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 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This is a case study of a 26-year-old Hispanic male who presented with an initial complaint of fevers, chills and generalized weakness for three weeks. Patient reported a classical history of diurnal fever with temperature spikes as high as 105.8F after returning from a trip to Guatemala. His symptoms had waxed and waned for 3 weeks. This case study will focus on the initial presentation, value of complete history and physical exam, use of laboratory data and use of specialized diagnostic procedures in the outpatient setting. This case proves to be highly relevant to primary care in the context of treating patients with fevers of unknown etiology. Primary care physicians should be alert for unusual diseases in patients who are returning from foreign travel. Malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the Anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of Plasmodium organisms on a specially prepared blood film. This case study speaks to the importance of prompt work up and treatment of fever of unknown origin that presents in an unusual clinical picture or that is not readily explainable.
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PMID:Fever of unknown origin. 1465 78

In order to competently advise people who are planning to travel abroad the doctor needs information both about the planned journey (the mode of travel, the itinerary, the time of the trip) and about possible preexisting health problems. The area where the traveller intends to stay determines the specific risk of endemic diseases such as malaria, dengue-fever, yellow-fever etc. The recommendations for prophylaxis of malaria and for the different vaccinations are constantly modified and can be attained from the internet. Pre-existing health hazards such as cardiovascular diseases, diabetes mellitus, HIV-infection need to be assessed. Special consideration should be taken for pregnant women. The traveller returning from an endemic malarious area who feels ill or is febrile is a medical emergency and must be assessed for the possibility of having malaria since nontreated malaria in non-immune people has a very high mortality rate. Diarrhea is a common problem but is rarely dangerous. Long standing or bloody diarrhea, however, calls for a thorough search for the responsible pathogen. Healthy return travellers do not need a check-up examination because there are virtually no consequences for treatment.
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PMID:[Travellers in medical practice]. 1577 39

After a trip to Zambia, a previously healthy adult traveler presented with a prolonged illness characterized by low-grade fevers and fatigue. Although malaria smears and antibody tests results for Plasmodium species were negative, a diagnosis of malaria was ultimately determined by polymerase chain reaction (PCR) amplification and species-specific nucleic acid hybridization techniques. The patient was successfully treated and cured. Clinical use of PCR technology may facilitate the identification of cases of smear-negative malaria, which up to the present time, have been difficult to diagnose.
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PMID:Occult Plasmodium vivax infection diagnosed by a polymerase chain reaction-based detection system: a case report. 1601 56

A 26-year-old woman presented with a 2-day history of fever peaking to 39 degrees C and cold shivers that developed after a 2-weeks trip to Guatemala and Belize. Prior to the fever the patient had felt symptoms of a common cold and general malaise. Moreover, she complained of generalised myalgia and nausea. She had taken paludrine as a prophylactic against malaria. Borrelia spirochaetes, the pathogen of relapsing fever, were detected in a thick blood smear preparation. On the basis of the anamnesis, geography and specific exposure, the patient had a form of relapsing fever that is transmitted by ticks and not by lice: tick-borne relapsing fever. She was treated with doxycycline, 100 mg b.i.d. for 7 days. She could be discharged home in good condition after 2 days.
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PMID:[A patient with fever following a visit to the tropics: tick-borne relapsing fever discovered in a thick blood smear preparation]. 1710 Jan 31

Infection with Plasmodium ovale is uncommon in travelers. We describe a case of ovale malaria in a traveler to Mozambique who initially presented several weeks after completion of his trip. Species identification was ultimately achieved with a PCR-based diagnostic method.
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PMID:Relapsing malaria infection in an adolescent following travel to Mozambique. 1757 50

Travelers with pre-existing medical disease are at risk of exacerbation of their underlying disease during their journey but are also more susceptible to various infectious agents, which consequences could be much more severe than in healthy subjects. Prevention and education are primordial in order to optimize the trip. Each new prescription should be checked for potential drug/drug interactions. Malaria chemoprophylaxis should be considered if concerned, as well as mechanical protection against insect-bites. Vaccinations should be recommended after weighting risks and benefits, keeping in mind that live-attenuated vaccines are not recommended in case of cellular immune suppression. Prevention of travel-related diarrhea by general hygiene measures is of particular interest in this population. Thereafter, we are discussing specific preventive measure according to different medical conditions.
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PMID:[Travelers with underlying medical conditions]. 1763 2

