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Background Gnathostomiasis, a helminthic infection commonly reported in Southeast Asia and Latin America, may follow consumption of raw seafood infected with muscle-encysted larvae of Gnathostoma species nematodes. As a result of increasingly exotic tastes for local ethnic dishes, including raw seafood, some regions outside of gnathostome-endemic areas import live species for raw consumption. This may facilitate imported human gnathostomiasis or potentially the establishment of this zoonosis in formerly nonendemic regions. Traveling to a gnathostome-endemic area is no longer a criterion for diagnosis. The objectives of this review are to enhance clinician awareness of this infection by describing the behavioral risk factors for its acquisition, life-cycle, clinical manifestations, diagnosis, management, and prevention. Methods Internet search engines were queried with the key medical subject heading words. Case reports, case series, epidemiological investigations, and laboratory studies were reviewed; high risk behaviors for gnathostomiasis were identified; and human cases were stratified as cutaneous gnathostomiasis, visceral gnathostomiasis, neurognathostomiasis, and ocular gnathostomiasis. Results The greatest risk factors for gnathostomiasis included the consumption of raw freshwater seafood dishes in endemic regions and the consumption of raw imported or domestic seafood dishes in households and ethnic restaurants in many nonendemic regions. Conclusions Gnathostomiasis is no longer a disease of returning travelers, and autochthonous cases may be anticipated to increase as a result of the importation of live Gnathostoma-infected species and the potential establishment of regional zoonoses of Gnathostoma-infected wild species. Since the eradication of gnathostomiasis is unlikely given the global distribution of Gnathostoma nematodes, the only effective preventive strategy is to educate persons in endemic and nonendemic areas that fish, eels, frogs, snakes, and birds must be cooked thoroughly first before eating and not eaten raw or marinated. The onset of migratory subcutaneous swellings with hyper-eosinophilia weeks to months after consuming raw seafood should provoke suspicion of gnathostomiasis. [ABSTRACT FROM AUTHOR]

Background The Scorpaenidae are a large family of venomous marine fish that include scorpionfish, lionfish, and stonefish. Although most stonefish are confined to the Indo-Pacific, scorpionfish are distributed in the tropics worldwide, and two species of Indo-Pacific lionfish were inadvertently introduced into the Eastern Atlantic in the 1990s. Since then, lionfish have invaded shallow reef systems in the Eastern Atlantic, Gulf of Mexico, and Caribbean Sea. All of these regions are popular travel destinations for beachcombing, fishing, swimming, and scuba diving-recreational activities that increase risks of Scorpaenidae envenomation. Methods To meet the objectives of describing species-specific presenting clinical manifestations, diagnostic and treatment strategies, and outcomes of Scorpaenidae envenomation in travelers, Internet search engines were queried with the key words. Results Well-conducted, retrospective epidemiological investigations of Scorpaenidae envenomation case series concluded: (1) most cases occurred in young adult male vacationers visiting endemic regions; (2) victims sought medical attention for pain control within 2 hours of injury and presented with intense pain, edema, and erythema in affected extremities; (3) systemic manifestations and surgical interventions were relatively uncommon following initial management with hot water soaks and parenteral analgesics; (4) all cases required tetanus prophylaxis; deeply penetrating, lacerated, and necrotic wounds required antibiotic prophylaxis; and (5) equine Fab stonefish antivenom does have antigen-neutralizing cross-reactivities with both Indo-Pacific and Atlantic Scorpaenidae species and is indicated in severe scorpionfish and stonefish envenomation worldwide. Conclusions Travel medicine practitioners should counsel their patients about Scorpaenidae envenomation risks in endemic regions and maintain a high index of suspicion regarding Scorpaenidae envenomation in all travelers returning from tropical beach and ocean holidays and reporting painful fish sting injuries. [ABSTRACT FROM AUTHOR]

