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Leprosy (Hansen’s Disease)

Leprosy, also known as Hansen's disease, is a chronic infectious disease predominantly affecting skin and nerves. The nerve damage occurring in leprosy may result in deformity, disability, and social stigma, creating problems for patients and their families. The interaction between the patient's immune system and the infection is dynamic, resulting in various clinical forms of leprosy and complications. Outside endemic areas, doctors often fail to diagnose…

Leishmaniasis

The leishmaniases are a group of chronic cutaneous, mucocutaneous, and visceral diseases caused by infection with one of several species of the protozoan parasite Leishmania . Members of the genus Leishmania are obligate intracellular parasitic protozoa in the family Trypanosomatidae. They exist as elongate, 10-15 µm, flagellated forms called promastigotes in their sand fly vectors. When an infected sand fly bites a mammalian host, it injects the…

Fungal Skin Infections

Residents and travelers experience a variety of fungal infections of the skin. Many are not unique to the travel location, but the heat and humidity of the tropical environment increases susceptibility to these infections. In addition, inoculation with endemic fungal pathogens can result in deep fungal infections of the skin and subcutaneous tissues. In some cases presentation is delayed until travelers have returned to their home…

Ectoparasites, Cutaneous Parasites, and Cnidarian Envenomation

This chapter describes common infestations by ectoparasites, including mites, lice, ticks, creeping eruption (cutaneous larva migrans), maggots (myiasis), and jiggers (tungiasis). Waterborne swimmer's itch (cercarial dermatitis) and jellyfish, or cnidarian (“nye- dare -ee-uhn”), envenomation are also discussed. Living in close quarters, hiking, camping, visiting beaches, and swimming can increase exposure to many of these organisms. Avoiding contact with sand and soil, using chemical insect repellents, wearing…

Acute Skin Reactions and Bacterial Infections

Acute skin reactions are often symptomatic and account for many of the skin-related complaints of travelers. Sunburn and other ultraviolet (UV) light reactions, bacterial infections, medication-related rashes, dermatitis, and insect bites and stings are all common. These occur with brief exposure to environmental hazards or drugs. In many cases, they can be prevented. Sunburn and Other Ultraviolet Light Reactions The intensity of UV radiation from the…

Fish and Shellfish Poisoning : Toxic Syndromes

Toxic seafoods are causative agents in a number of gastrointestinal and neurologic illnesses. Historically, these illnesses were seen mainly in specific geographic locations, associated with local seafood products and affecting local resident populations. However, that situation has now changed remarkably: ever-increasing growth in international tourism and the global fish market that emerged over the past two decades have contributed to increased cases of seafood intoxication presenting…

Food Poisoning: Toxic Syndromes

Once away from home, travelers are especially vulnerable to food-borne illness since with regard to food, they rely on the sourcing, processing, and culinary skills of others. Toxic syndromes due to food poisoning may occur after ingestion of foods that have been inadequately cooked, stored, or preserved. Knowledge of common food associations and clinical syndromes can help travelers to select safe foods or prompt them to…

Amebiasis, Giardiasis, and Other Intestinal Protozoan Infections

Entamoeba histolytica and Giardia lamblia are the most common protozoan pathogens of the human intestinal tract worldwide. In the United States, infections caused by Giardia and Cryptosporidium are most prevalent. Giardia and E. histolytica infection rates are significantly higher in developing countries. Despite this, neither protozoan is a common cause of disease in travelers. Giardia accounts for 1-4% of traveler's diarrhea, and E. histolytica for <1%.…

Approach to Diarrhea in Returned Travelers

Gastrointestinal infections are the most common illnesses in travelers, occurring in 34% of all travelers, typically those traveling from high-income countries to low and middle-income countries. Traveler's diarrhea (TD) is defined as three or more unformed stools per day and at least one additional gastrointestinal symptom, such as nausea, vomiting, and abdominal pain, and possibly systemic findings including fever and malaise. The majority of TD is…

The Role of Point-of-Care Testing in Travel Medicine

Health threats to travelers from infectious disease are common, with estimates of up to 75% of travelers becoming ill at some time during their travel. The World Health Organization (WHO) cites an extensive list ( ) of potential infectious agents, dependent on the countries visited. Because international travel can expose individuals to serious health risks, it is important that travelers have a medical consultation before…

Antibiotic-Resistant Bacteria in Returning Travelers

International travel often brings us into contact with multidrug-resistant (MDR) organisms (MRDOs), especially bacteria. These germs may or may not colonize or infect the traveler, but when they do, they present challenges to the clinician. This chapter will focus on strategies to prevent, diagnose, and treat MRDO infections in international travelers. Overview of Antibiotic Resistance Long before the human era, microbes competed for ecological niches in…

Ebola Virus Disease and Hemorrhagic Fevers

Hemorrhagic Fevers Overview and Transmission Hemorrhagic fevers are caused by infection with single-stranded, small RNA viruses in the Arenaviridae, Filoviridae, Bunyaviridae, or Flaviviridae families ( Table 28.1 ). The clinical picture is usually one of hemodynamic instability and coagulation abnormalities leading to bleeding. TABLE 28.1 Hemorrhagic Fever Viruses in Humans Adapted from Bausch, D.G., 2011. Viral hemorrhagic fevers. In: Goldman's Cecil Medicine, twenty-fourth ed. Saunders Elsevier,…

Human African Trypanosomiasis (Sleeping Sickness)

Human African trypanosomiasis (HAT), or African sleeping sickness, is a parasitic infection caused by the flagellated protozoa of the Trypanosoma brucei complex, which is spread by the tsetse fly. Sleeping sickness occurs in more than 30 countries in Africa, putting 60 million people at risk of infection. HAT ranks third among the world's most important parasitic diseases, behind malaria and schistosomiasis, in calculated disability-adjusted life years…

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…