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Fulltext Infected aneurysm after returning from Southeast Asia: think Burkholderia pseudomallei!

Auvens C, Neuwirth C, Piroth L, Blot M

BMJ Case Rep, 2019 May 22;12(5).
PMID: 31122956 DOI: 10.1136/bcr-2018-228856

Melioidosis is a protean disease which is endemic to Southeast Asia and northern Australia. Here, we report a case of infected aortic aneurysm due to Burkholderia pseudomallei in an immunocompetent man 6 months after a trip to northern Malaysia. This patient initially received inappropriate surgical and antibiotic treatment, leading to a peri-prosthetic aortic infection with lumbar spondylitis and contiguous psoas muscle abscess. This case highlights the difficulty of diagnosing melioidosis given its diverse clinical manifestations and the limits of routine microbiological methods to identify B. pseudomallei Melioidosis should be considered a possible diagnosis in individuals with unexplained fever subsequent to travel in an endemic area.

Matched MeSH terms: Travel*
Countries at risk of importation of chikungunya virus cases from Southern Thailand: A modeling study

Tuite AR, Watts AG, Khan K, Bogoch II

Infect Dis Model, 2019;4:251-256.
PMID: 31667444 DOI: 10.1016/j.idm.2019.09.001

Southern Thailand has been experiencing a large chikungunya virus (CHIKV) outbreak since October 2018. Given the magnitude and duration of the outbreak and its location in a popular tourist destination, we sought to determine international case exportation risk and identify countries at greatest risk of receiving travel-associated imported CHIKV cases. We used a probabilistic model to estimate the expected number of exported cases from Southern Thailand between October 2018 and April 2019. The model incorporated data on CHIKV natural history, infection rates in Southern Thailand, average length of stay for tourists, and international outbound air passenger numbers from the outbreak area. For countries highly connected to Southern Thailand by air travel, we ran 1000 simulations to estimate the expected number of imported cases. We also identified destination countries with conditions suitable for autochthonous CHIKV transmission. Over the outbreak period, we estimated that an average of 125 (95% credible interval (CrI): 102-149) cases would be exported from Southern Thailand to international destinations via air travel. China was projected to receive the most cases (43, 95% CrI: 30-56), followed by Singapore (7, 95% CrI: 2-12) and Malaysia (5, 95% CrI: 1-10). Twenty-three countries were projected to receive at least one imported case, and 64% of these countries had one or more regions that could potentially support autochthonous CHIKV transmission. The overall risk of international exportation of CHIKV cases associated with the outbreak is Southern Thailand is high. Our model projections are consistent with recent reports of CHIKV in travelers returning from the region. Countries should be alert to the possibility of CHIKV infection in returning travelers, particularly in regions where autochthonous transmission is possible.

Matched MeSH terms: Air Travel
Malaya and Singapore revisited

Brennan DJ

Med J Aust, 1970 Dec 26;2(26):1257-8.
PMID: 4939067
Matched MeSH terms: Travel
[Plasmodium knowlesi--the fifth malaria. Potentially lethal infection which can also affect tourists]

Färnert A, Bronner U

Lakartidningen, 2009 May-Jun;106(21-22):1465-9.
PMID: 19579434
Matched MeSH terms: Travel
The missing link: introducing travel medicine into the undergraduate medical curriculum

Flaherty G, Thong Zi Yi C, Browne R

J Travel Med, 2016 May;23(5).
PMID: 27378364 DOI: 10.1093/jtm/taw038
Matched MeSH terms: Travel Medicine/education*
Every breath you take: how does air pollution affect the international traveller?

