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Chapter 12 : Traveling Abroad
In response to the hazards posed to travelers, the medical specialty of travel medicine has evolved, and numerous travel clinics are in operation. Travel medicine involves both the prevention of travel-related diseases and the diagnosis and treatment of exotic, primarily tropical, diseases upon the traveler’s return. The main areas involved in prevention include pretravel advice, preparation of an individualized medical kit, immunizations, malaria prophylactic measures, and prophylaxis and self-treatment of traveler's diarrhea. Vaccination is particularly indicated for field workers who could have direct contact with potentially plague-infected wild rodents in rural areas where plague is endemic. A case of plague imported into the United States by an American rodent collector infected in rural Bolivia emphasizes the importance of vaccination for such workers. The most common problems in returning travelers are diarrhea or other gastrointestinal difficulties, fever, unexplained eosinophilia, and skin rashes. Ciguatera poisoning from ingestion of large marine reef fish (including grouper, snapper, and barracuda) containing ciguatoxin is the most common form of fish poisoning. The major exotic tropical fevers occurring in travelers include malaria, enteric fever, hepatitis, bacterial dysentery, and rickettsial and arboviral infections. Intravenous artesunate is now available in the United States as an investigational new drug application and can be obtained for use in severe malaria infections. A number of filariae infect humans and can cause quite high eosinophilia.