Infections and diseases after travelling to tropical and subtropical areas

Background and objective: With intensifying international travel numbers of travel associated infections and diseases will increase. Systematic studies on infections and diseases with regard to the travel destination in tropical and subtropical areas are scarce in Germany. Patients and Methods: Data regarding travel destination, reason, type and duration of travel, symptoms, clinical findings, laboratory results as well as diagnoses of 2024 patients (male 1010, mean age 35 years; female 1014, mean age 33 years) presenting at the outpatient clinic of the Institute of Tropical Medicine Berlin after returning from travel to tropical or subtropical areas were assessed. Results: The most frequent reasons for consultation were diarrhea (33%), fever (17%) and skin affections (14%). A definitive diagnosis was established in 31% (635). Significant differences were found for prevalences of infectious diseases with regard to travel destinations. 1.5% of the travellers had contracted malaria. Only 34% of the returnees from malaria-endemic areas had taken chemoprophylaxis; in case of travel to Africa and Asia, chemoprophyplaxis corresponded to international standards in only 48% and 23%, respectively. Giardia lamblia was the most frequently detected intestinal pathogen. Blastocystis hominis was found to be significantly associated with diarrhea. Conclusions: Most of the travel-associated infections are self-limited. In case of fever, malaria and potentially hemorrhagic fever should be excluded and be followed by a stepwise investigation on the cause of fever. In case of diarrhea, parasitologic investigations should be per-formed by an experienced laboratory and fresh stool samples should be used. Intensive co-operation will be necessary between physician, pharmacists and others active in the field of travel medicine in order to address the shortcomings in chemoprophylaxis for malaria. An increasing need for expertise in tropical and travel medicine, especially among private physicians is expected.