Guindi MN, Flaherty GT, Byrne M

J Travel Med, 2018 01 01;25(1).
PMID: 29718402 DOI: 10.1093/jtm/tay021
Matched MeSH terms: Travel*
Planning for sustainable tourism in southern Pulau Banggi: an assessment of biophysical conditions and their implications for future tourism development

Teh L, Cabanban AS

J Environ Manage, 2007 Dec;85(4):999-1008.
PMID: 17204361

A priori assessments of a site's biophysical and socio-economic capacity for accommodating tourism are less common than tourism impact studies. A priori evaluations can provide a contextual understanding of ecological, economic and socio-cultural forces, which shape the prospects for sustainable tourism development at the host destination, and can avert adverse impacts of tourism. We conduct an a priori assessment of the biophysical environment of Pulau Banggi, in the Malaysian state of Sabah for sustainable tourism development. We characterise baseline conditions of the island's marine biodiversity, seasonality, and infrastructure. We then evaluate how existing biophysical conditions will influence options for sustainable tourism development. In particular, we suggest conditions, if there are any, which constitute a limit to future tourism development in terms of compatibility for recreation and resilience to visitor impacts. We find that the biggest constraint is the lack of adequate water and sanitation infrastructure. Blast fishing, although occurring less than once per hour, can potentially destroy the major attraction for tourists. We conclude that while Pulau Banggi possesses natural qualities that are attractive for ecotourism, financial and institutional support must be made available to provide facilities and services that will enable local participation in environmental protection and enhance prospects for future sustainable tourism.

Matched MeSH terms: Travel
Jet lag: therapeutic use of melatonin and possible application of melatonin analogs

Srinivasan V, Spence DW, Pandi-Perumal SR, Trakht I, Cardinali DP

Travel Med Infect Dis, 2008 Jan-Mar;6(1-2):17-28.
PMID: 18342269 DOI: 10.1016/j.tmaid.2007.12.002

Each year millions of travelers undertake long distance flights over one or more continents. These multiple time zone flights produce a constellation of symptoms known as jet lag. Familiar to almost every intercontinental traveler is the experience of fatigue upon arrival in a new time zone, but almost as problematic are a number of other jet lag symptoms. These include reduced alertness, nighttime insomnia, loss of appetite, depressed mood, poor psychomotor coordination and reduced cognitive skills, all symptoms which are closely affected by both the length and direction of travel. The most important jet lag symptoms are due to disruptions to the body's sleep/wake cycle. Clinical and pathophysiological studies also indicate that jet lag can exacerbate existing affective disorders. It has been suggested that dysregulation of melatonin secretion and occurrence of circadian rhythm disturbances may be the common links which underlie jet lag and affective disorders. Largely because of its regulatory effects on the circadian system, melatonin has proven to be highly effective for treating the range of symptoms that accompany transmeridian air travel. Additionally, it has been found to be of value in treating mood disorders like seasonal affective disorder. Melatonin acts on MT(1) and MT(2) melatonin receptors located in the hypothalamic suprachiasmatic nuclei, the site of the body's master circadian clock. Melatonin resets disturbed circadian rhythms and promotes sleep in jet lag and other circadian rhythm sleep disorders, including delayed sleep phase syndrome and shift-work disorder. Although post-flight melatonin administration works efficiently in transmeridian flights across less than 7-8 times zones, in the case longer distances, melatonin should be given by 2-3 days in advance to the flight. To deal with the unwanted side effects which usually accompany this pre-departure treatment (acute soporific and sedative effects in times that may not be wanted), the suppression of circadian rhythmicity by covering symmetrically the phase delay and the phase advance portions of the phase response curve for light, together with the administration of melatonin at local bedtime to resynchronize the circadian oscillator, have been proposed. The current view that sleep loss is a major cause of jet lag has focused interest on two recently developed pharmacological agents. Ramelteon and agomelatine are melatonin receptor agonists which, compared to melatonin itself, have a longer half-life and greater affinity for melatonin receptors and consequently are thought to hold promise for treating a variety of circadian disruptions.

