METHOD: Crude annual attack rates (AR) per 100,000 Dutch travelers were calculated during the period 1997 to 2014 by dividing the number of typhoid fever cases by the estimated total number of travelers to a specific country or region. Regions of exposure and possible risk factors were evaluated.
RESULTS: During the study period 607 cases of typhoid fever were reported. Most cases were imported from Asia (60%). Almost half of the cases were ethnically related to typhoid risk regions and 37% were cases visiting friends and relatives. The overall ARs for travelers to all regions declined significantly. Countries with the highest ARs were India (29 per 100,000), Indonesia (8 per 100,000), and Morocco (10 per 100,000). There was a significant decline in ARs among travelers to popular travel destinations such as Morocco, Turkey, and Indonesia. ARs among travelers to intermediate-risk areas according to the Dutch guidelines such as Latin America or Sub-Saharan Africa remained very low, despite the restricted vaccination policy for these areas compared to many other guidelines.
CONCLUSION: The overall AR of typhoid fever among travelers returning to the Netherlands is very low and has declined in the past 20 years. The Dutch vaccination policy not to vaccinate short-term travelers to Latin-America, Sub-Saharan Africa, Thailand and Malaysia seems to be justified, because the ARs for these destinations remain very low. These results suggest that further restriction of the Dutch vaccination policy is justified.
PATIENTS AND METHODS: A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy.
RESULTS: On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae.
CONCLUSION: Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine.