ABSTRACT
Patients under immunosuppressive therapy with tumor necrosis factor alpha (TNF-α) antagonists are vulnerable to various opportunistic infections including leishmaniasis. We present a case series of 8 travellers developing cutaneous leishmaniasis whilst on TNF-α antagonist treatment and review the literature on aspects of cutaneous leishmaniasis developing in patients treated with TNF-α antagonists. We make interim recommendations regarding the drug therapy used to maintain remission in travellers with rheumatoid disease travelling to leishmania prone areas. Despite having a medical condition requiring continued rheumatological review the interval to diagnosis appears not to be reduced compared to that described in non-rheumatoid patients. Rheumatologists and family doctors should be aware of the need for post-travel surveillance for leishmaniasis in rheumatoid patients on TNF-alpha antagonist treatment.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antiprotozoal Agents/therapeutic use , Arthritis, Rheumatoid/parasitology , Leishmaniasis, Cutaneous/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adult , Arthritis, Rheumatoid/drug therapy , Female , Humans , Leishmaniasis, Cutaneous/complications , Male , Middle AgedABSTRACT
Extreme travelling experiences appear to be a quite popular kick offered by tourist operators and sought by some travellers. But some travellers expose themselves to increased risk also during normal holidays, either voluntarily by booking hikes or tours leading them to adventurous locations or to unexpectedly encountering dangerous situations. In planned adventures, precise information in advance, good physical condition, careful planning, and profound medical preparation may contribute to a less hazardous adventure. Advising medical persons may need an expert consultation for specific topics in order to optimise the preparation. Based on three specific environmental situations (jungle, desert, and cave) the specific conditions, dangers and some medical aspects are outlined.
Subject(s)
Accident Prevention/methods , Communicable Disease Control/methods , Patient Education as Topic/methods , Risk-Taking , Travel , HumansABSTRACT
Boosting adult travelers with the virosome-formulated, aluminum-free hepatitis A vaccine Epaxal up to 128 months after a single primary dose confers full protection against hepatitis A, even in travelers aged 50 years and above. Delaying the booster dose did not influence the immune memory response to Epaxal.
Subject(s)
Hepatitis A Vaccines/administration & dosage , Hepatitis A Vaccines/immunology , Hepatitis A/prevention & control , Immunization, Secondary/methods , Immunologic Memory , Adult , Aged , Female , Hepatitis A/immunology , Humans , Male , Middle Aged , Time Factors , Vaccines, Virosome/administration & dosage , Vaccines, Virosome/immunologyABSTRACT
This study demonstrates that a booster dose of the virosome-formulated, aluminum-free hepatitis A vaccine Epaxal (Berna Biotech) is highly immunogenic in subjects who received a single primary dose of this vaccine 18-54 months earlier. There were no significant differences in geometric mean antibody titers (GMTs) among subjects who received the booster dose 18-29 months (GMT, 2330 mIU/mL), 30-41 months (GMT, 2395 mIU/mL), or 42-54 months (GMT, 2432 mIU/mL) after primary vaccination, indicating that delays in the administration of booster vaccination do not lead to a loss of immunogenicity.