Matched MeSH terms: Travel*
Fulltext An analysis of international traveller deaths at the Cliffs of Moher in Ireland, 1993-2017

Flaherty GT, Caumes E

J Travel Med, 2018 01 01;25(1).
PMID: 29635642 DOI: 10.1093/jtm/tay019

Background: Traumatic deaths, and more particularly suicides, during international travel receive a disproportionately low level of attention in the travel medicine literature. We describe the demographic profile of international travellers whose death occurred at the Cliffs of Moher along the Atlantic seaboard in Ireland.
Methods: Coroners' files for the 25 years between 1993 and 2017 were interrogated. All cases of death on or at the cliffs were examined, and demographic data were extracted, including date of death, gender, age, nationality, whether the victims were alone at the cliffs prior to their death, whether the fall was witnessed, prevailing weather conditions, post-mortem examinations, toxicology reports and inquest verdicts.
Results: Overall, 66 deaths occurred on or at the base of the Cliffs of Moher during the period 1993 through August 2017. In total, 18 (27.3%) of the victims were international visitors to Ireland, including 11 males (61.1%). The mean age of travellers (n = 17) was 34.2 years. Victims were nationals of 12 different countries, with 13 being European nationals. Most deaths occurred in summer (n = 7) or spring (n = 6), with eight deaths (44%) reported at weekends. In total, 15 victims (83.3%) had walked along the cliff path alone. A jump or fall from the cliffs was witnessed in only two cases (11.1%). Post-mortem examinations revealed multiple traumatic injuries consistent with a fall from a height. Four cases had evidence of alcohol intoxication. Suicide or open verdicts were returned in 50% (n = 9) of the cases.
Conclusions: Travelling alone to the site, purchasing one-way tickets, or depositing belongings on the clifftop support the possibility of suicidal intent, while being intoxicated could be a co-factor in suicidal jumps or support the possibility of an accidental fall. This knowledge could help to identify travellers at the greatest risk of death at cliffs.

Matched MeSH terms: Travel*
Surveillance for travel-related disease--GeoSentinel Surveillance System, United States, 1997-2011

Harvey K, Esposito DH, Han P, Kozarsky P, Freedman DO, Plier DA, et al.

MMWR Surveill Summ, 2013 Jul 19;62:1-23.
PMID: 23863769

In 2012, the number of international tourist arrivals worldwide was projected to reach a new high of 1 billion arrivals, a 48% increase from 674 million arrivals in 2000. International travel also is increasing among U.S. residents. In 2009, U.S. residents made approximately 61 million trips outside the country, a 5% increase from 1999. Travel-related morbidity can occur during or after travel. Worldwide, 8% of travelers from industrialized to developing countries report becoming ill enough to seek health care during or after travel. Travelers have contributed to the global spread of infectious diseases, including novel and emerging pathogens. Therefore, surveillance of travel-related morbidity is an essential component of global public health surveillance and will be of greater importance as international travel increases worldwide.

Matched MeSH terms: Travel*
Fulltext Measles outbreak associated with an arriving refugee - Los Angeles County, California, August-September 2011

Centers for Disease Control and Prevention (CDC)

MMWR Morb Mortal Wkly Rep, 2012 Jun 1;61(21):385-9.
PMID: 22647743

Measles is a highly communicable, acute viral illness with potential for severe complications, including death. Although endemic measles was eliminated in the United States in 2000 as a result of widespread vaccination, sporadic measles outbreaks still occur, largely associated with international travel from measles-endemic countries and pockets of unvaccinated persons. On August 26, 2011, the Los Angeles County Department of Public Health (LACDPH) was notified of suspected measles in a refugee from Burma who had arrived in Los Angeles, California, on August 24, after a flight from Kuala Lumpur, Malaysia. Passengers on the flight included 31 other refugees who then traveled to seven other states, widening the measles investigation and response activities. In California alone, 50 staff members from LACDPH and the California Department of Public Health (CDPH) interviewed and reinterviewed 298 contacts. Measles was diagnosed in three contacts of the index patient (patient A). The three contacts with measles were two passengers on the same flight as patient A and a customs worker; no secondary cases were identified. Delayed diagnosis of measles in patient A and delayed notification of health officials precluded use of measles-mumps-rubella (MMR) vaccine as an outbreak intervention. This outbreak emphasizes the importance of maintaining a high level of vaccination coverage and continued high vigilance for measles in the United States, particularly among incoming international travelers; clinicians should immediately isolate persons with suspected measles and promptly report them to health authorities.

