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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…

Malaria Prevention

Malaria is the most important parasitic disease in the world. Human malaria is a blood-borne protozoal infection caused by five species of the genus Plasmodium : P. falciparum , P. vivax , P. ovale , P. malariae , and P. knowlesi . The infection is transmitted through the bite of infected female Anopheles mosquitoes. Less commonly, malaria may be transmitted by blood transfusion, with shared needle…

Immunizations for Travelers

Recommendations for travel immunizations are based on a risk assessment of each traveler's general health, trip itinerary, and knowledge of current health conditions at a given destination. Most travelers seek protection against vaccine-preventable diseases, yet their acceptance of the vaccines recommended for travel may depend largely on other concerns, such as number of doses and vaccine schedules, route of administration (oral vs. injection), and cost. Many…

Jet Health

Once onboard a commercial jet aircraft headed to destination, the traveler faces the novel environment of the airplane cabin, in which a passenger's health may be impacted by the air quality and pressurization, among other prevailing conditions. Chronic health concerns may be exacerbated and new health issues may arise after spending hours sitting with limited mobility in the company of strangers and in contact with potentially…

Emerging Infectious Diseases and the International Traveler

In 1992 a landmark report by the Institute of Medicine titled “Emerging Infections: Microbial Threats to Health in the United States” highlighted the importance of the often underappreciated concept of emerging infectious diseases (EIDs). This report brought EIDs back into scientific discourse; however, the awareness that diseases emerge and periodically reemerge goes back millenia, as highlight in their historical review. The term “emerging infectious diseases” is…

Urban Medicine: Threats to Travelers to Cities in Low-Income Nations

Each year, more than 50 million travelers from industrialized nations visit low-income nations. Whereas many travelers and travel providers associate international travel with rustic and sparsely peopled environments, an increasing proportion of travelers, including students and international business travelers, spend most or all of their time abroad in urban environments. Even tourists whose final destinations are rural and remote must contend with urban settings for at…

COVID-19 in Children and Adolescents

Coronavirus Infections in Children and Adolescents Coronaviruses are enveloped single-stranded RNA viruses comprising four genera: alpha, beta, gamma, and delta. They infect humans and animals and were first described in the 1960s as causative agents of mild upper respiratory tract infections. Four human coronaviruses caused up to 35% of upper respiratory tract infections in humans: 2229E, NL63 (both alpha coronaviruses), and HKU1 and OC43 (beta coronaviruses).…

Approach to Travel Medicine and Contents of a Personal Travel Medicine Kit

A new medical specialty, travel medicine, emerged in the 1980s in response to the health needs of increasing numbers of international travelers—a phenomenon resulting from the rapid expansion and growing accessibility of commercial jet transportation. In 1990, the World Tourism Organization (WTO) reported approximately 457 million international arrivals per year. In 2014, the WTO reported 1138 million international arrivals per year, and just under half of…

Impact of Maternal SARS-CoV-2 Infection on the Fetus and Newborn

History of Perinatal Coronavirus Infections Before the worldwide pandemic, data on coronavirus infection in pregnancy were limited despite two previous large epidemics. A 2020 systematic review and meta-analysis found only 12 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) and 33 cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections in pregnancy, all of which were from case reports, case series, or small retrospective cohort studies.…

Psychiatric Manifestations of COVID-19

Introduction Neuropsychiatric sequelae of viral infections have been described in the literature and are well known from studies of influenza pandemics , , human immunodeficiency virus (HIV) infections, and viral encephalitis. Perhaps the most researched neuropsychiatric disorder after a viral infection was the development of encephalitis lethargica after the Spanish flu outbreak in the last century. Encephalitis lethargica had prominent parkinsonian symptoms, psychosis, and catatonia. Prominent…

