Chapter 12 : Traveling Abroad

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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.

Citation: Wolfe M. 2009. Traveling Abroad, p 293-310. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch12

Key Concept Ranking

Immune Systems
Traveler's Diarrhea
Yellow Fever Vaccine
Inactivated Polio Vaccine
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Image of FIGURE 1

Giemsa stain (thin smear) of severe infection with Numerous ring forms are visible. Source: Steven Glenn, Laboratory and Consultation Division, CDC (http://phil.cdc.gov/phil/quicksearch.asp).

Citation: Wolfe M. 2009. Traveling Abroad, p 293-310. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch12
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1. Adachi, J. A.,, L. Ostrosky-Zeichner,, H. L. Du Pont, and, C. D. Ericsson. 2000. Empirical antimicrobial therapy for travelers’ diarrhea. Clin. Infect. Dis. 31: 10791083.
2. Aldeen,, W. E. K.,, K. Carroll,, A. Robison,, M. Morrison, and, D. Hale. 1998. Comparison of nine commercially available enzyme-linked assays for detection of Giardia lamblia in fecal specimens. J. Clin. Microbiol. 36: 13381340.
3. Anonymous. 1991. Editorial. Lancet 337: 15151516.
4. Anonymous. 2001. Twinrix: a combination hepatitis A and B vaccine. Med. Lett. Drugs Ther. 43: 6768.
5. Anonymous. 2003. Nitazoxanide (Alinia)—a new antiprotozoal agent. Med. Lett. Drugs Ther. 45: 2931.
6. Anonymous. 2004. Tinidazole (Tindamax)—a new anti-protozoal drug. Med. Lett. Drugs Ther. 46: 7072.
7. Anonymous. 2007. Drugs for parasitic infections. Treatment guidelines. Med. Lett. 5 (Suppl.):e1–e15. http://www.medletter.com.
8. Backer, H. 2002. Water disinfection for international and wilderness travelers. Clin. Infect. Dis. 34: 355364.
9. Baird, J. K.,, D. J. Fryauff, and, S. L. Hoffman. 2003. Primaquine for prevention of malaria in travelers. Clin. Infect. Dis. 37: 659667.
10. Beal, C. B.,, P. Viens,, R. G. L. Grant, and, J. M. Hughes. 1970. A new technique for sampling duodenal contents—demonstration of upper small bowel pathogens. Am. J. Trop. Med. Hyg. 19: 349352.
11. Bennish, M. L. 1995. Immunization against Salmonella typhi. Infect. Dis. Clin. Pract. 4: 114122.
12. Berman, J. 1997. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years. Clin. Infect. Dis. 24: 684703.
13. Blacklow, N. R., and, H. B. Greenberg. 1991. Viral gastroenteritis. N. Engl. J. Med. 325: 252264.
14. Boggild, A. K.,, M. E. Parise,, L. S. Lewis, and, K. C. Kain. 2007. Atovaquone-proguanil: report from the CDC Expert Meeting on Malaria Chemoprophylaxis (II). Am. J. Trop. Med. Hyg. 76: 208223.
15. Bryan,, R. T.,, H. A. Waskin,, F. O. Richards,, T. M. Bailey, and, D. D. Juranek. 1988. African trypanosomiasis in American travelers: a 20 year review, p. 384388. In R. Steffen,, H. O. Lobel,, J. Haworth, and, D. J. Bradley (ed.), Travel Medicine. Springer-Verlag, Berlin, Germany.
16. Castelli, F., and, A. Patroni. 2000. The human immunodeficiency virus infected traveler. Clin. Infect. Dis. 31: 14031408.
17. Centers for Disease Control and Prevention. 1993. Hepatitis E among US travelers, 1989–1992. MMWR Morb. Mortal. Wkly. Rep. 42: 14.
18. Centers for Disease Control and Prevention. 1993. Inactivated Japanese encephalitis vaccine. Recommendations of the ACIP. MMWR Morb. Mortal. Wkly. Rep. 42 (RR-1): 115.
19. Centers for Disease Control and Prevention. 1996. The role of BCG vaccine in the prevention and control of tuberculosis in the United States. MMWR Recomm. Rep. 45 (RR-4): 118.
20. Centers for Disease Control and Prevention. 2005. Guidelines for using the Quantiferon-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Morb. Mortal. Wkly. Rep. 54 (RR-15): 4955.
21. Centers for Disease Control and Prevention. 2007. Health Information for International Travel 2008. U.S. Department of Health and Human Services, Public Health Service, Atlanta, GA.
