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Infections exotic and ectopic, and everyday practice
Travel Medicine and Infectious Disease (2011) 9, 93e94 available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/tmid
EDITORIAL
Infections exotic and ectopic, and everyday practice This special edition of Travel Medicine and Infectious Disease takes a look at ‘exotic’ infections from a travel medicine perspective, from the development of vaccines against one of the world’s most feared viruses, to a very moving personal account of just what it feels like to be a patient struck down with a ‘new’ viral disease. These infections are considered ‘exotic’ when seen outside their home ranges, usually generating excitement when diagnosed in a developed country with temperate climate i.e. when they become ‘ectopic’, defined as “occurring in an abnormal position or place; displaced”.1 Dr Hoe Nam Leong of Singapore survived SARS. But he survived it while traveling, acquiring his infection in Singapore but first falling ill with symptoms while abroad. Dr Leong suffered a long and worrying illness, and his tale is one of fortitude and ultimately gratitude for a happy ending, but told with great humility. Dr Leong’s story need not have ended the way it did, and his recounting of the experience, told through the eyes of a physician-patient in a strange land with a strange illness, holds lessons for all of us: medical, scientific, and personal; if “Statistics are people with the tears wiped away”, Dr Leong’s contribution is to put the tears back. Physicians in training would also benefit from a reading of this story. Australia is a friendly and familiar country, but nevertheless an unusual one, providing as it does a home for a unique flora and fauna, including many venomous animal species, both terrestrial and marine. Australia also provides a home to some unusual viruses too. David Smith and his colleagues from ‘down under’ have in their turn provided us with a handsome review of these viruses. Practitioners advising travelers should have an awareness of these viruses. Apart from providing us with a very handy review, Smith and his colleagues remind us that travelers to and from Australia may have traversed Asian regions, and acquired other travel related infections, emphasizing once again the importance of eliciting a travel history. Hong Kong is a special place, with a fairly unusual history, where East and West really did (and still do) meet. The common image of this bustling, vibrant city-state is one of a densely packed metropolis, with not an inch of ground anywhere to spare, all having been sacrificed to
commercial activities and high rise housing. The truth of the matter is that half of Hong Kong’s land area is green and undeveloped, much being parkland; there is thus ample scope for vector borne disease to establish itself. This special autonomous region of China is by location and definition a tropical country, albeit a highly developed one with a sophisticated health care system. Nevertheless, vector borne diseases, including many infections not normally seen in developed countries, do pose a threat to Hong Kong. This topic is very comprehensively reviewed by John Simon and colleagues from Hong Kong, a small city-state with an impressive record in infectious disease control. Remaining in the Far East, Japan is another highly developed country exposed to the importation of exotic infections by travelers. Like Hong Kong, Japan has a highly sophisticated health care system, and well developed surveillance systems, but it sits at the edge of vast continent home to a host of tropical infections. In this special issue of the journal Takuya Maeda and Akihiko Kawana remind us that the unusual does occur in everyday practice, recounting their experiences with ‘silent’ exotic infections. Their experience is again a reminder of the importance of the travel history, and provides lessons for practitioners and public health officials in other countries. It is a fair bet that the very mention of the word ‘Ebola’ will evoke a strong reaction in most who hear it. Infections caused by Ebola and Marburg filoviruses display fearsome mortality, and Ebola is the archetypal ‘horror’ infection. If Hollywood, or indeed Bollywood and Nollywood too these days, were to invent a horror viral illness, it would look very like Ebola: extremely high mortality, no specific treatment, nosocomial transmission, and a fulminant and florid course from prodrome to death. Uzma Sarwar and colleagues share a fascinating tale with us: how these highly lethal viruses traversed the world, and the authors’ work on vaccines against the filoviruses. Their article provides a very readable overview of a topic that will not be going away anytime soon, and one which captures the attention of the traveling public. Although the average practitioner will be unlikely to see a case of filovirus infection, the traveling public will certainly
1477-8939/$ - see front matter ª 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.tmaid.2011.04.002
94 expect travel health advisors to be current on these viruses. Eventually, we look forward to the day when the work of Sarwar et al permits travel clinics to include filovirus vaccination in their offerings to travelers. Exotic infections will continue to emerge,2 often with the fairly nasty habit of pooping up where they may be least expected e.g. SARS in Toronto and Marburg fever in Germany and the United States. Meanwhile, infections such as schistosomiasis and other parasites may smolder away for many years. It is a given that exotic infections will continue to challenge practitioners, and that new infections will continue to emerge to threaten Homo sapiens, especially those members of the species of peripatetic habit. Doubtless, a revisit of this topic in few years will add the names of yet more infections, and tell tales of yet more exotic and ectopic infections.
Editorial
References 1. www.dictionary.com [accessed 20.04.11]. 2. Morens DM, Folkers GK, Fauci AS. Emerging infections: a perpetual challenge. Lancet Infect Dis 2008 Nov;8(11):710e9.
