Toxocariasis diagnosed in international travelers at the Institute of Tropical Medicine, Antwerp, Belgium, from 2000 to 2013.

Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium.

Serious altitude illness in travelers who visited a pre-travel clinic.

Background: Few data are available on the incidence and predictors of serious altitude illness in travelers who visit pre-travel clinics. Travel health consultants advise on measures to be taken in case of serious altitude illness but it is not clear if travelers adhere to these recommendations.

Methods: Visitors to six travel clinics who planned to travel to an altitude of ≥3,000 m were asked to complete a diary from the first day at 2,000 m until 3 days after reaching the maximum sleeping altitude.

Self-diagnosis of malaria by travelers and expatriates: assessment of malaria rapid diagnostic tests available on the internet.

Introduction: In the past malaria rapid diagnostic tests (RDTs) for self-diagnosis by travelers were considered suboptimal due to poor performance. Nowadays RDTs for self-diagnosis are marketed and available through the internet. The present study assessed RDT products marketed for self-diagnosis for diagnostic accuracy and quality of labeling, content and instructions for use (IFU).

Schistosomiasis in Belgian military personnel returning from the Democratic Republic of Congo.

The detection of schistosomiasis cases among Belgian military personnel returning from a mission in the Democratic Republic of Congo (DRC) prompted a nested case-control study of all military personnel deployed in the DRC between 2005 and 2008 to identify all infections and to start appropriate treatment. Of 197 patients exposed at Lake Tanganyika in the Kalemie area of DRC, 49 (24.9%) were diagnosed with schistosomiasis.

Acute mountain sickness in travelers who consulted a pre-travel clinic.

Background: The main objective of this study was to investigate the incidence and predictors of acute mountain sickness (AMS) in travelers who consulted a pre-travel clinic and the compliance with advices concerning this condition.

Methods: A post-travel questionnaire was sent to clients of five travel clinics who planned to climb above 2,000 m.

Results: The response was 77% and the data of all 744 respondents who stayed above 2,500 m were used for the analysis.

Therapy of vector-borne protozoan infections in nonendemic settings.

Vector-borne protozoan infections are responsible for a wide variety of illnesses (mainly malaria, trypanosomiasis and leishmaniasis) affecting tropical and subtropical areas, but increasingly diagnosed in nonendemic settings. This article summarizes the therapeutic developments for these conditions during the past decade and focuses specifically on treatment recommendations for returning travelers and migrants. The treatment of malaria has known the most spectacular improvements.

Schistosomiasis in travellers and migrants.

Schistosomiasis is a tropical parasitic disease caused by blood-dwelling fluke worms of the genus Schistosoma whose infective stages, the cercariae, are amplified through mollusks acting as intermediate hosts. People are infected when exposed to fresh water containing cercariae that penetrate the skin. There are however considerable differences in intensity of infection and morbidity, depending on the pattern of exposure and the infective species.

Anaphylaxis in an airplane after insecticide spraying.

Flights departing from malarious areas are sprayed with pyrethroids. They are presumed to be safe since reports of adverse responses among passengers or crew were only anecdotal. However, asthmatic reactions after domestic and occupational exposure have been published.

Vaccinations in patients with immune-mediated inflammatory diseases.

Patients with immune-mediated inflammatory diseases (IMID) such as RA, IBD or psoriasis, are at increased risk of infection, partially because of the disease itself, but mostly because of treatment with immunomodulatory or immunosuppressive drugs. In spite of their elevated risk for vaccine-preventable disease, vaccination coverage in IMID patients is surprisingly low. This review summarizes current literature data on vaccine safety and efficacy in IMID patients treated with immunosuppressive or immunomodulatory drugs and formulates best-practice recommendations on vaccination in this population.

Trends of norfloxacin and erythromycin resistance of Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers, 1994 to 2006.

Background: Campylobacter sp. is a major cause of bacterial enterocolitis and travelers' diarrhea. Empiric treatment regimens include fluoroquinolones and macrolides.

Fever after a stay in the tropics: clinical spectrum and outcome in HIV-infected travelers and migrants.

Objective: To investigate the epidemiology and clinical spectrum of fever in HIV-infected returning travelers and migrants.