Four cases of malaria in patients who had travelled to Equatorial Guinea the previous weeks and had not received prophylaxis are presented. There were three men and one woman, two natives of Equatorial Guinea who had been living in Spain for a long time and the other two Spanish. Following a 15-30 day trip in Equatorial Guinea they all presented with fever, shivering, headache and diarrhea( two cases) five to ten days after their return. Only one patient presented splenomegaly. The thick blood smear showed plasmodia in all patients and P. falciparum was identified in only two patients. All of them were treated with doxycycline and quinine sulfate with a favourable outcome. Only one of the patients needed hospitalization. Following some aspects of the epidemiology, symptoms, diagnosis and treatment of this emerging disease are presented.
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PMID:[Four cases of malaria in travellers. An emerging disease]. 1802 Aug 89

Mefloquine has been widely used for prophylaxis and treatment of patients with chloroquine-resistant malaria; the drug is usually well tolerated. Rarely, adverse effects may be severe, including gastrointestinal disturbances, neuropsychiatric reactions, cardiovascular manifestations, skin lesions, musculoskeletal symptoms, and bone marrow toxicity. We describe a 67-year-old woman with fever, dyspnea on exertion, peripheral blood eosinophilia, and diffuse pulmonary infiltrates on chest radiography. She had taken mefloquine for malaria prophylaxis for an 8-week trip to South Africa. A thorough work-up led to the diagnosis of eosinophilic pneumonia caused by the mefloquine. Her condition improved after the drug was discontinued. To our knowledge, this is the first report of mefloquine-induced eosinophilic pneumonia. Clinicians should be aware of this rare, potential adverse effect of mefloquine.
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PMID:Mefloquine-induced eosinophilic pneumonia. 1804 95

Persons crossing international boundaries away from their medical support systems are put at risk for illness and injury. Travel medicine is a new medical discipline that quantifies these health risks and develops strategies for reducing them. Obtaining health and evacuation insurance for a future trip is important for persons with medical conditions, those planning trips to developing tropical or semi-tropical regions of the world or when an international stay anywhere will be as long as a month. Pre-travel medical evaluation, vaccines against endemic infectious diseases and medications to reduce the occurrence of diarrhea and malaria during trips to endemic areas, and medications for self-treatment of common illnesses such as diarrhea are fundamental to travel medicine. There are a number of miscellaneous areas to consider in travel medicine including preventing deep vein thrombosis and minimizing jet lag during long haul air travel and reducing the occurrence of accidents and water- and altitude-related illnesses. An important recently defined challenge to the field is the growing number of ill-prepared persons put at great risk for illness while visiting friends and relatives living in areas of reduced hygiene. All persons need to have an idea of how and where they may find medical care if they develop illness while abroad. This article summarizes essential elements in travel medicine and offers 10 recommendations for safe travel.
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PMID:President's address: travel medicine and principles of safe travel. 1859 58

Length of travel appears to be associated with health risks. GeoSentinel Surveillance Network data for 4,039 long-term travelers (trip duration >6 months) seen after travel during June 1, 1996, through December 31, 2008, were compared with data for 24,807 short-term travelers (trip duration <1 month). Long-term travelers traveled more often than short-term travelers for volunteer activities (39.7% vs. 7.0%) and business (25.2% vs. 13.8%). More long-term travelers were men (57.2% vs. 50.1%) and expatriates (54.0% vs. 8.9%); most had pretravel medical advice (70.3% vs. 48.9%). Per 1,000 travelers, long-term travelers more often experienced chronic diarrhea, giardiasis, Plasmodium falciparum and P. vivax malaria, irritable bowel syndrome (postinfectious), fatigue >1 month, eosinophilia, cutaneous leishmaniasis, schistosomiasis, and Entamoeba histolytica diarrhea. Areas of concern for long-term travelers were vector-borne diseases, contact-transmitted diseases, and psychological problems. Our results can help prioritize screening for and diagnosis of illness in long-term travelers and provide evidence-based pretravel advice.
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PMID:Illness in long-term travelers visiting GeoSentinel clinics. 1989 65


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