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PubMed2006

Malaria: diagnosis and treatment of falciparum malaria in travelers during and after travel.

Plasmodium falciparum is responsible for most of the mortality in travelers related to imported malaria. Problems that occur during travel include the inaccuracy of a microscopic diagnosis of malaria, both false positives and false negatives, when ill travelers seek care while abroad. A false positive diagnosis can result in unnecessary parenteral injections that carry a risk of transmission of blood-borne pathogens, receipt of potentially dangerous drugs such as halofantrine, or receipt of fake, counterfeit drugs. Increased morbidity and mortality are associated with delays in diagnosis and initiation of prompt treatment for falciparum malaria. Availability of expert microscopy to confirm the diagnosis of malaria is limited. The presence of splenomegaly and thrombocytopenia are strongly associated with malaria and would justify empiric treatment. The availability of atovaquone-proguanil, a safe and well tolerated oral drug, should prompt a reconsideration of current treatment recommendations that discourage empiric treatment on clinical suspicion alone.

Journal Article↗
PubMed1995

Risk Behavior for Travelers' Diarrhea Among Finnish Travelers.

Background: Contaminated food and drink are the primary sources of traveler's diarrhea (TD). Identification of the characteristics that make a traveler more prone to TD is needed to improve prevention and therapy of this illness. Methods: We evaluated, by questionnaire, the association of dietary errors with TD among 933 adult Finnish tourists vacationing in Morocco. A stool specimen was obtained from patients in the group that developed TD at the onset of the diarrheal episode, and from all participants in the study on their return to Finland. Results: Only 5% of the 933 subjects who responded to the questionnaire, and who gave a stool sample, had adhered strictly to generally accepted recommendations. About 45% made five or more dietary errors during the trip; of these, 75% consumed raw vegetables, 65% salads, 33% puddings, 32% mayonnaise or other cold dressings, 31% consumed food bought from street vendors, 29% consumed cold meat, 18% cold sandwiches, 4% drank tap water, and 2% consumed raw meat. The age of the subjects did not correlate with the number of dietary errors. Subjects who had been abroad during the preceding 12 months committed more dietary errors than those who had not (mean 3.9 versus 4.5; p <.001). Also, subjects who spent 2 weeks in Morocco committed more dietary errors than those who spent only 1 week (mean 4.0 versus 4.8; p <.001). However, no association between TD and the number of dietary errors was observed. Differences with respect to eating habits were not observed between subjects, with or without TD or with or without an identified pathogen in stool specimens. There was no correlation between eating habits and the presence, or absence, of a specific pathogen in the stool sample; this is with the exception of Campylobacter spp: subjects with this pathogen consumed steak tartar or salad more often than did other subjects. Conclusions: Etiologic agents are so ubiquitous in this high-risk area that instructions to avoid certain foodstuffs commonly thought to be contaminated may be to some extent without value. Moreover, dietary self restraint proved to be impossible in the real situation. (J Travel Med 2:77-84, 1995)

Journal Article↗
PubMed1989

Current comment. (xxii) Traveller-Gypsies and general practitioners in East London: the role of the Traveller health visitor.

Traveller-Gypsy communities in the United Kingdom (UK) have higher morbidity and mortality levels than the national average and their members have only limited access to primary and preventative health care services in most areas. Results of a questionnaire survey of general practitioners (GPs) in East London support previous evidence that the appointment of specially trained health visitors could help improve levels of understanding between GPs and Traveller families and so help Travellers make more effective use of conventional local primary care networks. The relevance of this specific example for other minority populations is evident.

Ethnicity↗
PubMed1992

[Bacteriological study of traveller's diarrhoea. 4) Isolation of enteropathogenic bacteria from patients with traveller's diarrhoea at Osaka Airport Quarantine Station during 1984-1991].

During the last 8 years (1984 to 1991), 16,639,233 overseas travellers were quarantined at Osaka Airport Quarantine Station and 38,326 travellers reported that they were (or had been) suffering from diarrhoea. Bacteriological examination of stools from 12,573 persons revealed the following results. 1) Various enteropathogenic bacteria were isolated from 3,669 cases (29.2%) examined. The predominant species of bacteria isolated were as follows: Salmonella, 1049 cases; Plesiomonas shigelloides, 1030 cases; Vibrio parahaemolyticus, 789 cases; Shigella, 607 cases; enterotoxigenic Escherichia coli, 422 cases; Vibrio cholerae non-O1, 212 cases. 2) There were no apparent seasonal variations in the isolation rate of these pathogens. 3) The suspected regions for infection with these pathogens were as follows: a) Salmonella, Enterotoxigenic E. coli and Plesiomonas, mainly South-East and South-West Asia. b) Shigella, South-West Asia, especially India (59.8%). c) V. parahaemolyticus and V. fluvialis, mainly South-East and East Asia. d) V. cholerae non-O1, V. mimicus, almost restricted to Asia, mainly South-East Asia. 4) 22 strains of V. cholerae O1 were isolated and 19 were Ogawa, E1 Tor. Of these strains, 13 were cholera toxin-producing strains and 9 were non-toxigenic strains. 5) Several pathogens (mixed infection) were isolated simultaneously from 670 cases. 6) The 1247 Salmonella strains were identified into 98 serovars. 7) Of 624 Shigella strains isolated, 57.9% were S. sonnei, 29.2% were S. flexneri, 8.6% were S. boydii, 4.3% were S. dysenteriae. 8) The most predominant serovar of V. parahaemolyticus was O4:K8. Of 1,247 strains isolated, 9.8% were not producing thermostable direct hemolysin (TDH). 9) 570 (91.3%) of 624 Shigella strains and 409 (32.8%) of 1,247 Salmonella strains isolated were resistant to any one of the drugs tested (SM. CP. TC. KM. ABPC. NA. OFLX). The resistance rate and the number of multiple drug-resistance strains increased year by year. 10) Enterotoxigenic E. coli was isolated from 422 cases (10.7%) of 3,939 cases. Cases with enterotoxigenic E. coli strains producing ST (heat-stable), LT (heat-labile) or both ST and LT were 53.8%, 24.2% and 14.2% respectively. The others were cases with mixed types of enterotoxin production.

