I may want to remember this reference: “Enteropathogens and Chronic Illness in Returning Travelers” NEJM 2013; 368: 1817-25.
Some “fun facts:”
- In 2007, more than 30 million Americans traveled to developing regions. ~8% traveling to these regions needed medical care during or after travel. Gastrointestinal symptoms were present in more than 25% who sought medical care.
- According to the GeoSentinel Surveillance Network (42 travel medicine sites), between 1996-2005, 65% of enteric infections were due to parasites, 31% bacteria, and 3% viral. (J Infect 2009; 59: 19-27) (Parasites typically have more long-lasting infections which should be considered in interpreting this data; in addition, some pathogens are more difficult to isolate.)
- Six pathogens were most prevalent: Giardia, Campylobacter, Entamoeba histolytica, Shigella, Stronglyoides, and Salmonella.
In addition to an enteric pathogen color-coded prevalence map, the article has a useful table identifying areas at high risk, mode of transmission, incubation period, common symptoms, recommended diagnostic tests and treatments.
To minimize the impact of these enteropathogens, physicians can help prepare travelers with appropriate vaccinations, malaria chemoprophylaxis (if needed), and effective anti-bacterial drugs for self-treatment should symptoms develop.
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