Ophthalmic Manifestations of COVID-19

Introduction and Historical Perspectives In late December 2019, an ophthalmologist named Li Wenliang sent a message to a group of fellow physicians in Wuhan, China, warning them of an emerging respiratory illness that he thought bore resemblance to severe acute respiratory syndrome (SARS). Weeks later, after local authorities admonished him for “spreading rumors,” Dr. Li contracted the virus from one of his glaucoma patients and passed…

Kidney Manifestations of COVID-19

Acute Kidney Injury Incidence and Mortality Associated With SARS-CoV-2 Infection AKI incidence has varied based on the geographic location and clinical situation during the pandemic. A meta-analysis of over 13,000 patients reported an AKI prevalence of 17%, although the range from the individual studies that made up the meta-analysis was broad at 0.5% to 80%. Critically ill patients are more likely to have AKI in the…

Gastrointestinal Manifestations of COVID-19

OUTLINE Prevalence of Gastrointestinal Symptoms, 191 Implications of Gastrointestinal Symptoms in COVID-19, 191 Mechanism on How SARS-CoV-2 Affects Gut Health, 192 Angiotensin-Converting Enzyme-2 Receptor Mechanism, 192 Impact of SARS-CoV-2 on Gut Microbiota, 193 Impact of Gastric Acid Reduction on COVID-19 Outcomes, 193 Proton Pump Inhibitors, 193 Histamine Receptor Antagonists (H 2 -Blockers), 194 Impact of COVID-19 in Inflammatory Bowel Disease, 194 Pathogenesis of COVID-19 in Inflammatory Bowel…

Oral Cavity and COVID-19: Clinical Manifestations, Pathology, and Dental Profession

The Oral Cavity and Viral Infections The oral cavity is home to a vast microbial flora that also include a robust community of viruses. Although the viruses that infect bacteria or bacteriophages constitute the majority, viruses that infect human cells form a significant component of the oral microbiome. , Much like bacteria, viral communities are also site-specific alterations that can lead to disease. Indeed, one of…

Neurological Manifestations of COVID-19

OUTLINE Epidemiology of Neurological Manifestations of COVID-19, 159 Historical Background of Neurological Effects of the Coronavirus Family, 160 Pathophysiology, Pathogenesis, and Proposed Mechanisms of the SARS-CoV-2 Virus and the Nervous System, 161 COVID-19 and the Peripheral Nervous System, 162 Anosmia and Dysgeusia, 162 Guillain-Barré Syndrome and Associated Variants, 163 COVID-19 and the Central Nervous System, 166 Encephalopathy and Encephalitis, 166 Transverse Myelitis, 166 Seizures, 166 Cerebrovascular…

COVID-19 and the Cardiovascular System

OUTLINE Epidemiology of Cardiac Injury From COVID-19, 137 History of Cardiovascular Effects From SARS-CoV-1 and MERS-CoV, 138 Pathophysiology and Potential Mechanisms of Cardiovascular Injury From COVID-19, 138 Renin-Angiotensin System, 138 Direct Infection of the Myocardium, 139 Cytokine-Mediated Cardiac Injury, 140 COVID-19–Associated Thrombosis, 140 Clinical Manifestations and Complications, 143 Myocarditis, 143 Acute Coronary Syndrome, 143 Heart Failure, 144 Cardiac Arrhythmias, 144 Thromboembolic Events, 145 Cardiovascular Comorbidities and…

Pulmonary Manifestations of COVID-19

OUTLINE COVID-19 Manifestations in the Respiratory System, 100 Clinical Presentation, 100 Complications, 101 Acute Respiratory Distress Syndrome, 102 COVID-19 Acute Respiratory Distress Syndrome, 111 Lung Microbiome and COVID-19, 114 Specific COVID-19 Pulmonary Complications, 115 COVID-19 Long-Term Pulmonary Complications, 116 Treatment and Management of Salient Pulmonary Manifestations and Complications of COVID-19, 118 Treatment of Hypoxemia, 118 Management of Respiratory Failure, 119 Management of COVID-19 Pneumonia and Pneumonitis,…