Asia, Southeastern↗
PubMed1983

Mecillinam, a new prophylactic for travellers' diarrhoea. A prospective double-blind study in tourists travelling to Egypt and the Far East.

The efficacy of mecillinam when given orally in preventing travellers' diarrhoea has been studied. Preliminary investigations in volunteers showed that single daily doses of up to 200 mg for 3 weeks were well tolerated. A randomised double-blind study was carried out in a group of tourists visiting Egypt and the Far East. The subjects took either mecillinam (200 mg daily) or placebo for 25 days. 19/36 tourists (53%) taking placebo and 5/38 tourists (13%) taking mecillinam developed travellers' diarrhoea during the treatment period (p less than 0.001). In the placebo group enterotoxigenic Escherichia coli (LT/ST) were found in 2 cases of diarrhoea and Salmonella in another 2 cases. In the remaining cases of diarrhoea the etiological agent was not found in either of the 2 groups.

Administration, Oral↗
PubMed1983

Changes in serotype and resistance pattern of the intestinal Escherichia coli flora during travel. Results from a trial of mecillinam as a prophylactic against travellers' diarrhoea.

The changes in the intestinal Escherichia coli flora during travel has been studied by serological methods. A group of 74 tourists visiting Egypt and the Far East were given mecillinam or placebo in a randomized double-blind study. In all but 3 participants, 2 in the placebo group and 1 in the mecillinam group, a complete change in the E. coli flora occurred after a few days, and changes continued to occur during the 25 days of travel. The percentage of multiresistant strains rose from 8% in the pretravel samples to 50-60% in the posttravel samples. Less than 5% of the pretravel E. coli strains were resistant to mecillinam, whereas in the posttravel samples 42.9% of the E. coli strains in the mecillinam group and 19.1% in the placebo group were resistant to mecillinam. Of the 30 mecillinam resistant E. coli strains from the diarrhoeal samples only 6 showed transferable mecillinam resistance.

Adult↗
PubMed2000

[Fast prophylaxis for last-minute travelers. Which measures are still possible 1 week before traveling?].

Vaccinations or booster injections against tetanus, diphtheria and polio shortly before leaving on a journey are both possible and to be recommended. Active hepatitis-A-vaccination can also be applied immediately prior to the journey, and offers better protection than gamma globulins. As a rule, vaccinations against hepatitis B, yellow fever and typhoid must be given one to four weeks before the journey. Effective malaria prophylaxis for last-minute travellers is always possible. In addition to mandatory "exposure prevention", effective chemoprophylaxis is also recommended for travellers to tropical Africa. The dose of the first week should, whenever possible, be taken prior to the start of the journey.

Communicable Disease Control↗
PubMed2003

Travellers' health: minimising the hazards of overseas travel.

More people in the UK are travelling abroad on both business and pleasure today, which makes it imperative for primary care professionals to be up to date on the risks facing international travellers. This paper looks at the assessment process, and outlines appropriate health-promotion advice and the types of vaccination that may be necessary.

Health Education↗
PubMed1992

[Disability, vacation and travel--goals of a humane travel culture].

In our society, holiday-making and travelling have become civic rights. Handicapped people however frequently find this "civic right to holiday travelling" difficult to implement in the usual manner. Mobility barriers, behavioural uncertainty in the social-communicative contact of disabled and non-disabled people but also financial limitations act as disincentives. It therefore is necessary that disabled persons' organizations, non-profit and commercial service providers but also the Federal government step-up their involvement in this field and get efforts toward improvement started, an endeavour that could be coordinated and inspired by the Tourism and People with Disabilities working group established in 1989.

Architectural Accessibility↗
PubMed2001

Bloodsucking arthropods: the danger for travellers and hazard of vector travelling.

