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No systematic studies exist on sex and gender differences across a broad range of travel-associated diseases.Travel and tropical medicine GeoSentinel clinics worldwide contributed prospective, standardized data on 58,908 patients with travel-associated illness to a central database from 1 March 1997 through 31 October 2007. We evaluated sex and gender differences in health outcomes and in demographic characteristics. Statistical significance for crude analysis of dichotomous variables was determined using chi2 tests with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). The main outcome measure was proportionate morbidity of specific diagnoses in men and women. The analyses were adjusted for age, travel duration, pretravel encounter, reason for travel, and geographical region visited.We found statistically significant (P.001) differences in morbidity by sex. Women are proportionately more likely than men to present with acute diarrhea (OR, 1.13; 95% CI, 1.09-1.38), chronic diarrhea (OR, 1.28; 95% CI, 1.19-1.37), irritable bowel syndrome (OR, 1.39; 95% CI, 1.24-1.57), upper respiratory tract infection (OR, 1.23; 95% CI, 1.14-1.33); urinary tract infection (OR, 4.01; 95% CI, 3.34-4.71), psychological stressors (OR, 1.3; 95% CI, 1.14-1.48), oral and dental conditions, or adverse reactions to medication. Women are proportionately less likely to have febrile illnesses (OR, 0.15; 95% CI, 0.10-0.21); vector-borne diseases, such as malaria (OR, 0.46; 95% CI, 0.41-0.51), leishmaniasis, or rickettsioses (OR, 0.57; 95% CI, 0.43-0.74); sexually transmitted infections (OR, 0.68; 95% CI 0.58-0.81); viral hepatitis (OR, 0.34; 95% CI, 0.21-0.54); or noninfectious problems, including cardiovascular disease, acute mountain sickness, and frostbite. Women are statistically significantly more likely to obtain pretravel advice (OR, 1.28; 95% CI, 1.23-1.32), and ill female travelers are less likely than ill male travelers to be hospitalized (OR, 0.45; 95% CI, 0.42-0.49).Men and women present with different profiles of travel-related morbidity. Preventive travel medicine and future travel medicine research need to address gender-specific intervention strategies and differential susceptibility to disease.

Objectives. To report on the burden and outcome of episodes of acute otitis media (AOM) based on awareness of AOM and compliance to referral by community health workers (CHWs) in rural children aged under 2 in Bangladesh.Study design. Retrospective population-based cohort study.Method. Secondary data analysis on episodes of AOM, care-seeking pattern, compliance with referral, antibiotic use and duration of episodes from morbidity data collected by CHWs on 252 children aged under 2 who completed biweekly household surveillance starting from birth.Results. A total of 375 episodes of AOM were observed in 45.6% (115/252) of the study subjects; 19.4% (49/252) experienced single and26.2% (66/252) recurrent episodes. Just over 34% (129/375) of episodes were recognised by caregivers and reported to CHWs, and the remaining 246 episodes, unrecognised by caregivers, were detected by CHWs during home visits. CHWs referred all subjects with AOM to the study doctor. The caregivers complied with referral in all episodes they had recognised, but in only 21.5% (53/246) of episodes they had not recognised (p

Objectives. To obtain knowledge on the burden of infestation with soil-transmitted helminths (STHs) in rural children from birth to age2 years.Methods. Household visits to enrolled children were made twice a week for 2 years, and stool samples were collected once a month. Stools were also collected during diarrhoeal episodes, and when STHs were identified, a single dose of pyrantel pamoate was administered to patients with diarrhoea. All stool samples were examined using the formalin-ether sedimentation technique.Results. About 70% of the children had had STH infestation by 2 years, and approximately 80% of these had STH ova identified on morethan one occasion. The mean age at first acquisition was 14 months (standard deviation (SD) 4 months, range 1 - 24 months). Microscopicexamination revealed ova of Ascaris lumbricoides (9%), Trichuris trichiura (0.6%), hookworm (0.06%) and mixed infestation (0.4%). In 41 of the 178 children with STH infestation, its first identification was associated with episodes of diarrhoea. Following pyrantel pamoate deworming, 66% of subjects were re-infested after a mean interval of 90 days (SD 79 days).Risk behaviours such as disposal of child faeces and defaecation by adult family members in open spaces and use of common source surface water for washing clothes and utensils were practised by 62%, 83% and 50% of the cohort families, respectively. Bivariate analysis shows that disposal of child faeces in a closed space resulted in a 35% reduction in helminth infestation (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.49 - 0.87), use of tube well water in a 48% reduction (OR 0.52, 95% CI 0.29 - 0.93, p