Background Dirofilariasis is a zoonotic nematode infection of domestic and wild carnivores that can be transmitted to man by infected mosquitoes. Methods Internet search engines were queried with the key words to examine case reports, series, and descriptive analyses of animal and human dirofilariasis to meet the objectives of this review to describe the increasing prevalence of animal and human dirofilariasis worldwide; to resolve misconceptions regarding the pathophysiology and outcomes of animal versus human dirofilariasis; and to recommend new strategies for the diagnosis, management, and prevention of human dirofilariasis in travelers. Results Descriptive epidemiological studies in the United States and Europe have now established dirofilariasis as an emergent parasitic disease of dogs and man. Global warming has extended the mosquito-vector-borne transmission cycles, enzootic distributions, and canine microfilarial prevalences of the disease to non-endemic regions. Conclusions Travel medicine clinicians must remain vigilant regarding the possibilities of human pulmonary dirofilariasis when solitary 'coin lesions' appear on screening chest X-rays or abdominal neuroimaging studies in asymptomatic patients without peripheral hypereosinophilia. The least invasive diagnostic methods are recommended. Future investigations should focus on conducting active epidemiological surveillance for dirofilariasis in humans and animals; on improving canine dirofilarial chemoprophylaxis; and on developing new, rapid molecular methods for diagnosing and differentiating human dirofilarial infections. [ABSTRACT FROM AUTHOR]

Background Bacterial skin and soft tissue infections ( SSTIs) in travelers often follow insect bites and can present a broad spectrum of clinical manifestations ranging from impetigo to necrotizing cellulitis. Significant SSTIs can also follow marine injuries and exposures in travelers, and the etiologies are often marine bacteria. Methods To meet the objectives of describing the pathogen-specific presenting clinical manifestations, diagnostic and treatment strategies, and outcomes of superficial and deep invasive infections in travelers caused by commonly encountered and newly emerging marine bacterial pathogens, Internet search engines were queried with the key words as MESH terms. Results Travel medicine practitioners should maintain a high index of suspicion regarding potentially catastrophic, invasive bacterial infections, especially Aeromonas hydrophila, Vibrio vulnificus, Chromobacterium violaceum, and Shewanella infections, following marine injuries and exposures. Conclusions Travelers with well-known risk factors for the increasing severity of marine infections, including those with open wounds, suppressed immune systems, liver disease, alcoholism, hemochromatosis, hematological disease, diabetes, chronic renal disease, acquired immunodeficiency syndrome, and cancer, should be cautioned about the risks of marine infections through exposures to marine animals, seawater, the preparation of live or freshly killed seafood, and the accidental ingestion of seawater or consumption of raw or undercooked seafood, especially shellfish. With the exception of minor marine wounds demonstrating localized cellulitis or spreading erysipeloid-type reactions, most other marine infections and all Gram-negative and mycobacterial marine infections will require therapy with antibiotic combinations. [ABSTRACT FROM AUTHOR]

Background Although there have been recent advances in the development of photoprotective clothing and broad-spectrum sunscreens, few peer-reviewed publications have focused on photoprotection recommendations for travelers. Methods In order to describe the adverse health effects of excessive ultraviolet ( UV) radiation exposures; review recent studies of public perceptions regarding photoprotection and sun exposure behaviors; identify special populations at increased risks of drug-induced photosensitivity reactions and UV-induced skin cancers; and recommend several effective photoprotection strategies for travelers, Internet search engines were queried with the key words as search terms to examine the latest references on photoprotection and the epidemiology of UV-associated skin cancers. Results Observational studies have demonstrated that the public knows little about proper sunscreen protection, selection, and use, and often abuses sunscreens for intentional UV overexposures. Cohort studies have identified special populations at increased risks of UV-associated skin cancers without the proper use of sunscreens and photoprotective clothing including children, fair-skinned persons, patients taking photosensitizing drugs, and organ transplant recipients ( OTRs). Clinical investigations support the regular use of broad-spectrum sunscreens to prevent the development of premalignant actinic keratoses ( AK) in all sun-exposed subjects, especially OTRs; to prevent the development of squamous cell carcinomas from new AK in sun-exposed subjects, especially OTRs; to possibly prevent the development of cutaneous malignant melanomas in children and adults; and to possibly prevent the development of basal cell carcinomas in OTRs. Conclusions Recommended photoprotection strategies for travelers should include avoiding intense sunlight, wearing photoprotective clothing, wearing sunglasses, and selecting the right sunscreen for their skin type. Travel medicine practitioners should counsel travelers about photoprotection and encourage travelers to take advantage of recent advances in the development of more effective broad-spectrum sunscreens and photoprotective clothing for themselves and their children. [ABSTRACT FROM AUTHOR]

