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Travel-related infections
Miller: Infection o n expeditions
conventional overseas travel, except that expedition members may be at somewhat enhanced risk of the more esoteric infections by virtue of their more sustained and intimate exposure to indigenous populations and pathogens.
CONCLUSIONS
The practice of medicine on expeditions differs significantly from that in more conventional settings. Many of the medical problems on expeditions are caused by infection. The risk of acquiring many of these can be reduced by sensible preparation (including vaccination) before the expedition and sensible behavior in the field. Illness caused by infection on expeditions usually has to be treated empirically on a ‘best guess’ basis and it is important to have a number of different antimicrobial agents available. Following return from expeditions, members may still be harboring potentially pathogenic organisms acquired overseas, and any appropriate symptoms require active investigation.
183
References 1. Zell SC. Environmental and recreational hazards associated with adventure travel. J Travel Med 1997; 4: 9.1-9. 2. Miller ARO. Preparing to travel. J R N Med Serv 1994; 80: 126-32. review of current 3. Levin JH, Clarke PD. Travel vaccines-a thinking. Br Med Bull 1993; 49: 326-47. 4. Bradley DJ, Warhurst DC. Guidelines for the prevention of malaria in travellers &om the United Kingdom. Comm Dis Rev 1997; 7: R137-52. 5. Phillips-Howard PA, Radalowicz A, Mitchell J, Bradley DJ. Risk of malaria in British residents returning from malarious areas. Br Med J 1990; 300: 499-503. 6. Miller ARO. Antibiotics for expeditions. J Antimicroh Chemother 1985; 16: 277-86. 7. A’Court CHD, Stables R H , Travis S. Doctor on a mountaineering expedition. Br Med J 1995; 310: 1248-52. 8. Salam I, Katelaris P, Leigh-Smith S, Farthing MG. Randomised trial of single-dose ciprofloxacin for travellers’ diarrhoea. Lancet 1994; 344: 1537-9. 9. Rudland S, Little M, Miller A, et al. The enemy within: diarrhoeal rates among British and Australian troops in Iraq. Military Med 1996: 161: 728-31. 10. Straushaugh LJ, Girgis NI, Mikhail IA, et al. Penetration of amoxicillin into cerebrospinal fluid. Antimicrob Agents Chemother 1978: 144: 899-903.
EDITORIAL COMMENT
Travel- related infections Chi Microbiol It@ 1999; 5 : 183 In response to a massive increase in international travel, the 1990s has seen the development of organizations such as The International Society of Travel Medicine and The British Travel Health Association, which focus on and promote the health of travelers. Such organizations have an important educative role to play and it is likely that travel medicine will develop into a subspeciality of its own. While a significant proportion of the morbidity among travelers comes from noninfectious causes such as road traffic accidents and cardiovascular disease, infections continue to present a challenge to their health, more so on visits to resourcepoor countries. There is increasing awareness of the role of travel in the spread of emerging infectious diseases [l] and the inevitable consequence that they may present as problems for diagnosis, treatment and prevention of spread in any part of the world. Thus, expertise in travel-related infection is a necessity for all
those practicing clinical microbiology/infection. The CMI Editorial Board has agreed to encourage the submission of articles and original papers on travelrelated infection for publication in the Journal. The first in the series, from Dr Alastair Miller, appears in this issue. Dr Miller, himself an infectious disease physician, has first-hand experience of the medical care of expeditions to remote areas of the world, which is reflected in his clear and practical analysis of the problems posed by infection on expeditions. The Editors look forward to receiving further manuscripts on infection in relation to travel.
Peter L. Chiodirii Editor, CMI Reference 1. Cetron M, Keystone J, Shlim D, Steffen R. Travelers’ health. Emerg Infect Dis 1998; 4: 405-7.
conventional overseas travel, except that expedition members may be at somewhat enhanced risk of the more esoteric infections by virtue of their more sustained and intimate exposure to indigenous populations and pathogens.
CONCLUSIONS
The practice of medicine on expeditions differs significantly from that in more conventional settings. Many of the medical problems on expeditions are caused by infection. The risk of acquiring many of these can be reduced by sensible preparation (including vaccination) before the expedition and sensible behavior in the field. Illness caused by infection on expeditions usually has to be treated empirically on a ‘best guess’ basis and it is important to have a number of different antimicrobial agents available. Following return from expeditions, members may still be harboring potentially pathogenic organisms acquired overseas, and any appropriate symptoms require active investigation.
183
References 1. Zell SC. Environmental and recreational hazards associated with adventure travel. J Travel Med 1997; 4: 9.1-9. 2. Miller ARO. Preparing to travel. J R N Med Serv 1994; 80: 126-32. review of current 3. Levin JH, Clarke PD. Travel vaccines-a thinking. Br Med Bull 1993; 49: 326-47. 4. Bradley DJ, Warhurst DC. Guidelines for the prevention of malaria in travellers &om the United Kingdom. Comm Dis Rev 1997; 7: R137-52. 5. Phillips-Howard PA, Radalowicz A, Mitchell J, Bradley DJ. Risk of malaria in British residents returning from malarious areas. Br Med J 1990; 300: 499-503. 6. Miller ARO. Antibiotics for expeditions. J Antimicroh Chemother 1985; 16: 277-86. 7. A’Court CHD, Stables R H , Travis S. Doctor on a mountaineering expedition. Br Med J 1995; 310: 1248-52. 8. Salam I, Katelaris P, Leigh-Smith S, Farthing MG. Randomised trial of single-dose ciprofloxacin for travellers’ diarrhoea. Lancet 1994; 344: 1537-9. 9. Rudland S, Little M, Miller A, et al. The enemy within: diarrhoeal rates among British and Australian troops in Iraq. Military Med 1996: 161: 728-31. 10. Straushaugh LJ, Girgis NI, Mikhail IA, et al. Penetration of amoxicillin into cerebrospinal fluid. Antimicrob Agents Chemother 1978: 144: 899-903.
EDITORIAL COMMENT
Travel- related infections Chi Microbiol It@ 1999; 5 : 183 In response to a massive increase in international travel, the 1990s has seen the development of organizations such as The International Society of Travel Medicine and The British Travel Health Association, which focus on and promote the health of travelers. Such organizations have an important educative role to play and it is likely that travel medicine will develop into a subspeciality of its own. While a significant proportion of the morbidity among travelers comes from noninfectious causes such as road traffic accidents and cardiovascular disease, infections continue to present a challenge to their health, more so on visits to resourcepoor countries. There is increasing awareness of the role of travel in the spread of emerging infectious diseases [l] and the inevitable consequence that they may present as problems for diagnosis, treatment and prevention of spread in any part of the world. Thus, expertise in travel-related infection is a necessity for all
those practicing clinical microbiology/infection. The CMI Editorial Board has agreed to encourage the submission of articles and original papers on travelrelated infection for publication in the Journal. The first in the series, from Dr Alastair Miller, appears in this issue. Dr Miller, himself an infectious disease physician, has first-hand experience of the medical care of expeditions to remote areas of the world, which is reflected in his clear and practical analysis of the problems posed by infection on expeditions. The Editors look forward to receiving further manuscripts on infection in relation to travel.
Peter L. Chiodirii Editor, CMI Reference 1. Cetron M, Keystone J, Shlim D, Steffen R. Travelers’ health. Emerg Infect Dis 1998; 4: 405-7.