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PubMed2000

[Diarrhea and fever after vacation in the south. Specific to tropics only in every 5th patient].

Post-travel medicine is mainly European medicine: Some 80% of the diseases are ubiquitous in nature, and only 20% tropics-specific. The leading symptoms are diarrhoea (68%), fever (20%) and skin conditions (9%), sometimes in combination. The travel history is of decisive importance for the diagnosis. Quite simple questions aimed at identifying the start of the illness, symptoms, destination, travel class and vaccinations can be useful for differentiation purposes. For the acute diagnosis, such aids as urine stick test, centrifuge, microscope, a range of stains, and a stool test for occult blood suffice. The most common serious travel-specific diseases include malaria, falciparum > tertian, dengue fever, hepatitis, and rickettsiosis. When falciparum malaria is suspected ("flu without a runny nose", and a visit to a tropical country), the patients must be hospitalized. Emergency diagnosis is done with a blood smear, "thick drop", and rapid malaria test.

Diagnosis, Differential↗
PubMed2000

[Vacation souvenirs: inoculation pathologies (cutaneous larva migrans, cutaneous leishmaniases, Lyme disease, rickettsioses)].

Residents of western countries travel more and more to (sub)tropical areas for holidays or work. During their stay they come in contact with insects and parasites susceptible to induce skin disorders that can manifest during their stay or after returning. This dermatosis account for approximatively 10% of referral to outpatient tropical clinics. The aim of this paper is to provide family physicians not familiar with these pathologies some practical guidelines to help them to identify and treat some tropical dermatosis: cutaneous larva migrans, cutaneous leishmaniasis, Lyme disease, rickettsiosis. Cutaneous larva migrans is the most frequent serpiginous itching eruption observed in travellers. It is cause by transepidermal penetration of animal hookworms (ancylostomas) through contact with soil infested with cat and dog feces. Effective treatments include topical thiabendazole or oral albendazole or ivermectine. Persons visiting mediterranean countries can acquire cutaneous leishmanisis that has many clinical presentations; the most typical is "bouton d'Orient", which manifests as painless ulceration resistant to antibiotic treatment. Treatment with intralesionel pentavalent antimony or pentamidine injection are effective. Lyme disease is an endemic infection in certain areas of North America and Europe, caused by the spirochete borrelia and transmitted through tick bite. It manifest as non-itching large persistent migrant erythema. If untreated this infection may expose to chronic debilitating rheumatologic, cardiac and neurological complications. Rickettsiosis, especially boutonneuse fever, are a potentially fatal multisystemic infectious diseases transmitted through the bite of a dog tick. Diagnosis must be evoked in the presence of a brutal fever syndrome, a painless eschar and widespread eruption associate to systemic symptoms. This infection must be recognized clinically in order to begin rapidly treatment with cyclines.

Animals↗