Vol 27 No 2 December - The Indian Society for Parasitology
Vol 27 No 2 December - The Indian Society for Parasitology
Vol 27 No 2 December - The Indian Society for Parasitology
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JPD : <strong>Vol</strong>. <strong>27</strong> (2), 2003<br />
Parasitic infections in travelers<br />
81<br />
CLM, has shown that the efflorescences typically must to prevent morbidity and mortality from travel<br />
were found on the lower extremities (73.4% of all related infections (Weise, 1976).<br />
locations). <strong>The</strong> buttocks and anogenital region were<br />
<strong>The</strong> parasitic diseases pose two major problems. <strong>The</strong><br />
affected in 12.6% of all locations, and the trunk and<br />
first is the problem of the disease itself. <strong>The</strong> other is<br />
upper extremities each were affected in 7.1%. Only a<br />
associated with the development of drug resistance<br />
minority of patients presented with eosinophilia or an<br />
(Sundar, 2001) treatment failures (El Hassan and<br />
elevated serum level of IgE. <strong>The</strong>rapy with topical<br />
Khalil, 2001) co-existence of other diseases or<br />
thiabendazole was successful <strong>for</strong> 98% of the patients.<br />
interacting drugs which cause immune suppression<br />
Systemic antihelmintic therapy was necessary in two<br />
(corticosteroid therapy, HIV infection) (Martinez,<br />
cases because of disseminated, extensive infection<br />
2000). Chemotherapy is the most efficient strategy.<br />
(Jelinek et al, 1997). Nakamura-Uchiyam have Improvement in sanitation, vector and reservoir<br />
suggested that A. braziliense and A. caninum be<br />
control, and development of suitable vaccines are<br />
considered as possible causative agents <strong>for</strong> creeping<br />
other alternative approaches. <strong>The</strong> spectrum of drug<br />
eruption, especially when the patients have a history of<br />
resistance mandates search <strong>for</strong> new drugs,<br />
traveling overseas (Nakamura-Uchiyama et al, 2002).<br />
combination of existing drugs, and understanding the<br />
Occasional reports regarding the occurrence of rare biology of parasitic infection like ivermectin<br />
intestinal parasitic diseases in travelers include modulated chloride channel receptors (Tracy and<br />
visceral larva migrans due to Toxocara species (Lund- Webster, 2001).<br />
Tonnesen, 1996) and syndrome pulmonary infiltration<br />
<strong>The</strong> traveler returning from the tropics in clinical<br />
with eosinophilia (PIE) caused by Ascaris suum<br />
practice poses a definitive problem be<strong>for</strong>e the<br />
(Matsuyama et al, 1998). An imported human case of<br />
clinicians. Sometimes travelers returning from the<br />
rectal hookworm infection with worms in the rectum<br />
tropics consult a physician even if they have no actual<br />
has been reported in South Korea in a patient returning<br />
symptoms. However, physical check-ups in<br />
after a travel to South -East Asia (Yong et al, 1992).<br />
asymptomatic travelers rarely detect any specific<br />
Future prospects with parasitic diseases due to parasitic infection. If no diagnostically suggestive<br />
international travel<br />
symptoms are apparent a systematic, step-by-step<br />
workup based on the laboratory investigations are<br />
Tropical countries have a favourable warm and humid<br />
essential. Laboratory investigations may include stool<br />
climate, which flourishes the parasitic diseases, and is<br />
microscopy <strong>for</strong> intestinal parasites, serology, and<br />
transmitted by various ways to travelers. International<br />
special methods to demonstrate parasites in blood or<br />
travel exposes the travelers in tropics to infectious<br />
tissues (like Millipore filtration of blood to detect<br />
diseases, insect vectors, and contaminated food and<br />
microfilaria, and bone marrow aspiration to detect LD<br />
water.<br />
bodies in cases of PUO). <strong>The</strong> diagnostic approach of<br />
<strong>The</strong> risk of infection is an intrinsic part of tourism, the clinician should be to consider first all those<br />
especially tropical tourism. Reasons are many which systemic parasitic infections, which are potentially<br />
increase susceptibility of travelers in tropical life threatening and can be cured by specific therapy<br />
countries to many parasitic infections (Box I). <strong>The</strong> such as falciparum malaria, extra intestinal<br />
alteration of the mode of living caused by the holiday, amoebiasis, and African trypanosomiasis<br />
and the frequent development of a false sense of (Markwalder et al, 1995).<br />
confidence and safety in the hygienic conditions in<br />
An increased awareness of family physicians <strong>for</strong><br />
tourist resorts in tropical countries favor the infection.<br />
recognition of unusual diseases in patients who have<br />
Factors which are less dependent on the behavior of<br />
returned from <strong>for</strong>eign travel is crucial in proper<br />
the tourists, are the infections produced by insect bites,<br />
diagnosis and management of the parasitic diseases<br />
such as malaria, filariasis, or leishmaniases, many of<br />
acquired by patients during travel. For example, an<br />
which may end fatally <strong>for</strong> lack of recognition. Hence, a increased awareness is essential about the possibility<br />
better enlightenment of the travelers, the use of of intestinal coccidian parasitic infections in patients<br />
prophylactic agents and improvement of diagnosis is a with prolonged diarrhea who have traveled to endemic