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No systematic studies exist on sex and gender differences across a broad range of travel-associated diseases.Travel and tropical medicine GeoSentinel clinics worldwide contributed prospective, standardized data on 58,908 patients with travel-associated illness to a central database from 1 March 1997 through 31 October 2007. We evaluated sex and gender differences in health outcomes and in demographic characteristics. Statistical significance for crude analysis of dichotomous variables was determined using chi2 tests with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). The main outcome measure was proportionate morbidity of specific diagnoses in men and women. The analyses were adjusted for age, travel duration, pretravel encounter, reason for travel, and geographical region visited.We found statistically significant (P.001) differences in morbidity by sex. Women are proportionately more likely than men to present with acute diarrhea (OR, 1.13; 95% CI, 1.09-1.38), chronic diarrhea (OR, 1.28; 95% CI, 1.19-1.37), irritable bowel syndrome (OR, 1.39; 95% CI, 1.24-1.57), upper respiratory tract infection (OR, 1.23; 95% CI, 1.14-1.33); urinary tract infection (OR, 4.01; 95% CI, 3.34-4.71), psychological stressors (OR, 1.3; 95% CI, 1.14-1.48), oral and dental conditions, or adverse reactions to medication. Women are proportionately less likely to have febrile illnesses (OR, 0.15; 95% CI, 0.10-0.21); vector-borne diseases, such as malaria (OR, 0.46; 95% CI, 0.41-0.51), leishmaniasis, or rickettsioses (OR, 0.57; 95% CI, 0.43-0.74); sexually transmitted infections (OR, 0.68; 95% CI 0.58-0.81); viral hepatitis (OR, 0.34; 95% CI, 0.21-0.54); or noninfectious problems, including cardiovascular disease, acute mountain sickness, and frostbite. Women are statistically significantly more likely to obtain pretravel advice (OR, 1.28; 95% CI, 1.23-1.32), and ill female travelers are less likely than ill male travelers to be hospitalized (OR, 0.45; 95% CI, 0.42-0.49).Men and women present with different profiles of travel-related morbidity. Preventive travel medicine and future travel medicine research need to address gender-specific intervention strategies and differential susceptibility to disease.

A 21-year-old male presented at the emergency room with jaundice, itching, dry cough, malaise and weight loss of 10 kg during the preceding four weeks. Eighteen months earlier, the patient had suffered an automobile accident leading to polytrauma. Serological markers for viral or other causes of hepatitis were absent. For suspected secondary sclerosing cholangitis, ultrasound and ERCP were performed but failed to reveal pathological findings. A liver biopsy showed cholestatic liver disease without signs of portal field-associated hepatitis. Hepato-biliary scintigraphy demonstrated hepatocellular dysfunction. The patient finally mentioned his guinea pig farm with around 50 animals, 20 of which had recently died for unknown reasons. The patient and three of his guinea pigs were subsequently tested for serological evidence of leptospirosis. IgG and IgM antibodies reacting with Leptospira interrogans were detected in the patient's serum, and all 3 guinea pigs were serologically positive for serovar Bratislava. Bacterial culture was not successful, and also PCR tests remained negative. The clinical symptoms quickly resolved after the initiation of antibiotic therapy with amoxicillin.

Cutaneous larva migrans is a skin infection with a typical clinical appearance caused by active penetration of nematode larvae and their subsequent epidermal migration. The typical clinical appearance is caused by hookworm larvae, usually Ancylostoma braziliense but sometimes other canine or feline types of hookworm.This guideline aims to enhance patient care by optimizing the diagnosis and treatment of infections due to creeping disease (cutaneous larva migrans) and to raise awareness among doctors of current treatment options. Die kutane Larva migrans ist eine in ihrem klinischen Bild typische Hautinfektion, die durch aktives Eindringen und anschließende epidermale Wanderung von Nematodenlarven hervorgerufen wird. Dieses typische klinische Bild wird durch Larven von Hakenwürmern, meist Ancylostoma braziliense, selten andere bei Kaniden und Feliden vorkommende Hakenwurmarten, verursacht.Ziele der Leitlinie sind die Verbesserung der Versorgung der Patienten durch Optimierung von Diagnostik und Therapie bei Infektionen mit Larva migrans cutanea sowie die Verbesserung der Kenntnisse von Ärztinnen und Ärzte über aktuelle Therapieoptionen.