Matched MeSH terms: Travel
Notes from the field: acute muscular sarcocystosis among returning travelers - Tioman Island, Malaysia, 2011

Centers for Disease Control and Prevention (CDC)

MMWR Morb Mortal Wkly Rep, 2012 Jan 20;61(2):37-8.
PMID: 22258418

GeoSentinel (the surveillance program of the International Society of Travel Medicine and CDC) has identified 32 cases of suspected acute muscular sarcocystosis in travelers returning from Tioman Island off the east coast of peninsular Malaysia. All the patients traveled to Tioman Island during the summer of 2011. Within days or weeks of returning home, all experienced fever and muscle pain, often severe and prolonged. All had peripheral eosinophilia, and most had elevated serum creatinine phosphokinase levels. Most were tested for acute trichinosis and toxoplasmosis by serology, and all of these tests were negative. Approximately half of the patients were identified in Germany; others were reported elsewhere in Europe, and in North America and Asia. Muscle biopsy from two patients demonstrated organisms consistent with sarcocystosis, one from a group of five ill travelers and one from a group of three.

Matched MeSH terms: Travel
Fulltext Measles among U.S.-bound refugees from Malaysia--California, Maryland, North Carolina, and Wisconsin, August-September 2011

Centers for Disease Control and Prevention (CDC)

MMWR Morb Mortal Wkly Rep, 2011 Sep 23;60(37):1281-2.
PMID: 21937975

On August 26, 2011, California public health officials notified CDC of a suspected measles case in an unvaccinated male refugee aged 15 years from Burma (the index patient), who had lived in an urban area of Kuala Lumpur, Malaysia, which is experiencing ongoing measles outbreaks. Currently, approximately 92,000 such refugees are living in urban communities in Malaysia. Resettlement programs in the United States and other countries are ongoing. The health and vaccination status of urban refugees are largely unknown.

Matched MeSH terms: Travel
International travel requirements

Chan JS

Family Practitioner, 1973;1(1):16-18.

Matched MeSH terms: Travel
Fulltext Identification of Neisseria gonorrhoeae as the causative agent in a case of culture-negative dermatitis-arthritis syndrome using real-time PCR

Kimmitt PT, Kirby A, Perera N, Nicholson KG, Schober PC, Rajakumar K, et al.

J Travel Med, 2008;15(5):369-71.
PMID: 19006515 DOI: 10.1111/j.1708-8305.2008.00240.x

Sexually transmitted infections (STIs) are an increasingly common and important cause of a fever in a returning traveler. Systemic complications of STIs, human immunodeficiency virus seroconversion illness, and secondary syphilis are diagnoses that can easily be missed. We present a case of culture-negative disseminated gonococcal infection presenting with fever, malaise, polyarthralgia, arthritis, and a rash that developed following orogenital contact and was diagnosed using real-time polymerase chain reaction. This technology has major potential to improve the speed and sensitivity of diagnosis and consequent management of patients with this syndrome.
Study site: United Kingdom (patient had recent travel to Thailand and Malaysia)

Matched MeSH terms: Travel*
Fulltext The tobacco industry's accounts of refining indirect tobacco advertising in Malaysia

Assunta M, Chapman S

Tob Control, 2004 Dec;13 Suppl 2:ii63-70.
PMID: 15564223 DOI: 10.1136/tc.2004.008987

OBJECTIVE: To explore tobacco industry accounts of its use of indirect tobacco advertising and trademark diversification (TMD) in Malaysia, a nation with a reputation for having an abundance of such advertising.
METHODS: Systematic keyword and opportunistic website searches of formerly private tobacco industry internal documents made available through the Master Settlement Agreement.
RESULTS: 132 documents relevant to the topic were reviewed. TMD efforts were created to advertise cigarettes after advertising restrictions on direct advertising were imposed in 1982. To build public credibility the tobacco companies set up small companies and projected them as entities independent of tobacco. Each brand selected an activity or event such as music, travel, fashion, and sports that best suited its image. RJ Reynolds sponsored music events to advertise its Salem brand while Philip Morris used Marlboro World of Sports since advertising restrictions prevented the use of the Marlboro man in broadcast media. Despite a ban on tobacco advertisements in the mass media, tobacco companies were the top advertisers in the country throughout the 1980s and 1990s. The media's dependence on advertising revenue and support from the ruling elite played a part in delaying efforts to ban indirect advertising.
CONCLUSION: Advertising is crucial for the tobacco industry. When faced with an advertising ban they created ways to circumvent it, such as TMDs.

