1/18. typhoid fever and hiv infection: a rare disease association in industrialized countries.typhoid fever is still a global health problem, mainly in tropical and subtropical areas of the world and in developing countries, where relatively elevated morbidity and mortality rates still are present, mostly because of persisting poor hygienic conditions. In the majority of Mediterranean regions, including italy, the disease is constantly present, though with a low prevalence rate, as a result of an endemic persistence of salmonella typhi infection.1-4 On the other hand, in industrialized countries, most cases of S. typhi infection are related to foreign travel or prior residence in endemic countries.4-6 In the united states, 2445 cases of typhoid fever have been reported in the decade 1985 to 1994, and the annual number of cases remained relatively stable over time: over 70% of episodes were acquired in endemic countries (mostly mexico and india).6 The persisting morbidity of S. typhi also may be supported by the increasing resistance rate of this pathogen against a number of commonly used antimicrobial compounds. For instance, 6% of 331 evaluable S. typhi strains were resistant to ampicillin, chloramphenicol, and cotrimoxazole, and 22% of isolates were resistant to at least one of these three agents in a recent survey performed in the united states.6 The spread of antibiotic resistance among S. typhi isolates is emerging in many countries, and multidrug-resistant strains have been isolated, as well as isolates with poor susceptibility to fluoroquinolones,3-5,7-9 so that in vitro susceptibility should be determined for all cultured strains, and antimicrobial treatment should be adjusted accordingly. Nevertheless, fluoroquinolones (e.g., ciprofloxacin and pefloxacin) or third-generation cephalosporins, still represent the best choice for empirical treatment,2,4,6-8,10 and mortality remains rare in Western countries (less than 1% of episodes), although it is expected to be greater in developing areas of the world. The aim of this report is to describe two cases of typhoid fever that occurred in patients with human immunodeficiency virus (hiv) infection, a rarely reported disease association in industrialized countries.- - - - - - - - - - ranking = 1keywords = travel (Clic here for more details about this article) |
2/18. Yellow fever vaccination of human immunodeficiency virus-infected patients: report of 2 cases.yellow fever vaccine (17D, a live attenuated virus vaccine) was effective and safe in 2 human immunodeficiency virus-infected patients without severe immunosuppression, one of whom traveled to kenya and the other of whom traveled to senegal.- - - - - - - - - - ranking = 2keywords = travel (Clic here for more details about this article) |
3/18. Illustrations and implications of current models of hiv health service provision in rural areas.Despite recent evidence of faster than average increases in hiv/AIDS cases in rural areas across the U.S., there is still a generally poor understanding of successful models of rural hiv/AIDS health-care delivery. Past research in rural kentucky suggested several barriers to care resulting in most rural hiv-positive patients traveling from rural to urban areas for care. patients sought urban areas for care for reasons including patient confidentiality, a perceived lack of expertise on the part of rural physicians in caring for hiv-positive patients, and outright referral from rural to urban areas. Case histories are used to illustrate a variety of models of care used by rural hiv-positive patients. These include splitting and sharing care between rural primary care physicians and urban medical specialists, as well as patients receiving all their care in urban areas. Implications of these models for quality of care are discussed.- - - - - - - - - - ranking = 1keywords = travel (Clic here for more details about this article) |
4/18. Mucocutaneous leishmaniasis in a patient with the human immunodeficiency virus.We report a case of mucocutaneous leishmaniasis (MCL) in a patient with the human immunodeficiency virus (hiv), Centers for disease Control (CDC) Stage A2, with no previous history of cutaneous or systemic leishmaniasis. The patient had not travelled outside the province of Malaga, on the Mediterranean coast of southern spain, so that it concerns an indigenous case, extremely unusual in this area. The hiv infection may well have influenced the defence against leishmania, but the exact mechanism by which this occurred is unknown.- - - - - - - - - - ranking = 1keywords = travel (Clic here for more details about this article) |
5/18. 9: Infections in the returned traveller.The usual presentation of a returned traveller is with a particular syndrome - fever, respiratory infection, diarrhoea, eosinophilia, or skin or soft tissue infection - or for screening for asymptomatic infection. Fever in a returned traveller requires prompt investigation to prevent deaths from malaria; diagnosis of malaria may require up to three blood films over 36-48 hours. Diarrhoea is the most common health problem in travellers and is caused predominantly by bacteria; persistent diarrhoea is less likely to have an infectious cause, but its prognosis is usually good. While most travel-related infections present within six months of return, some important chronic infections may present months or years later (eg, strongyloidiasis, schistosomiasis). Travellers who have been bitten by an animal require evaluation for rabies prophylaxis.- - - - - - - - - - ranking = 8keywords = travel (Clic here for more details about this article) |