We investigated epidemiologic and clinical aspects of rickettsial diseases in 280 international travelers reported to the GeoSentinel surveillance Network during 1996–2008. Of these 280 travelers, 231 (82.5%) had spotted fever (SFG) rickettsiosis, 16 (5.7%) scrub typhus, 11 (3.9%) Q fever, 10 (3.6%) typhus group (TG) rickettsiosis, 7 (2.5%) bartonellosis, 4 (1.4%) indeterminable SFG/TG rickettsiosis, and 1 (0.4%) human granulocytic anaplasmosis. One hundred ninety-seven (87.6%) SFG rickettsiosis cases were acquired in sub-Saharan Africa and were associated with higher age, male gender, travel to southern Africa, late summer season travel, and travel for tourism. More than 90% of patients with rickettsial disease were treated with doxycycline, 43 (15.4%) were hospitalized, and 4 had a complicated course, including 1 fatal case of scrub typhus encephalitis acquired in Thailand. Rickettsial diseases are acute and potentially severe zoonotic infections caused by obligate intracellular, gram-negative bacteria belonging to the order Rickettsiales. The taxonomy of Rickettsiales is complex and continues to be updated, but currently the agents of rickettsial diseases are classified as belonging to 4 distinct genera: Rickettsia (including 2 biogroups: spotted fever group [SFG] rickettsiae with >10 species and typhus group [TG] rickettsiae with 2 species), Orientia (Orientia tsutsugamushi, the agent of scrub typhus), Ehrlichia (Ehrlichia chaffeensis, the agent of human monocytic ehrlichiosis), and Anaplasma (Anaplasma phagocytophilium, the agent of human granulocytic anaplasmosis). Diseases caused by Rickettsia and Orientia species are often collectively referred to as rickettsioses. Coxiella burnetii, the agent of Q fever, and Bartonella spp. were recently removed from the order Rickettsiales, but Q fever and bartonelloses are still frequently categorized as rickettsial diseases (1). Rickettsial diseases are increasingly being recognized among international travelers (2). A recent study of ≈7,000 returnees with fever as a chief reason to seek medical care suggests that 2% of imported fevers are caused by rickettsioses and that 20% of these patients are hospitalized (3). Most cases are acquired in sub-Saharan Africa, where SFG rickettsioses are second only to malaria as the most commonly diagnosed diseases in returnees with systemic febrile illness (4). With few exceptions, however, our knowledge of the incidence rates, associated factors, signs, symptoms, and outcome of rickettsial diseases in travelers is rudimentary and mostly based on smaller case series. We report all cases of rickettsial diseases in returned travelers reported to the GeoSentinel Surveillance Network from June 1996 through December 2008.

Daily doxycycline (DX), known to be effective prophylaxis against travelers' diarrhea (TD) in areas of the world where enterotoxigenic Escherichia coli (ETEC) are sensitive to the drug, has not been extensively studied in geographic areas where antibiotic resistance is common. Therefore we studied 44 U.S. Peace Corps Volunteers during their first 5 weeks in Honduras, which is such an area. During the first 3 weeks, volunteers took daily either 100 mg DX or placebo (PL) in a double-blind, randomized fashion. All 22 taking PL developed TD during the first 3 weeks, compared to 7 of 22 (32%) taking DX (P less than 0.001; 68% protection). ETEC were isolated from 39% of episodes of TD. From the PL group, ETEC from 7 of 13 stool samples (54%) were resistant to DX, whereas from the DX group, ETEC from 10 of 11 stool samples were resistant (P less than 0.05). TD that developed in persons taking DX was also found to be less severe, as judged by length of illness (P less than 0.01) and frequency of stools (P less than 0.05). This study demonstrates that DX 1) significantly prevents TD even in areas where antibiotic resistance is common, although it does not prevent TD caused by docycycline -resistant ETEC, and 2) significantly diminishes the severity of illness.This study analyzed the effect of doxycycline prophylaxis of travelers' diarrhea in Honduras, an area where antibiotic resistance is common among enterotoxigenic Escherichia coli (ETEC). 44 newly arrived US Peace Corps volunteers were given either 100 mg of doxycycline/day or a placebo. All 22 subjects who received a placebo developed travelers' diarrhea within 3 weeks compared to 7 of 22 subjects (32%) who received doxycycline. ETEC were isolated from 39% of the travelers' diarrhea episodes. In the placebo group, ETEC from 7 of 13 stool samples (54%) were resistant to doxycycline. In the doxycycline group, ETEC from 10 of 11 stool samples (91%) were resistant. Volunteers who took doxycycline had a shorter diarrheal illness than controls and a less severe disease, as measured by the peak numberof stools/day. No clinical adverse drug effects were noted. The protective effect of the drug lasted only while the drug was being taken. This study demonstrates that prophylactic doxycycline significantly reduces the severity of illness among those who experience travelers' diarrhea and can provide a 60-70% protection rate even in countries where ETEC are resistant to antibiotics. Antibiotic prophylasix should be viewed as a temporary measure, however, until safer and perhaps more effective methods such as vaccines or nonpharmacologic agents become available.

The site and characteristics of gastrointestinal electrolyte loss were investigated in eight dogs with experimental cholera induced by orogastric administration of 6-hr broth cultures of Vibrio cholerae, strain Ogawa 395. In these animals, all electrolyte losses originated in the small bowel, predominantly from the jejunum and ileum. The bicarbonate concentration of the small bowel fluid showed a progressive increase from duodenum, where it was less than that of plasma, to the terminal ileum, where it was significantly greater than that of simultaneously obtained plasma. Studies of the responses of chronic Thiry-Vella jejunal loops (five dogs) and chronic Thiry-Vella ileal loops (five dogs) to intraluminal challenge by cholera exotoxin demonstrated that all loops exhibited isotonic electrolyte loss for a 14-18 hr period after challenge. The bicarbonate concentration of fluid produced by exotoxin-challenged jejunal loops was not significantly different from that of plasma, whereas the ileal loops produced fluid with a bicarbonate concentration approximately three times that of plasma. The effect of intraluminal glucose on the response of canine gut to cholera exotoxin was investigated by perfusion studies in 12 dogs with chronic Thiry-Vella fistulae. Intraluminal glucose significantly enhanced isotonic fluid absorption in both jejunal and ileal loops. The net effects of glucose on isotonic fluid absorption were equal before and after intraluminal administration of crude cholera exotoxin. These data suggest that cholera exotoxin causes gut electrolyte loss by a mechanism independent of that by which glucose enhances sodium absorption.