1,721,321 research outputs found
Sexually transmitted diseases in travelers
No full textPrevention of sexually transmitted diseases (STDs) is a low priority among travel clinic services, despite increasing evidence that travelers have an increased risk of acquiring such infections. A proportion of 5%-50% of short-term travelers engage in casual sex while abroad, and this rate is even higher among long-term travelers. Few publications are available on STD preventive interventions among travelers. Education and counseling are recognized as key components of risk reduction. New efforts should be put forth with regard to identifying effective tools to promote safer sexual behaviors and to reduce the spread of infection by promoting condom use. Travelers at increased risk should be identified for targeted interventions; research to validate proposed markers of increased risk is prospectively needed. Hepatitis B infection is the only STD that is preventable by vaccination. The feasibility and cost-effectiveness of STD screening in travelers after exposure is a virtually unexplored field, though it may represent an important component of STD control strategies in developed countries
Drug-resistant tuberculosis
No full textPurpose of review: This review discusses the recent evidence on epidemiology, diagnosis, and treatment of drug-resistant and multidrug-resistant (MDR) tuberculosis (TB), an area where solutions for better diagnosis and treatment continually develop. Recent findings: The prevalence of drug resistance has been constantly rising during the recent years. It has peaked in eastern European countries such as Belarus, where a record of 35.5% MDR-TB amongst new cases have been reported from Minsk. New diagnostic tools are becoming available. Xpert MTB/RIF is by far the most promising of these new techniques. Clinical management of drug-resistant TB is still cumbersome. However, after over 40 years of neglect, new drugs are becoming readily available: delamanid, bedaquiline, and PA-824 combined into innovative regimens raise hopes for substantially higher success rates. Summary: The innovative diagnostic tools recently validated are changing the traditional paradigms of TB diagnosis, for too long based on sputum smear, culture, and drug susceptibility testing. New anti-TB compounds, which can be combined with several 'old' drugs with new indications, are gradually modifying the chances of cure for MDR-TB cases. Although initial evidence appears promising, the market use of new drugs must be accompanied by a serious public health approach aimed at preventing the development of further drug resistance. Copyright © 2013 Lippincott Williams & Wilkins
Dengue and international travel
No full textThe increasing number of international travelers makes dengue infection an increasingly important public health problem. Dengue is endemic in most tropical and subtropical areas, which are the destination of an increasing number of travelers. Increasingly high numbers of dengue fever cases have been reported in several surveillance studies, reflecting both the increasing travel morbidity and the expanding geographical distribution of vectors. The true incidence of dengue in travelers may be underestimated owing to the high number of asymptomatic cases, the generalized lack of standardized diagnostic procedures for febrile travelers and the diversity in reporting requirements. Diagnosis of dengue is important in order to differentiate primary and secondary infection and to better address pretravel counseling. Healthcare providers should be aware of dengue infection, better understand its clinical presentation and be skilled in diagnosis and management in returning travelers. Risk factors for dengue include typology and duration of stay, season of travel and epidemic activity at the destination. Travelers may play a role as sentinels in alerting the international community about the onset of epidemics in endemic regions and may be involved in the spread of dengue to nonendemic regions, where the mosquito vectors, Aedes aegypti and/or Aedes albopictus, are present. This highlights the importance of surveillance for dengue, focusing on mosquito control strategies and the need to increase vigilance by health professionals. Dengue is a major vector-borne disease in tropical and subtropical regions. This chapter aims to discuss the challenges of dengue for international travelers, analyzing epidemiological, clinical and diagnostic aspects and focusing on preventive measures and specific risk factors. Physicians should be aware of this issue, in order to improve diagnostic and therapeutic procedures and to enhance their practice in pretravel counseling
Treatment of TB
No full textThe treatment of all forms of tuberculosis (TB) is based on two principles: 1) the combination of drugs (at least four) to avoid the selection of anti-TB drug resistances; and 2) the need for prolonged treatment in order to ensure that all bacteria in their different phases of metabolic growth are effectively killed. The selection of drugs to be included in the combination is based on their bactericidal and sterilising capacity, and their ability to prevent drug resistance. Following extensive research in the field in the second part of the last century, the optimal regimen of initial treatment of all forms of drug-sensitive TB, both pulmonary and extrapulmonary, is 2 months of isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E), followed by 4 months of treatment with H and R (2HRZE/4HR). The impossibility of using R, the most powerful of all anti-TB drugs, substantially complicates the treatment of TB. In this chapter, we discuss the fundamental basis of anti-TB therapy, demonstrating that with proper clinical and operational management, patients with TB have a high probability of being cured, even though this probability is reduced with increasing levels of Mycobacterium tuberculosis drug resistance. © ERS 2012
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