Introduction: This article examines salivary cotinine concentrations to characterize secondhand smoke (SHS) exposure among non-smoking hospitality employees (bar and casino employees and musicians who perform in bars) who are exposed to SHS in the workplace. Methods: A pre-post test study design was implemented to assess SHS exposure in the workplace. The convenience sample of 41 non-smoking hospitality employees included 10 controls (non-smoking hospitality employees not exposed to SHS in the workplace). Results: The findings demonstrate that post-shift saliva cotinine levels of hospitality employees who are exposed to SHS in the workplace are significantly higher than controls who work in smoke-free venues. Findings also suggested a statistically significant increase between pre- and post-shift saliva cotinine levels of hospitality employees who are exposed in the workplace. No statistically significant difference was noted across labor categories, suggesting that all exposed employees are at increased risk. Conclusion: The study results indicate that non-smoking hospitality employees exposed to SHS in the workplace have significantly higher cotinine concentration levels compared with their counterparts who work in smoke-free venues. Findings from other studies suggest that these increased cotinine levels are harmful to health. Given the potential impact on the health of exposed employees, this study further supports the efforts of tobacco prevention and control programs in advocating for comprehensive smoke-free air policies to protect bar and casino employees. [ABSTRACT FROM AUTHOR]

The article offers information on the study conducted to describe the epidemiology, pathophysiology, and clinical manifestations, related to free-living amebic infections. It highlights the materials and methods of the study and the conclusions drawn from it. The article also presents a table depicting the human free-living amebic infections.

The article presents a literature review on the most common dermatoses and infectious diseases transmitted through mites which affect returning travelers. It is stated that mites are tissue-juice feeders and transmit infectious microbial diseases such as rickettsial pox and scrub typhus. It details the prevention, clinical manifestations and management of mite-transmitted dermatoses and infectious diseases. It also mentions the geographic distribution and maintenance of common mite species.

The article offers information on the epidemiology and management of hymenopteran stings. It discusses the global occurrence of hymenopteran-inflicted injuries, particularly to travelers, causing allergic reactions through the stings of insect families including vespids, apids, and formicids. It discusses the ways in dealing of allergic reactions to hymenopteran stings including the use of oral pharmacologic therapy, oxygen and intravenous fluid therapy, and venom allergen immunotherapy (VIT).

The article focuses on the risks of helminthic eosinophilic meningitis (EM) in travelers in the U.S. It is noted that the helminthic causes of EM are due to the emerging epizoonoses including the globalization of agriculture and commerce, mass immigration and lifestyle. It suggests the need for public health authorities to upgrade surveillance programs for zoonotic diseases, improve rodent and wild animal control programs and minimize adventurous eating habits and risky survivor-like behaviors.

The article focuses on research which was done in an effort to determine and reduce the risks of the arthropod borne protozoan infectious disease Chagas disease (American Trypanosomiasis) in travelers visiting Latin America. A discussion of the causes, including contact with kissing bugs, symptoms and treatment for the disease is presented. The role HIV and AIDS plays in chronic infection with Chagas disease is discussed. The history, disease burden and epidemiology of the disease in the Americas is examined.

This article attempts to organize information about stingrays and stingray injuries to tourists. With the increasing number of travelers who will spend time exploring tropical waters, often in isolated areas with limited access to advanced medical care services, it is important to organize information about stingrays and the treatment of injuries inflicted by them to humans. The biology and behavior of stingrays is described. Stingray venoms contain enzymatically active proteins that are cardiotoxic and heat labile. Several stingray injuries are described and an injury management procedure is described in detail.

