterized the broad clinical manifestations of Lyme disease. Interestingly, several authors had previously described patients in Europe with clinical manifestations similar…

Leptospirosis

Leptospirosis is the commonest zoonosis worldwide. It occurs in all areas except polar regions and is particularly common in the tropics and subtropics. Typical cases present abruptly with high fever and chills, intense headache, severe myalgias, and conjunctival suffusion. Many cases have a nonspecific presentation, however, and are often misdiagnosed. Adventurous travelers, especially to tropical and subtropical regions, are at increased risk of leptospirosis and should…

Viral Hepatitis in Travelers and Immigrants

The various forms of viral hepatitis are a ubiquitous concern for travelers, immigrants, and the healthcare providers responsible for their care ( Table 22.1 ). This chapter will cover the five hepatitis viruses that are associated with the majority of human disease: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV; formerly known as the delta agent), and hepatitis…

Malaria Diagnosis and Treatment

General Considerations Malaria is preventable by taking chemoprophylaxis and using mosquito avoidance measures ( Chapter 6 ). However, healthcare providers should be knowledgeable about the work-up of malaria, as it is not uncommon for a returned traveler to present with fever. When a patient presents with fever, healthcare providers working in malaria-free areas might not consider malaria in the differential diagnosis, especially since this disease can…

Travel-Acquired Illnesses Associated with Fever

The evaluation of fever in travelers poses a diagnostic challenge to clinicians for many reasons. First, there are many possible etiologies, some of which are geographically localized and are, thus, unfamiliar ( Table 20.1 ). Diagnosis may be delayed owing to lack of familiarity with routes of infection or clinical presentations of these geographically limited illnesses. Fever in travelers may be caused by infections that are…

Health Screening in Immigrants, Refugees, and International Adoptees

In an increasingly globalized world, migration and population mobility are important factors in the demographic makeup of national populations. In the United States, for example, recent estimates indicate that the foreign-born cohort comprises some 40 million people, or 13% of the total population. Many foreign-born individuals arrive as immigrants, refugees, or children adopted abroad. As such, and depending on their status, health screening may be a…

Pre-Travel Assessment and Advice for Expatriates and Volunteers

Expatriates Definitions Expatriates are defined as travelers who reside abroad for work or volunteer reasons but intend to return eventually to their home country, in contrast to immigrants, who intend to stay in the destination country. They typically spend longer durations abroad than tourists or short-term business travelers. Type of Expatriate Exposures depend largely on the nature of work. This may range from executives in large…

Travel and Mental Health

Medevac Statistics Although mental health is often an afterthought in travel medicine, in fact, the psychiatric impact of travel is an area of growing interest, not only because of the prevalence of international travelers from all sectors of the population, but also because of the changing nature of international travel. A recent Swiss travel clinic study of 22,584 travelers seeking pre-travel advice revealed the purposes of…

Travel with Chronic Medical Conditions

In addition to travel by rail, ship, and automobile, almost 2 billion people travel by air annually. It is generally expected that primary care providers as well as travel medicine clinic personnel will identify individuals who are unfit for air travel and provide them with advice. Studies show that more than 95% of travelers with health problems who travel by air would like to receive additional…

The Immunocompromised Traveler

As the world becomes increasingly interconnected, more people have the opportunity to travel outside their home communities and thus be at risk for novel and unexpected infections. The immunocompromised host requires special attention in pre-travel planning. This chapter will review travel preparations for immunocompromised patients, including human immunodeficiency virus (HIV)-infected individuals, solid organ or hematopoietic transplant recipients, and persons taking immunosuppressive medications. The Immunocompromised Traveler People…

Advice for Women Travelers

Travel health issues for women will vary according to the life stage and lifestyle of the women. Issues differ depending on whether the woman is in her second trimester of pregnancy or about to go on her first solo journey at age 80. To adapt the standard pre-travel health recommendations to the needs of a female traveler, one needs to consider potential gender- and age-related issues…

Students Traveling Abroad

Students are traveling abroad in increasing numbers, with the largest increase observed in the university-student age group. Preparing the student for travel abroad encompasses the depth and breadth of travel medicine. The benefits of foreign travel and educational international exchange programs include cross-cultural knowledge and competency, international language development, leadership development, and personal growth. Current data show shifting patterns of travel within the 13- to 17-year-old…

Travel Advice for Pediatric Travelers

Pediatric travelers present unique challenges to the travel medicine provider. Each facet of travel medicine has special caveats relating to the different developmental stages, sizes, and maturity levels of the infant, child, or adolescent traveler. In addition, children traveling to any destination require attention to basic pediatric issues. The pre-travel consultation provides an opportunity to highlight specific travel medicine issues and vulnerabilities in the pediatric population.…

Dive Medicine

In diving, the predominant forces of nature are the gas laws, and the two most important ones are Boyle's law and Henry's law. Simply stated, Boyle's law refers to a pressure–volume relationship. As a diver descends in the water, each 33 ft of seawater (fsw) adds approximately one additional atmosphere of pressure. At that pressure (33 fsw = 1 bar = 1 atm = 760 mmHg = 14.7 psi) the volume in…

High-Altitude Travel

Increasing numbers of people are traveling to high altitude for work or pleasure. While the rewards of such travel are often great and include opportunities to see places of great beauty or historical and cultural significance, to accomplish lifelong objectives, or to simply have an enjoyable vacation, there are risks associated with such travel. Unacclimatized lowlanders are at risk for one of several forms of acute…

Disequilibrium: Jet Lag, Motion Sickness, Cold Exposure, and Heat Illness

When travelers cross several time zones, go to hot or cold climates, or are subject to novel motion stimuli, they may face problems adapting to new environmental situations. This chapter presents some common states of disequilibrium likely to be encountered by the traveler and suggests practical approaches to the problems. Socioeconomic position, class, or economic status can affect individuals with these conditions profoundly, but like most…

Traveler’s Diarrhea : Prevention and Self-Treatment

Traveler's diarrhea is a common malady affecting up to 60% of international travelers during a 2-week trip. Areas of the world can be divided into high, intermediate, and low risk for acquiring traveler's diarrhea ( Fig. 8.1 ). Lowering risk from high to intermediate speaks to excellent efforts by many countries to improve their food and beverage hygiene. However, in the preparation of travelers for self-treatment…

Water Disinfection

Risk of Water-Borne Infection Water disinfection is an essential component of the prevention strategy for enteric infections. In developing countries, surface water may be highly contaminated with human waste. The World Health Organization (WHO) reports that 780 million people still lack access to an improved drinking water supply, and 2.4 billion people lack access to improved sanitation. This lack of safe drinking water, sanitation, and hygiene…