Patterns of local and tourist use of an emergency department.
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Illness patterns of local and tourist patients in an emergency department of a medium-sized Ontario city with a single hospital were compared. Frequencies of specific and broad categories of ailments and rates of admission to the hospital were similar in the two groups. However, non-Canadian tourists were admitted to hospital at a much lower rate than Canadian tourists. Rates of visits to the emergency department within certain age categories were remarkably similar, as were rates within the sexes. It is concluded that, in view of the striking similarity in the illness pattern of a group of patients not professionally referred to the hospital and that of local patients, who have potential contact with a more extensive medical network, public attitudes, rather than availability of health professionals, determine the pattern of illness observed in an emergency department. (+info)
Legionnaires' disease on a cruise ship linked to the water supply system: clinical and public health implications.
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The occurrence of legionnaires' disease has been described previously in passengers of cruise ships, but determination of the source has been rare. A 67-year-old, male cigarette smoker with heart disease contracted legionnaires' disease during a cruise in September 1995 and died 9 days after disembarking. Legionella pneumophila serogroup 1 was isolated from the patient's sputum and the ship's water supply. Samples from the air-conditioning system were negative. L. pneumophila serogroup 1 isolates from the water supply matched the patient's isolate, by both monoclonal antibody subtyping and genomic fingerprinting. None of 116 crew members had significant antibody titers to L. pneumophila serogroup 1. One clinically suspected case of legionnaires' disease and one confirmed case were subsequently diagnosed among passengers cruising on the same ship in November 1995 and October 1996, respectively. This is the first documented evidence of the involvement of a water supply system in the transmission of legionella infection on ships. These cases were identified because of the presence of a unique international system of surveillance and collaboration between public health authorities. (+info)
A train passenger with pulmonary tuberculosis: evidence of limited transmission during travel.
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In January 1996, smear- and culture-positive tuberculosis (TB) was diagnosed for a 22-year-old black man after he had traveled on two U.S. passenger trains (29.1 hours) and a bus (5.5 hours) over 2 days. To determine if transmission had occurred, passengers and crew were notified of the potential exposure and instructed to undergo a tuberculin skin test (TST). Of the 240 persons who completed screening, 4 (2%) had a documented TST conversion (increase in induration of > or = 10 mm between successive TSTs), 11 (5%) had a single positive TST (> or = 10 mm), and 225 (94%) had a negative TST (< 10 mm). For two persons who underwent conversion, no other risk factors for a conversion were identified other than exposure to the ill passenger during train and/or bus travel. These findings support limited transmission of Mycobacterium tuberculosis from a potentially highly infectious passenger to other persons during extended train and bus travel. (+info)
Salmonella infections in Norway: descriptive epidemiology and a case-control study.
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The epidemiological progression of human salmonellosis in Norway is parallel to trends noted elsewhere in Europe. During the past two decades, the number of reported cases has increased steadily, with a special sharp rise in the early 1980s due to the emergence of Salmonella enteritidis, followed by a levelling off in recent years. However, in contrast to the situation in most other European countries, about 90% of the cases from whom a travel history is available, have acquired their infection abroad. The incidence of indigenous salmonella infections as well as the prevalence of the microorganism in the domestic food chain, are both comparatively low. In 1993-4, a national case-control study of sporadic indigenous salmonella infections was conducted to identify preventable risk factors and guide preventive efforts. Ninety-four case patients and 226 matched population controls were enrolled. The study failed to demonstrate any statistically significant association between salmonellosis and consumption of domestically produced red meat, poultry or eggs. The only factor which remained independently associated with an increased risk in conditional logistic regression analysis, was consumption of poultry purchased abroad during holiday visits to neighbouring countries. A separate analysis of Salmonella typhimurium infections incriminated food from catering establishments and foreign travel among household members, in addition to imported poultry. (+info)
International travel and vaccinations.
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With the increase in global travel, no disease is beyond the reach of any population. Traveling patients should be advised to follow food and water precautions and encouraged to receive the recommended immunizations. Travel medicine plays a vital role not only in limiting the morbidity of travel-related illnesses but also in limiting the spread of diseases. This article addresses the common issues related to travel, reviews the care of the immunocompromised traveler, and updates the available vaccinations and prophylactic regimens available to limit sickness abroad. (+info)
Amebic liver abscess: epidemiology, clinical features, and outcome.
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Amebic liver abscess (ALA) is a serious, but readily treatable form of hepatic infection. In order to understand the clinical features of this condition in the United States, we reviewed the medical histories of 56 patients with ALA at two large San Francisco Hospitals from 1979 to 1994. Patients were divided into the following groups based on the presumed manner in which they had acquired ALA: those born or raised in the United States, with a history of travel to an endemic area (Tr-ALA); those from an endemic area, but living in the United States for less than one year (En-ALA); and those neither from nor having traveled to an endemic area (N-ALA). We found distinct clinical patterns in patients from different epidemiological groups. Patients with Tr-ALA were a decade older than those from endemic regions, were more likely to be male, and tended to have an insidious onset. Furthermore, compared to patients with En-ALA, those with Tr-ALA were more likely to have hepatomegaly (P < 0.0001) and large abscesses (ALA > 10 cm; P < 0.01). One third of the patients studied had no associated travel history or endemic origin as risk factors. Of these, 63% had a condition consistent with severe immunosuppression, such as infection with the human immunodeficiency virus (HIV), malnourishment with severe hypoalbuminemia, or chronic infection. In patients with N-ALA, the presence of a presumed immunosuppressed state increased significantly, as compared to patients with endemic or travel risk factors for ALA. During the last five years of the study, one third of all patients diagnosed with ALA were HIV positive (including 2 with a new diagnosis of AIDS), many of whom were discovered to be HIV-infected only after presentation with ALA. We conclude that travel to and origin in an endemic area are important risk factors for the development of ALA, and patients in these different epidemiological groups appear to have distinct clinical features. Further, in the absence of recognized risk factors, the development of ALA may suggest an immunocompromised host. (+info)
Neurocysticercosis in an Italian traveler to Latin America.
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Neurocysticercosis is rarely reported in short-term travelers, although the disease remains a major public health problem in tropical regions. We present a case of neurocysticercosis that was probably acquired by ingestion of Taenia solium eggs contained in the stomach of a pig butchered by the traveler. Complete clinical resolution was obtained by medical treatment, underlying the importance of early suspicion and diagnosis of the disease. (+info)
Risk of Helicobacter pylori infection among long-term residents in developing countries.
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The seroprevalence and incidence of Helicobacter pylori infection were determined among 312 North American missionaries who were serving in developing countries between 1967 and 1984. The majority (81%) resided in sub-Saharan Africa. When initially evaluated, the missionaries had a mean age of 40 years, 65% were female, and all were of white race/ethnicity. An ELISA showed that the initial prevalence of IgG antibody to H. pylori was 17%. After a mean of 7.4 years of service (1917 person-years of exposure), 37 (14%) of 259 initially seronegative subjects seroconverted to anti-H. pylori, giving an annual incidence of 1.9%. These data indicate a relatively higher risk of H. pylori infection among missionaries compared with an annual incidence of seroconversion of 0.3-1.0% in industrialized nations. Long-term residents in developing countries should be evaluated for H. pylori infection when gastrointestinal symptoms develop. (+info)