Risk of Infection when travelling South. Liège Crowne Plaza 19/11/2016

Transcription

1 Risk of Infection when travelling South Filipom Klik Moerman, de ondertitelstijl Infectiologist. van het model te bewerken Liège Crowne Plaza 19/11/2016

2 Strongyloides

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4 Middle East respiratory syndrome

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6 Malaria, severe malaria

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8 HIV.sex is not without a risk and after three beers AIDS does no longer exist

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11 Sexually transmitted infections: WELCOME HOME DADDY!

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15 And what about road accidents??

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17 Then DIARRHEA is a small problem

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19 Some people DIE whilst on holiday

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21 Time to get serious now!

22 Selection of hot topics Zika virus infection Hepatitis E Approach at first line health care when travelers come back with diarrhea

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24 Between 1947 and 2006, there were only 14 reports of human cases, but in 2007, an outbreak occured on the Island of Yap Higgs, et al. Trans R Soc Trop Med Hyg 2016;110:207-8.

25 Distribution of Zika virus infection

26 Pathogenesis

27 Zika an emerging virus? Viral disease transmitted by Aedes mosquitos Aedes biting behaviour different than Anopheles Lifelong immunity, when having been infected, very probably 80% subclinical infection (!): hence.. IF clinically active, then usually benign with flu-like symptoms Very probably* linked to microcephaly max 1% in 1st trim only (non Zika-incidence = 2/10000 b/yr) * extremely frustrating knowledge gaps. John Maurice. Lancet 2016;388:449-50

28 Further Zika properties Transovarian transmission in the mosquito cycle. Interhuman sexual transmission exists, esp man to woman/man Emerging infection, due to mutative adaptive evolution.? Only potentially lethal in AIDS, drepanocytos Reproductive coefficient max 1,1

29 In overview

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31 Microcephaly and Zika

32 Current attitude towards travelers Early pregnancy: AVOID traveling to endemic regions! [Young] couples: safe sex When back and wanting a child: serology, 14 days after return + safe sex meanwhile. When serology NEG: high NPV: ok! When serology POS: FP exist (YF vacc, JE vacc), wait > 1 month to practice unprotected sex

33 Diagnostics in Zika Serology (cfr supra) PCR on blood only valid for a couple of days, in urine about 5 days, about one month in sperm. So very cumbersome. However, specificity better than with serology. Waiting for a vaccin

34 Hepatitis E

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36 Hepatitis E: Lab Diagnosis.

37 Hepatitis E: Transmission routes

38 Hepatitis E: clinical aspects Faeco-oral transmission route (= as Hepatitis A) 4 different genotypes exist: 1 & 2 hyperendemic in developing countries; 3 & 4 in industrialised countries. Clinically similar to HAV (symptom and subclinical cases exist), but more neurological symptoms* Gt 1 & 2: often acute & self-limiting, exc in pregnant women in Afr/Asia Navaneethan, et al. Liver Int 2008 *benign or even GB, meningo-encephalitis, brachial neuritis,

39 Hepatitis E: clinical aspects (2) HEV3 often missed in European travelers! HEV3-4 can become chronic or acute fatal in immunocompromised patients. Not serious in pregnancy GP s: consider HEV in transplant patients posttravel with Δliver-set and/or Δneuro. Prevalence rates of HEV RNA-pos blood donors: 1:2848 (UK), 1:1240 (Germany), 1:1761 (Nl) Mansuy JM et al. Emerg Infect Dis 2011

40 Hepatitis E: treatment options Usually not necessary If severe disease or in immunocompromised host: Ribavirine +/- Peg IFN Two candidate vaccines on the run. One vaccine licensed in China but efficacy = source of criticism and debate; unsure whether it will be commercialised elsewhere.

41 Diarrhea after traveling south: approach for the GP History taking! Incl mode of travel +/- fever +/- blood +/- acute or chronic

42 1. Acute, blood, fever: ANTIBIOTICS Bacillary dysentery Shigella sp., Esch. coli O157:H7, Salmonella, Campylobacter

43 2. Acute, blood, +/- no fever: FLAGYL (FASIGYN in Giardia) RISK OF AMOEBIC DYSENTERY E. histolytica or Balantidium coli Clostridium perfringens

44 3. Acute, no blood, fever: THINK ABOUT OTHER DISEASES Mild bacterial dysentery Malaria! Onset of typhoid fever (!)

45 4. Acute, no blood, no t : AB shorten duration of sickness (Cholera) Staphylococcus aureus diarrea (neurotoxine) Most traveler s diarrheas Viral origin Which AB? AZITHROMYCINE (Asia) FLUOROQUINOLONES CAVE Loperamide, Nifuroxazide.

46 Some typical histories post-travel On-and-off slight diarrhea and nausea: Giardia! R/ (usually waterborne; even hotel-travel ) Diarrhea not responding to any AB. Think about Strongyloides, Cappilaria, Schistosoma, HIV, Cryptosporidium,. Abdominal pain months after return +/- fever: think about.ala! (esp Asia) Fever = exclud M, TF, ALA, then formula + Doxy!!

47 But above all, remain a happy traveler!