Matched MeSH terms: Travel
[Emerging parasitic diseases]

Weibel Galluzzo C, Wagner N, Michel Y, Jackson Y, Chappuis F

Rev Med Suisse, 2014 May 7;10(429):1008-13.
PMID: 24908745

Travels, migration and circulation of goods facilitate the emergence of new infectious diseases often unrecognized outside endemic areas. Most of emerging infections are of viral origin. Muscular Sarcocystis infection, an acute illness acquired during short trips to Malaysia, and Chagas disease, a chronic illness with long incubation period found among Latin American migrants, are two very different examples of emerging parasitic diseases. The former requires a preventive approach for travelers going to Malaysia and must be brought forth when they return with fever, myalgia and eosinophilia, while the latter requires a proactive attitude to screen Latin American migrant populations that may face difficulties in accessing care.

Matched MeSH terms: Travel; Travel Medicine/organization & administration
Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers

Piyaphanee W, Stoney RJ, Asgeirsson H, Appiah GD, Díaz-Menéndez M, Barnett ED, et al.

J Travel Med, 2023 May 18;30(3).
PMID: 36637429 DOI: 10.1093/jtm/taad002

BACKGROUND: International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists.
METHODS: Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis.
RESULTS: From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers' planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n = 405; 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9; 19%), expertise abroad (n = 9; 19%), lower cost (n = 8; 17%) and convenience (n = 7; 15%); a third (n = 13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter.
CONCLUSIONS: International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.

Matched MeSH terms: Travel; Travel Medicine
Fulltext Diagnosis and management of imported Chikungunya fever in Taiwan: a case report

Chang K, Hsieh HC, Tsai JJ, Lin WR, Lu PL, Chen YH

Kaohsiung J. Med. Sci., 2010 May;26(5):256-60.
PMID: 20466336 DOI: 10.1016/S1607-551X(10)70037-1

Chikungunya virus, a mosquito-borne alphavirus, is endemic in Africa and Southeast Asia but is rarely reported in Taiwan. We report the case of a Taiwanese woman who developed Chikungunya fever, which was first diagnosed by a clinician rather than by fever screening at an airport. The woman presented with fever, maculopapular rash, and arthralgia, the triad for the disease, on the day she returned home after a trip to Malaysia. These symptoms are very similar to those of dengue fever, which is endemic in Southern Taiwan. Chikungunya infection was confirmed by reverse transcriptase-polymerase chain reaction and seroconversion on paired serum specimens. For approximately 40 years until 2006, no cases of Chikungunya fever had been found in Taiwan. Clinicians in Taiwan should consider Chikungunya fever as a possible diagnosis for a febrile patient with arthralgia, rash, and a history of travel to an endemic area, such as Africa or Southeast Asia.

Matched MeSH terms: Travel*
A Case of Severe Falciparum Malaria in a Returned Traveler

Low QJ, Lau WK, Lim TH, Lee RA, Cheo SW

Malays Fam Physician, 2020;15(3):86-89.
PMID: 33329868

Primary care providers should be alert to travel-related infections. Around 10-40% of returning travelers from all destinations and 15-70% of travelers from tropical settings experience ill health, either overseas or upon returning home.1 A systematic approach concentrating on possible infections should be undertaken based on the patient's travel location, immunization history, presence of malaria chemoprophylaxis at the destination, other potential exposures, incubation period, and clinical presentation.2-3 The World Health Organization (WHO) website is constantly being updated on specific travel-related infections and recent geographical outbreaks. In this paper, we report a case of severe falciparum malaria in a returned traveler.

Matched MeSH terms: Travel

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