Correspondence

Illness after International Travel

N Engl J Med 2002; 347:1984December 12, 2002

Article

To the Editor:

The review by Ryan and colleagues (Aug. 15 issue)1 about illness after international travel focuses mainly on tropical diseases, but common bacterial infections are a leading cause of illness in travelers.

Of 779 American travelers in one study, 202 (26 percent) reported 235 illnesses.2 Diarrhea was the leading health problem (affecting 13 percent), followed by respiratory tract symptoms (in 10 percent) and skin problems (in 3 percent). The incidence of malaria was low (3.8 cases per 1000 travelers). In a retrospective Australian study of 232 consecutive patients, malaria was the most common diagnosis (incidence, 27 percent), followed by respiratory tract infection (24 percent), gastroenteritis (14 percent), dengue fever (8 percent), and pneumonia (6 percent).3 In our series of 187 travelers, the most frequent diagnoses were malaria (44 percent), urinary tract infection (6 percent), gastrointestinal tract infection (5 percent), and respiratory tract infection (3 percent).4 Bacterial skin infections are particularly important and ranked second in a prospective study of dermatologic conditions.5

Common bacterial infections are a growing cause of illness after travel.

Eric Caumes, M.D.
François Bricaire, M.D.
Hôpital Pitié–Salpêtrière, 75013 Paris, France
eric.caumes@psl.ap-hop-paris.fr

5 References

1. 1

   Ryan ET, Wilson ME, Kain KC. Illness after international travel. N Engl J Med 2002;347:505-516
   Full Text | Web of Science | Medline

2. 2

   Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med 2000;7:259-266
   CrossRef | Web of Science | Medline

3. 3

   O'Brien D, Tobin S, Brown GV, Torresi J. Fever in returned travelers: review of hospital admissions for a 3-year period. Clin Infect Dis 2001;33:603-609
   CrossRef | Web of Science | Medline

4. 4

   Zeller V, Didier B, Dos Santos G, Bossi P, Bricaire F, Caumes E. Causes of fever in patients returning from the topics. In: Program and book of abstracts of the 7th Conference of the International Society of Travel Medicine (CISTM 7), Innsbruck, Austria, May 27–31, 2001:173. abstract.
   

5. 5

   Caumes E, Carriere J, Guermonprez G, Bricaire F, Danis M, Gentilini M. Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit. Clin Infect Dis 1995;20:542-548
   CrossRef | Web of Science | Medline

To the Editor:

In their review of illness after international travel, Ryan et al. might have given more attention to the importance of psychological problems. From disabling anxiety attacks to frank psychosis, these problems often force termination of a trip to distant lands. The relative poverty, amazing cultural differences, and sometimes unusual environments (e.g., high altitude) can precipitate acute psychological problems that must be recognized and dealt with. Travel can be stressful.1

Buddha Basnyat, M.D.
Nepal International Clinic, Kathmandu 3596, Nepal
nic@naxal.wlink.com.np

1 References

1. 1

   Phelan M. Psychological disorders. In: Dawood R, ed. Travellers' health: how to stay healthy abroad. 4th ed. Oxford, England: Oxford University Press, 2002:444-7.
   

Author/Editor Response

The authors reply:

To the Editor: As Caumes and Bricaire point out, bacterial infections are frequent causes of illness after travel. In our review, we tried to emphasize the need for a standard history taking and physical examination and, where appropriate, evaluation of the urine, chest radiography, and evaluation of the stool for evidence of any infection. We also agree with Basnyat. Psychological stress related to travel can result in disabling psychological conditions.

Edward T. Ryan, M.D.
Massachusetts General Hospital, Boston, MA 02114
etryan@partners.org

Mary E. Wilson, M.D.
Mount Auburn Hospital, Cambridge, MA 02238

Kevin C. Kain, M.D.
Toronto General Hospital, Toronto, ON M5G 2C4, Canada

Citing Articles (1)

Citing Articles

1. 1

   Séverine Ansart, Lucia Perez, Olivier Vergely, Martin Danis, François Bricaire, Eric Caumes. (2005) Illnesses in Travelers Returning from the Tropics: A Prospective Study of 622 Patients. Journal of Travel Medicine 12:6, 312-318
   CrossRef