Tritt bei Patienten nach einem Tropenaufenthalt Fieber auf, stellt das auch fur erfahrene Arztinnen und Arzte ein Problem dar, weil zunachst nicht klar ist, ob das Fieber uberhaupt mit dem Tropenaufenthalt in ursachlichem Zusammenhang steht oder eine ganz andere Ursache hat. Die Erfahrung lehrt auch, das nicht selten eine Erkrankung vorliegt, die zwar wahrend oder nach einer Tropenreise aufgetreten, aber dennoch keine Tropenerkrankung im engeren Sinn ist. So kommt es – wieder einmal mehr – auf die genaue Anamnese an, auf die Art des Fiebers und dessen Hohe, aber auch auf die eingehende Befragung nach moglichen Risikofaktoren fur fieberhafte Erkrankungen. Weiteren Aufschlus gibt sodann die Basisdiagnostik, vor allem der sorgfaltig erhobene klinische Status sowie einige Labor- und technisch gestutzte Untersuchungen. Ziel der vorliegenden Ubersichtsarbeit ist, in aller Kurze die effektive Stufendiagnostik aufzuzeigen, die moglichst rasch zur richtigen Diagnose fuhrt. Dabei wird besonderer Wert darauf gelegt, welche weiterfuhrenden Masnahmen bei negativer Basisdiagnostik zu treffen sind. Liegen richtungsweisende Begleitbefunde wie z.B. Hautveranderungen, Splenomegalie oder pulmonale Infiltrate vor, ist das weniger schwierig. Bekanntermasen kompliziert wird es, wenn sowohl die Basisuntersuchungen negativ ausfallen als auch richtungsweisende Begleitbefunde fehlen. Auch diese Konstellation wird eingehend erlautert.

Length of travel appears to be associated with health risks. GeoSentinel Surveillance Network data for 4,039 long-term travelers (trip duration >6 months) seen after travel during June 1, 1996, through December 31, 2008, were compared with data for 24,807 short-term travelers (trip duration 1 month, eosinophilia, cutaneous leishmaniasis, schistosomiasis, and Entamoeba histolytica diarrhea. Areas of concern for long-term travelers were vector-borne diseases, contact-transmitted diseases, and psychological problems. Our results can help prioritize screening for and diagnosis of illness in long-term travelers and provide evidence-based pretravel advice.

We investigated epidemiologic and clinical aspects of rickettsial diseases in 280 international travelers reported to the GeoSentinel surveillance Network during 1996–2008. Of these 280 travelers, 231 (82.5%) had spotted fever (SFG) rickettsiosis, 16 (5.7%) scrub typhus, 11 (3.9%) Q fever, 10 (3.6%) typhus group (TG) rickettsiosis, 7 (2.5%) bartonellosis, 4 (1.4%) indeterminable SFG/TG rickettsiosis, and 1 (0.4%) human granulocytic anaplasmosis. One hundred ninety-seven (87.6%) SFG rickettsiosis cases were acquired in sub-Saharan Africa and were associated with higher age, male gender, travel to southern Africa, late summer season travel, and travel for tourism. More than 90% of patients with rickettsial disease were treated with doxycycline, 43 (15.4%) were hospitalized, and 4 had a complicated course, including 1 fatal case of scrub typhus encephalitis acquired in Thailand. Rickettsial diseases are acute and potentially severe zoonotic infections caused by obligate intracellular, gram-negative bacteria belonging to the order Rickettsiales. The taxonomy of Rickettsiales is complex and continues to be updated, but currently the agents of rickettsial diseases are classified as belonging to 4 distinct genera: Rickettsia (including 2 biogroups: spotted fever group [SFG] rickettsiae with >10 species and typhus group [TG] rickettsiae with 2 species), Orientia (Orientia tsutsugamushi, the agent of scrub typhus), Ehrlichia (Ehrlichia chaffeensis, the agent of human monocytic ehrlichiosis), and Anaplasma (Anaplasma phagocytophilium, the agent of human granulocytic anaplasmosis). Diseases caused by Rickettsia and Orientia species are often collectively referred to as rickettsioses. Coxiella burnetii, the agent of Q fever, and Bartonella spp. were recently removed from the order Rickettsiales, but Q fever and bartonelloses are still frequently categorized as rickettsial diseases (1). Rickettsial diseases are increasingly being recognized among international travelers (2). A recent study of ≈7,000 returnees with fever as a chief reason to seek medical care suggests that 2% of imported fevers are caused by rickettsioses and that 20% of these patients are hospitalized (3). Most cases are acquired in sub-Saharan Africa, where SFG rickettsioses are second only to malaria as the most commonly diagnosed diseases in returnees with systemic febrile illness (4). With few exceptions, however, our knowledge of the incidence rates, associated factors, signs, symptoms, and outcome of rickettsial diseases in travelers is rudimentary and mostly based on smaller case series. We report all cases of rickettsial diseases in returned travelers reported to the GeoSentinel Surveillance Network from June 1996 through December 2008.