Holiday horrors Travellers diseases

Introduction Over 90% of infections related to short-term travel present within six months of return. Diseases with long latent periods or potential for lifetime persistence are rare after short-term travel, but more common in those who have lived abroad or were born overseas. The usual presentation of a returned traveller is with a particular syndrome — fever, respiratory infection, diarrhea, eosinophilia, or skin or soft tissue infection — or for screening for asymptomatic infection.

What to look for- a complete travel history, including dates and places visited, and potential exposures to exotic diseases (e.g., travel to rural areas, freshwater exposure, insect bites and sexual contacts) time of symptom onset in relation to travel, which may help eliminate diseases with different incubation periods (e.g., fever beginning over 10 days after departure from an endemic area is unlikely to be dengue, which has a short incubation period). 

Major infections Malaria Typhoid Yellow fever Hepatitis Polio Diphtheria Leprosy Dysentery Herpes Encephalitis Meningitis Dengue Tuberculosis Parasites

Short incubation periods <10 days Influenza Dengue Yellow fever Plague Paratyphoid fever Mediterranean spotted fever African tick-bite fever

Intermediate incubation 10-21 days Malaria Viral hemorrhagic fevers Typhoid fever Scrub typhus Q fever Relapsing fever (Borrelia spp.) African trypanosomiasis

Longer incubations >21 days Malaria Hepatitis A, B, C, E Rabies Schistosomiasis Leishmaniasis Amoebic liver abscess Tuberculosis Filariasis Brucellosis

What’s the usual? Bacteria >80% Viruses 0-35% Parasites 0-20%

Hookworm Diagnosis is predominantly clinical. Treatment is often necessary because of intense pruritus, long duration (over a year) and complications, such as impetigo and allergic reactions.  Cutaneous larva migrans – Malaysia

Cutaneous leishmaniasis is relatively common after sand fly bites in travelers returning from South and Central America, the Mediterranean and the Middle East. Mucous membranes and viscera may be involved.

Malaria Falciparum, vivax, ovale, malariae Generally presents within six weeks of return from an endemic area, although onset may be delayed by prophylactic mefloquine Periodic and characteristically repeating fevers. China, Ars, Carb-v, Eup, Gels, Nat-m, Phos-ac, Nux-v, Ipecac

Dengue Diagnosis of dengue are the short incubation period (four to seven days), maculo-papular rash, thrombocytopenia and leucopenia. Transmission by the aedes aegypti mosquito The last three features also occur in some rickettsial diseases (e.g., scrub typhus), HIV sero-conversion, Q fever, meningococcal disease, toxic shock syndrome, measles, secondary syphilis and rubella.  Ars Alb, Eup-perf, Gels, Rhus-T

Typhoid Enteric fever is the clinical syndrome caused by Salmonella typhi or "paratyphi" Salmonella species. Fever especially continuous low grade, is the dominant symptom, with gastrointestinal symptoms Baptisia, Ars Alb, Lach, Lyc, Pyr

The runs- Delhi belly ! Acute diarrhoea is common in travellers to developing countries. Despite the advice "cook it, boil it, peel it or forget it", dietary transgressions are usually unavoidable. Most cases of travellers' diarrhoea are caused by bacterial contamination of food, particularly with entero-toxigenic Escherichia coli (ETEC). It is rarely life-threatening. Mean duration of symptoms is four days. Up to 60% of people complain of cramps, 15% of bloody stools, and 10% of fever or vomiting.

Entamoeba Histolytica

Commonly called Amoebiasis or Amoebic Dysentry