6/18. Disseminated histoplasmosis with atypical cutaneous lesions in an Italian hiv-infected patient: another autochtonous case.Disseminated histoplasmosis is recognized as a common AIDS-defining opportunistic disease in endemic areas (americas, Africa, East asia), while it is rarely described in europe, usually in individuals returning from endemic regions, or following endogenous reactivation of a latent infection imported long before from overseas countries. However, reports of autochtonous cases in europe suggest the possible, endemic presence of histoplasma capsulatum in some European regions, such as the South of france or the Po valley in italy. A case of disseminated histoplasmosis with atypical, papular and ulcerate skin lesions in an Italian hiv-infected patient, without history of travels outside his native region, is described. Our patient represents the fifth autochtonous case of AIDS-associated histoplasmosis described in italy.- - - - - - - - - - ranking = 1keywords = travel (Clic here for more details about this article) |
7/18. Cosmopolitan HTLV-Ia subtype among Spanish native patients.HTLV-I isolates exhibit peculiar geographic distributions, but are believed not to be associated with different pathogenic outcomes of these retroviral infections. We have analyzed two HTLV-I-infected Spanish native patients: one patient with a T-cell lymphoma had not travelled to HTLV endemic areas, and the other patient had a paraparesis and had travelled to many HTLV endemic areas such as south america, and Central and south africa. LTR proviral sequences of these isolates were amplified and sequenced to generate phylogenetic trees with different reported HTLV-I strains in order to subtype them. Spanish isolates clustered into the cosmopolitan HTLV-Ia subtype. It is important to know which HTLV-I subtypes are circulating in spain. It is possible that a subtype other than the cosmopolitan one is present in spain, especially African subtypes due to the proximity of this continent and the rise of immigration from Central and South African countries.- - - - - - - - - - ranking = 2keywords = travel (Clic here for more details about this article) |
8/18. Disseminated penicillium marneffei sepsis in a hiv-positive Thai woman in denmark.We report the first case of disseminated penicillium marneffei infection, in a 32-y-old hiv positive Thai woman, in denmark. Untreated it is a life-threatening infection. Therefore it is extremely important to consider P. marneffei in patients who are immunocompromized and who have been travelling to Southeast asia or china.- - - - - - - - - - ranking = 1keywords = travel (Clic here for more details about this article) |
9/18. With this eruption, there is not a second to lues.A 28-year-old white man presented to the Emergency Department with a 24-hour history of an eruption on his extremities, trunk, and face. The patient was known to be hiv positive with a CD4 count of 527 and a viral load of 20,300. He denied fever, chills, malaise, and headache. His social history was significant for the fact that he was in a monogamous homosexual relationship. He had no recent travel, pet exposures, or sick contacts. physical examination revealed stable vital signs and no documented fever. A maculopapular eruption was present on his face, trunk, and extremities (Figures 1 and 2). There was no palmar or plantar involvement. He was treated with diphenhydramine and topical 2.5% hydrocortisone and advised to return if his condition did not improve. Twelve days after the initial evaluation, the patient consulted us again due to progression of his dermatitis. He had no additional complaints other than an eruption on both palms but neither sole. (Figure 3). The eruption now demonstrated erythematous pink-red oval macules and papules 1-2 cm in size distributed on his scalp, face, trunk, and arms. A few papules contained fine collarettes of scale. Further questioning revealed that the patient had experienced a tender rectal ulcer 2 months previously. A punch biopsy and rapid plasma reagin were performed. The histopathologic examination revealed interface dermatitis with lymphocytes, plasma cells, occasional neutrophils, and a prominent lymphoplasmacytic perivascular dermatitis with infiltration of the vessel walls. Warthrin-Starry and Steiner methods demonstrated spirochetes at the dermal-epidermal junction and in vessel walls, consistent with treponema pallidum (Figure 4). Rapid plasma reagin and fluorescent Treponema antibody were both reactive with a Venereal disease research Laboratory (VDRL) of 1:16. The patient was diagnosed as having secondary syphilis and treated with 2.4 million units of IM benzathine penicillin for 3 weeks. His eruption resolved after the initial treatment and he did not experience a Jarisch-Herxheimer reaction.- - - - - - - - - - ranking = 1keywords = travel (Clic here for more details about this article) |
10/18. Chronic microsporidian infection of the nasal mucosae, sinuses and conjunctivae in hiv disease.A case of chronic infection of the nasal mucosae, sinuses and conjunctivae with a microsporidian parasite in association with hiv infection and immune deficiency is reported. This microsporidian resembles both encephalitozoon cuniculi and the newly described Encephalitozoon hellem by electron microscopy. This occurred in an adult male resident in the UK with no history of foreign travel. Although there are previous descriptions of conjunctival infections from the USA, this is the first description of infection of the nasal epithelium. Further studies are underway to classify this protozoan.- - - - - - - - - - ranking = 1keywords = travel (Clic here for more details about this article) |
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