The newly obtained data supplemented our knowledge about risk for travellers, tourists and natives of Europe connected with malaria, leishmaniasis and other tropical diseases. It was discovered that healthy carriers of Epstein-Barr virus (nearly 90% of human population) have a great risk to get chronic Burkitt lymphoma disease as a result of Plasmodium falciparum (tropical malaria agent) infection. HIV carriers being occasionally in contact with visceral leishmaniasis vectors (sand-flies infected on dogs in the Mediterranean area) not only got a heavy form of disease but became a source of infection for healthy people. Airport malaria and outbreaks of dengue fever sometimes were (and are) connected with an import of infective Anopheles or Aedes mosquitoes. The high risk of borreliosis and ehrlichiosis infection exists in the forested European areas along the highways, where picnics and other types of recreation of travellers and tourists are typical and where the anthropogenically changed Ixodes ticks subpopulations are distributed. Such physiologically changed part of tick population is more aggressive and "changed ticks" more often are vectors of one, two or even more agent species simultaneously.

AIDS-Related Opportunistic Infections↗
PubMed1991

Placental abruption associated with air travel. A case report and an overview on safety of air travel in pregnant women.

A case of placental abruption during air travel is described. None of the known predisposing factors could be demonstrated. Although it may be a true coincidence, the connection between the abruption and the flight could not be totally excluded. Safety of air travel in pregnant women is discussed, and it may be summed-up that flying is not contraindicated in uncomplicated pregnancy.

Abruptio Placentae↗
PubMed1994

[HIV and travel. Advice concerning immunizations and pre-travel evaluation].

HIV and AIDS infection has reached epidemic proportions; however, advances in treatment have made it possible for an increasing number of infected individuals to travel. These patients should be given travel advice before they leave. Mainly for political reasons, they should be advised to avoid certain countries. For other destinations, more detailed information might be required.

Clinical Protocols↗
PubMed2002

Traveling length and minimal traveling time for flow through percolation networks with long-range spatial correlations.

We study the distributions of traveling length l and minimal traveling time t(min) through two-dimensional percolation porous media characterized by long-range spatial correlations. We model the dynamics of fluid displacement by the convective movement of tracer particles driven by a pressure difference between two fixed sites ("wells") separated by Euclidean distance r. For strongly correlated pore networks at criticality, we find that the probability distribution functions P(l) and P(t(min)) follow the same scaling ansatz originally proposed for the uncorrelated case, but with quite different scaling exponents. We relate these changes in dynamical behavior to the main morphological difference between correlated and uncorrelated clusters, namely, the compactness of their backbones. Our simulations reveal that the dynamical scaling exponents d(l) and d(t) for correlated geometries take values intermediate between the uncorrelated and homogeneous limiting cases, where l(*) approximately r(d(l)) and t(*)(min) approximately r(d(t)), and l(*) and t(*)(min) are the most probable values of l and t(min), respectively.

Journal Article↗
PubMed2005

Traveling wave fronts and localized traveling wave convection in binary fluid mixtures.

Nonlinear fronts between spatially extended traveling wave (TW) convection and quiescent fluid and spatially localized traveling waves (LTWs) are investigated in quantitative detail in the bistable regime of binary fluid mixtures heated from below. A finite-difference method is used to solve the full hydrodynamic field equations in a vertical cross section of the layer perpendicular to the convection roll axes. Results are presented for ethanol-water parameters with several strongly negative separation ratios where TW solutions bifurcate subcritically. Fronts and LTWs are compared with each other and similarities and differences are elucidated. Phase propagation out of the quiescent fluid into the convective structure entails a unique selection of the latter while fronts and interfaces where the phase moves into the quiescent state behave differently. Interpretations of various experimental observations are suggested.

Journal Article↗
PubMed2005

Internet offenders: traders, travelers, and combination trader-travelers.

The Internet opens a vast array of communication, entertainment, and educational resources for children; however, it also opens a gateway to home and school for offenders who wish to exploit children. A convenience sample of 225 cases published in the news media was examined. The cases were classified using law enforcement terminology to describe Internet offenders as traders, travelers, or combination trader-travelers. The media is seen as a critical source of information for the public to be aware of how the Internet is being used to commit sexual exploitation and sex crimes against children.

Adolescent↗
PubMed2003

Fluoroquinolone resistance in Campylobacter jejuni isolates in travelers returning to Finland: association of ciprofloxacin resistance to travel destination.

Ciprofloxacin resistance was analyzed in 354 Campylobacter jejuni isolates collected during two study periods (1995-1997 and 1998-2000) from travelers returning to Finland. The increase in resistance between the two periods was significant among all isolates (40% vs. 60%; p<0.01), as well as among those from Asia alone (45% vs. 72%; p<0.01).

Anti-Infective Agents↗
PubMed2000

[When travel joy winds up in the pants... Prevention, differential diagnosis and therapy of travel diarrhea].

Diarrhea is the most common symptom experienced during and after a visit to a tropical or subtropical region. It is estimated that one-third of all travellers abroad contract diarrhea. The most frequent causes are infectious pathogens that, under the circumstance of poor sanitation, are picked up via the fecal-oral route. As a preventive measure, therefore, recommendations regarding food hygiene should be strictly observed. The most important therapeutic measure is replacement of lost fluid and electrolytes. In the event of bloody stools and fever, suitable antimicrobial treatment should be instituted.

Anti-Infective Agents↗