22. Centers for Disease Control and Prevention. 2007. Notice to readers: malaria rapid diagnostic test. MMWR Morb. Mortal. Wkly. Rep. 56: 286.
23. Centers for Disease Control and Prevention. 2007. Notice to readers: new medication for severe malaria available under an investigational new drug protocol. MMWR Morb. Mortal. Wkly. Rep. 56: 769770.
24. Chen, L. H.,, M. E. Wilson, and, P. Schlagenhauf. 2007. Controversies and misconceptions in malaria chemoprophylaxis for travelers. JAMA 20: 22512263.
25. Dembert, M. L.,, K. F. Strosahl, and, R. L. Baumgarner. 1981. Diseases from fish and shellfish ingestion. Am. Fam. Physician 24: 103108.
26. DuPont,, H. L.,, C. D. Ericsson,, P. C. Johnson,, J. M. Bitsura,, M. W. DuPont, and, F. J. de la Cabada. 1987. Prevention of travelers’ diarrhea by the tablet formulation of bismuth subsalicylate. JAMA 257: 13471350.
27. Ericsson, C. D. 1998. Travelers’ diarrhea: epidemiology, prevention, and self-treatment. Infect. Dis. Clin. N. Am. 83: 285304.
28. Fradin, M. S., and, J. F. Day. 2002. Comparative efficacy of insect repellants against mosquito bites. N. Engl. J. Med. 347: 1318.
29. Freedman,, D. O. 2008. Sources of travel medicine information, p. 2934. In J. S. Keystone,, P. E. Kozarsky,, D. O. Freedman,, H. D. Northdurft, and, B. A. Connor (ed.), Travel Medicine, 2nd ed. Mosby Elsevier, Philadelphia, PA.
30. Gorbach, S. L., and, R. Edelman (ed.). 1986. Travelers’ diarrhea: National Institutes of Health Consensus Development Conference. Rev. Infect. Dis. 8: S109S227.
31. Grendon, J. H.,, R. F. Di Giacomo, and, F. J. Frost. 1995. Descriptive features of Dientamoeba fragilis infections. J. Trop. Med. Hyg. 98: 309315.
32. Gupta,, S. K.,, F. Medalla,, M. W. Omondi,, J. M. Whichard,, P. I. Fields,, P. Gerner-Smidt,, N. J. Patel,, K. L. F. Cooper,, T. M. Chiller, and, E. D. Mintz. 2008. Laboratory-based surveillance of paratyphoid fever in the United States: travel and antimicrobial resistance. Clin. Infect. Dis. 46: 16561663.
33. Hill, D. R., and, F. J. Bia. 2005. Coming of age in travel medicine and tropical diseases: a need for continued advocacy and mentorship. Infect. Dis. Clin. N. Am. 19: XVXXI.
34. Hill, D. R., and, R. D. Pearson. 1989. Editorial. Ann. Intern. Med. 111: 699701.
35. Hochedez, P., and, E. Caumes. 2008. Common skin infections in travelers. J. Travel Med. 15: 252262.
36. Isaacson, M. 2001. Viral hemorrhagic fever hazards for travelers in Africa. Clin. Infect. Dis. 33: 17071712.
37. Jensenius, M.,, P. E. Fournier, and, D. Raoult. 2004. Rickettsioses and the international traveler. Clin. Infect. Dis. 39: 14931499.
38. Jong, E. C., and, H. D. Nothdurft. 2001. Current drugs for antimalarial chemoprophylaxis: a review of safety and efficacy. J. Travel Med. 8 (Suppl. 3): 548556.
39. Klipstein, F. A. 1981. Tropical sprue in travelers and expatriates living abroad. Gastroenterology 80: 590600.
40. Kozarsky, P. E., and, J. S. Keystone. 2002. Body of knowledge for the practice of travel medicine. J. Travel Med. 9: 112115.
41. Levine, J.,, R. K. Dykoski, and, E. N. Janoff. 1995. Candida-associated diarrhea: a syndrome in search of credibility. Clin. Infect. Dis. 21: 881886.
42. MacLean, J. D., and, M. Libman. 1998. Screening returning travelers. Infect. Dis. Clin. N. Am. 12: 431443.
43. Markell, L. K., and, M. P. Udkow. 1986. Blastocystis hominis: pathogen or fellow traveler? Am. J. Trop. Med. Hyg. 35: 10231026.
44. Memish, Z. 2002. Meningococcal disease and travel. Clin. Infect. Dis. 34: 8490.
45. Miller, K. D.,, A. E. Greenberg, and, C. C. Campbell. 1989. Treatment of severe malaria in the United States with a continuous infusion of quinidine gluconate and exchange transfusion. N. Engl. J. Med. 321: 6570.
46. Ottesen, E. 1993. Filarial infections. Infect. Dis. Clin. N. Am. 7: 619633.
47. Rosenthal, P. J.,, C. Peterson,, F. R. Geertsma, and, S. Kohl. 1996. Availability of intravenous quinidine for falciparum malaria. N. Engl. J. Med. 348: 621.
48. Rosenthal, P. J. 2008. Artesunate for the treatment of severe falciparum malaria. N. Engl. J. Med. 358: 18291836.