Whether the result of cyclical atmospheric changes, anthropogenic activities, or combinations of both, authorities now agree that the earth is warming from a variety of climatic effects, including the cascading effects of greenhouse gas emissions to support human activities. To date, most reports of the public health outcomes of global warming have been anecdotal and retrospective in design and have focused on heat stroke deaths following heat waves, drowning deaths in floods and tsunamis, and mosquito-borne infectious disease outbreaks following tropical storms and cyclones. Accurate predictions of the true public health outcomes of global climate change are confounded by several effect modifiers including human acclimatization and adaptation, the contributions of natural climatic changes, and many conflicting atmospheric models of climate change. Nevertheless, temporal relationships between environmental factors and human health outcomes have been identified and may be used as criteria to judge the causality of associations between the human health outcomes of climate changes and climate-driven natural disasters. Travel medicine physicians are obligated to educate their patients about the known public health outcomes of climate changes, about the disease and injury risk factors their patients may face from climate-spawned natural disasters, and about the best preventive measures to reduce infectious diseases and injuries following natural disasters throughout the world. [ABSTRACT FROM AUTHOR]

Ectoparasitic diseases have been reported in travelers returning from both developed and developing nations. 1–3 Ectoparasitic diseases afflict the skin and its appendages and orifices, especially the scalp, facial, and pubic hairs; external ears; nares; orbits and eyelids; and genitourinary and rectal orifices. Like endoparasites, ectoparasites may be either obligatory parasites, which need to feed on human hosts to complete their life cycles, or facultative parasites, which prefer to feed on nonhuman hosts and infest humans only as accidental or dead-end hosts. 4,5 [ABSTRACT FROM AUTHOR]

Offers ways to prevent and treat toxic seafood-borne diseases in travelers. Information on the botanical divisions of species of marine phytoplankton; Event that takes place when marine conditions are no longer favorable for asexual reproduction; Categories of harmful algal blooms.

Intravenous infusions of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in experimental animals increase the numbers of angiotensin-converting enzyme 2 (ACE2) receptors in the cardiopulmonary circulation. ACE2 receptors serve as binding sites for SARS-CoV-2 virions in the lungs. Patients who take ACEIs and ARBS may be at increased risk of severe disease outcomes due to SARS-CoV-2 infections. [ABSTRACT FROM AUTHOR]

The article discusses travel-related risks of regionally-endemic systemic mycose. Topics include use of GeoSentinel to predict the regional risks of fungal infections in returning travellers, determining the epidemiology and geographic distribution of regional endemic mycoses in Canada, and retrospective investigations.

Background: Coccidioidomycosis is a regionally endemic systemic mycosis with unique risk factors. Since people travel for business or pleasure, and often in conjunction with their avocations or hobbies, the objectives of this review were to describe these and other risk factors for coccidioidomycosis; to alert travel medicine clinicians to the different presenting manifestations of coccidioidomycosis; and to recommend effective treatment, disease control and prevention strategies.Methods: To meet the objectives of this review, Internet search engines were queried with the keywords as medical subject headings over the study period, 1970-2017.Results: The principle transmission mechanism of coccidioidomycosis is by deep inhalation of aerosolized arthroconidia with resulting symptomatic pulmonary infections ranging from febrile influenza-like illnesses to fatal disseminated mycoses. In addition to residency or travel in endemic areas, persons immunocompromised by advancing age, pregnancy, cancer, corticosteroid therapy, diabetes, organ transplantation and human immunodeficiency virus infection are at significantly increased risks of contracting coccidioidomycosis. Persons of African, Asian, Filipino and Hispanic descent are also at increased risks of contracting coccidioidomycosis. Hobbies associated with coccidioidomycosis have included armadillo hunting, model airplane flying and archaeological digging. Occupational risk factors for coccidioidomycosis include endemic exposures during military maneuvers, outdoor track and field events, road construction, solar-power and wind-power farm construction, archaeological excavation and prison work.Conclusions: Coccidioidomycosis is more common in endemic and non-endemic areas than previously recognized and can result in considerable morbidity and mortality. Coccidioidomycosis is increasingly imported from endemic areas in the Western Hemisphere to non-endemic areas worldwide. Increased awareness of disease risk factors among the public and the international healthcare community will improve the timely diagnosis and treatment of coccidioidomycosis and prevent disease progression, dissemination and deaths in residents in and in travellers returning from endemic regions. A vaccine for the primary prevention of coccidioidomycosis would be cost-effective. [ABSTRACT FROM AUTHOR]