Stephen Toovey* Jane Zuckerman University College London Medical School, Research and Training in Travel Medicine, Burggartenstrasse 32, CH-4103 Bottmingen, Switzerland *Corresponding author. Tel.: þ41 61 421 7872; fax: þ41 61 421 7063. E-mail address: [email protected] (S. Toovey)
journal homepage: www.elsevierhealth.com/journals/tmid
EDITORIAL
Infections exotic and ectopic, and everyday practice This special edition of Travel Medicine and Infectious Disease takes a look at ‘exotic’ infections from a travel medicine perspective, from the development of vaccines against one of the world’s most feared viruses, to a very moving personal account of just what it feels like to be a patient struck down with a ‘new’ viral disease. These infections are considered ‘exotic’ when seen outside their home ranges, usually generating excitement when diagnosed in a developed country with temperate climate i.e. when they become ‘ectopic’, defined as “occurring in an abnormal position or place; displaced”.1 Dr Hoe Nam Leong of Singapore survived SARS. But he survived it while traveling, acquiring his infection in Singapore but first falling ill with symptoms while abroad. Dr Leong suffered a long and worrying illness, and his tale is one of fortitude and ultimately gratitude for a happy ending, but told with great humility. Dr Leong’s story need not have ended the way it did, and his recounting of the experience, told through the eyes of a physician-patient in a strange land with a strange illness, holds lessons for all of us: medical, scientific, and personal; if “Statistics are people with the tears wiped away”, Dr Leong’s contribution is to put the tears back. Physicians in training would also benefit from a reading of this story. Australia is a friendly and familiar country, but nevertheless an unusual one, providing as it does a home for a unique flora and fauna, including many venomous animal species, both terrestrial and marine. Australia also provides a home to some unusual viruses too. David Smith and his colleagues from ‘down under’ have in their turn provided us with a handsome review of these viruses. Practitioners advising travelers should have an awareness of these viruses. Apart from providing us with a very handy review, Smith and his colleagues remind us that travelers to and from Australia may have traversed Asian regions, and acquired other travel related infections, emphasizing once again the importance of eliciting a travel history. Hong Kong is a special place, with a fairly unusual history, where East and West really did (and still do) meet. The common image of this bustling, vibrant city-state is one of a densely packed metropolis, with not an inch of ground anywhere to spare, all having been sacrificed to
commercial activities and high rise housing. The truth of the matter is that half of Hong Kong’s land area is green and undeveloped, much being parkland; there is thus ample scope for vector borne disease to establish itself. This special autonomous region of China is by location and definition a tropical country, albeit a highly developed one with a sophisticated health care system. Nevertheless, vector borne diseases, including many infections not normally seen in developed countries, do pose a threat to Hong Kong. This topic is very comprehensively reviewed by John Simon and colleagues from Hong Kong, a small city-state with an impressive record in infectious disease control. Remaining in the Far East, Japan is another highly developed country exposed to the importation of exotic infections by travelers. Like Hong Kong, Japan has a highly sophisticated health care system, and well developed surveillance systems, but it sits at the edge of vast continent home to a host of tropical infections. In this special issue of the journal Takuya Maeda and Akihiko Kawana remind us that the unusual does occur in everyday practice, recounting their experiences with ‘silent’ exotic infections. Their experience is again a reminder of the importance of the travel history, and provides lessons for practitioners and public health officials in other countries. It is a fair bet that the very mention of the word ‘Ebola’ will evoke a strong reaction in most who hear it. Infections caused by Ebola and Marburg filoviruses display fearsome mortality, and Ebola is the archetypal ‘horror’ infection. If Hollywood, or indeed Bollywood and Nollywood too these days, were to invent a horror viral illness, it would look very like Ebola: extremely high mortality, no specific treatment, nosocomial transmission, and a fulminant and florid course from prodrome to death. Uzma Sarwar and colleagues share a fascinating tale with us: how these highly lethal viruses traversed the world, and the authors’ work on vaccines against the filoviruses. Their article provides a very readable overview of a topic that will not be going away anytime soon, and one which captures the attention of the traveling public. Although the average practitioner will be unlikely to see a case of filovirus infection, the traveling public will certainly
1477-8939/$ - see front matter ª 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.tmaid.2011.04.002
94 expect travel health advisors to be current on these viruses. Eventually, we look forward to the day when the work of Sarwar et al permits travel clinics to include filovirus vaccination in their offerings to travelers. Exotic infections will continue to emerge,2 often with the fairly nasty habit of pooping up where they may be least expected e.g. SARS in Toronto and Marburg fever in Germany and the United States. Meanwhile, infections such as schistosomiasis and other parasites may smolder away for many years. It is a given that exotic infections will continue to challenge practitioners, and that new infections will continue to emerge to threaten Homo sapiens, especially those members of the species of peripatetic habit. Doubtless, a revisit of this topic in few years will add the names of yet more infections, and tell tales of yet more exotic and ectopic infections.
Editorial
References 1. www.dictionary.com [accessed 20.04.11]. 2. Morens DM, Folkers GK, Fauci AS. Emerging infections: a perpetual challenge. Lancet Infect Dis 2008 Nov;8(11):710e9.
Stephen Toovey* Jane Zuckerman University College London Medical School, Research and Training in Travel Medicine, Burggartenstrasse 32, CH-4103 Bottmingen, Switzerland *Corresponding author. Tel.: þ41 61 421 7872; fax: þ41 61 421 7063. E-mail address: [email protected] (S. Toovey)