Methods: From April 2000 to December 2006, we explored prospectively, at our referral travel/HIV clinics, the etiology and outcome of febrile illnesses developing within 3 months after a stay in the tropics. For this study, we compared the morbidity profile between HIV-infected individuals and all other cases tested HIV negative.

Eosinophilic meningitis due to Angiostrongylus cantonensis in a Belgian traveller.

Eosinophilic meningitis is a rare clinical entity. The most frequent cause in travellers to the tropics is infection with the rat lungworm Angiostrongylus cantonensis. In this report, we describe a case of eosinophilic meningitis due to infection with this nematode in a traveller who presented with slight headache, diarrhoea, general malaise and thoracic radicular pain after a trip through Latin America and the Fiji Islands.

Evaluation of the GIDEON expert computer program for the diagnosis of imported febrile illnesses.

Objective: The authors evaluate the performance of the expert system Global Infectious Diseases and Epidemiology Network (GIDEON) in diagnosing febrile illnesses occurring after a stay in the tropics.

Methods: One investigator (E.B.

Sexual risk behavior of travelers who consulted a pretravel clinic.

Objective: The objective of this study was to determine to which degree travelers who received pretravel advice at a travel clinic have protected or unprotected sexual contact with a new partner and what factors influence this behavior.

Method: An anonymous questionnaire was sent to travelers who came to a pretravel clinic between June 1 and August 31, 2005. Risk factors for casual travel sex and predictors of protected sex were studied in a multivariate model.

Travel-acquired scrub typhus: emphasis on the differential diagnosis, treatment, and prevention strategies.

Scrub typhus should be considered in any febrile patient presenting with a macular rash, a polyadenopathy, an eschar, or a history of environmental exposure in endemic areas. The differential diagnosis includes malaria, typhoid fever, leptospirosis, and arboviroses. Doxycycline 100 mg twice daily for 7 days should be initiated as soon as the disease is suspected.

Factors influencing standard pretravel health advice--a study in Belgium.

Background: Travelers with risk factors, medical conditions such as immunosuppression, medication intake, pregnancy, or elderly age, need adaptation or reinforcement of pretravel health advice. The literature provides little data on the frequency of these risk groups in the travel population. This study intended to investigate whether risk factors influencing standard travel advice are common in the population attending our travel clinic.

Bridging the gap between clinical practice and diagnostic clinical epidemiology: pilot experiences with a didactic model based on a logarithmic scale.

Rationale From general practitioners to academic staff, clinicians continue to have difficulties in applying clinical epidemiology in their everyday work. They do not fully understand the logical rules behind the numbers and they do not recognize these rules in their work. We present a new model where the pre-test and the post-test probabilities are converted to log10 of odds, and the likelihood ratio (LR) to its own log10.

Dengue fever and pregnancy - a review and comment.

Background: The increasing incidence of dengue with the concomitant rise in travel during pregnancy makes it likely that a pregnant woman will plan travel to or present after travel to endemic areas.

Method: Literature search and communication with researchers.

Results: Case reports of dengue during pregnancy, the peripartum period and neonatal dengue were found.

The pregnant wilderness traveler.

Background: Travel during pregnancy, especially, when it involves potentially hazardous activities in remote areas, often raises serious concerns regarding the health and safety risks involved.

Method: The authors have researched the available medical literature to identify these risks and present the current recommendations for their prevention and treatment.

Results: Topics addressed include some political and social issues, insurance, basic comfort measures, complications of pregnancy, infectious diseases, environmental exposures, and trauma.

Special infectious disease risks of expatriates and long-term travelers in tropical countries. Part II: infections other than malaria.

A wide range of viral, bacterial, and protozoal diseases pose risk to long-term tropical travelers. Risk varies geographically and with lifestyle. For some infections, risk increases with duration of stay, coming to resemble that of the local population.

Special infectious disease risks of expatriates and long-term travelers in tropical countries. Part I: malaria.

Malaria risk is dependent upon the entomological inoculation rate actually faced by the long-term traveler. Risk is cumulative, increases with duration of exposure, is greatest in rural and periurban areas, and least in urban centers. Risk may be zero in some urban centers, especially during dry seasons.