49. Ryan, E. T., and, S. B. Calderwood. 2000. Cholera vaccines. Clin. Infect. Dis. 31: 561565.
50. Shaffer, N., and, L. Moore. 1989. Chronic travelers’ diarrhea in normal host due to Isospora belli. J. Infect. Dis. 159: 596597.
51. Soave, R., and, P. Ma. 1985. Cryptosporidiosis. Travelers’ diarrhea in two families. Arch. Intern. Med. 145: 7072.
52. Soave, R. 1996. Cyclospora. An overview. Clin. Infect. Dis. 23: 429437.
53. Suh, K. N.,, P. E. Kozarsky, and, J. S. Keystone. 1999. Evaluation of fever in the returned traveler. Med. Clin. N. Am. 83: 9971017.
54. Sung, V.,, D. P. O’Brien,, E. Matchett, G. V. Brown, and, J. Torresi. 2003. Dengue fever in travelers returning from Southeast Asia. J. Travel Med. 10: 208213.
55. Tanyuksel, M., and, W. A. Petri. 2003. Laboratory diagnosis of amebiasis. Clin. Microbiol. Rev. 16: 713729.
56. Taubitz,, W.,, J. P. Cramer,, A. Kapaun,, M. Pfeffer,, C. Drosten,, G. Dobles,, G. D. Burchard, and, T. Löscher. 2007. Chikungunya fever in travelers: clinical presentation and course. Clin. Infect. Dis. 45: e1e4.
57. Van Creval, R.,, P. Speelman, and, C. Gravekamp. 1994. Leptospirosis in travelers. Clin. Infect. Dis. 19: 132134.
58. Van Damme, P.,, J. Banatvala,, O. Fay,, O. Iwarson,, B. McMahon,, K. Van Herck,, P. Shouval,, P. Bonanni,, B. Connor,, G. Cooksley,, G. Leroux-Roels, and, F. Von Sonnenburg. 2003. Hepatitis A booster vaccination: is there a need? Lancet 362: 10651071.
59. Weinberg,, M.,, J. Weeks,, S. Lance-Parker,, M. Traeger,, S. Wiersma,, Q. Phan,, D. Dennison,, P. MacDonald,, M. Lindsley,, J. Guarner,, P. Connolly,, M. Cetron, and, R. Hajjeh. 2003. Severe histoplasmosis in travelers to Nicaragua. Emerg. Infect. Dis. 9: 13221325.
60. White, N. 1996. The treatment of malaria. N. Engl. J. Med. 335: 800806.
61. White, N. 2003. Melioidosis. Lancet 361: 17151722.
62. Whitty,, C. J. M.,, D. C. Mabey,, M. Armstrong,, S. G. Wright, and, P. Chiodini. 2000. Presentation and outcome of 1107 cases of schistosomiasis from Africa diagnosed in a non-endemic country. Trans. R. Soc. Trop. Med. Hyg. 94: 531534.
63. Wilde, H.,, D. J. Briggs,, F.-X. Meslin,, T. Hemachudha, and, V. Sitprija. 2003. Rabies update for travel medicine advisors. Clin. Infect. Dis. 37: 96100.
64. Wolfe, M. S. 1982. The treatment of intestinal protozoa. Med. Clin. N. Am. 66: 707720.
65. Wolfe, M. S., and, J. F. Cordero. 1985. Safety of chloroquine in chemosuppression of malaria. Br. Med. J. 290: 14661467.
66. Wolfe, M. S.,, C. Tuazon, and, R. Schultz. 1990. Imported bubonic plague—District of Columbia. MMWR Morb. Mortal. Wkly. Rep. 39: 895901.
67. Wolfe, M. S. 1990. Acute diarrhea associated with travel. Am. J. Med. 88 (Suppl. 6A): 34S37S.
68. Wolfe, M. S. 1992. Giardiasis. Clin. Microbiol. Rev. 5: 93100.
69. Wolfe, M. S. 1995. Typhim Vi: a new typhoid vaccine. Infect. Dis. Clin. Pract. 4: 186188.
70. Wolfe, M. S. 1995. Hepatitis A and the American traveler. J. Infect. Dis. 171 (Suppl. 1): S29S32.
71. Wolfe, M. S. (ed.). 2005. Health Hints for the Tropics, 13th ed. American Society of Tropical Medicine and Hygiene, Northbrook, IL.
72. Wolfe, M. S. 2008. The eosinophilia patient with suspected parasitic infection, p. 637649. In E. G. Jong and, C. Stanford (ed.), The Travel and Tropical Medicine Manual, 4th ed. Elsevier, Philadelphia, PA.
73. Wongsrichanalai, C.,, A. L. Pickard,, W. H. Wernsdorfer, and, S. R. Meshnick. 2002. Epidemiology of drug-resistant malaria. Lancet Infect. Dis. 2: 209218.
74. World Health Organization. 2000. Severe falciparum malaria. Trans. R. Soc. Trop. Med. Hyg. 94 (Suppl. 1): S1S74.
75. World Health Organization. 2008. International Travel and Health: Vaccination Requirements and Health Advice. World Health Organization, Geneva, Switzerland.
76. Young, E. J. 1983. Human brucellosis. Rev. Infect. Dis. 5: 821842.
77. Zimmerman, R. K. 1996. Varicella vaccine: rationale and indications for use. Am. Fam. Physician 53: 647652.

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