Vol 27 No 2 December - The Indian Society for Parasitology

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