Escherichia coli Meningitis in a 72-year-old Woman.

Spontaneous community-acquired meningitis caused by E. coli is rare in the adult population. It is associated with a high risk of morbidity and mortality. We describe a case of a 72-year-old woman who presented with altered mental status and neck stiffness and was found to have E. coli meningitis. Urine cultures grew E. coli, representing a likely source. The E. coli strain was identified as sequence type 73 (E. coli ST73). Her symptoms and laboratory values improved following antibiotic initiation, and she was discharged from the hospital to a rehabilitation facility.

Japanese Encephalitis Vaccine.

Travelers to 24 endemic countries in Asia may be at risk for Japanese encephalitis. The ACIP has recently expanded guidelines on the use of Ixiaro, the inactivated Japanese encephalitis vaccine. This article reviews the disease burden of Japanese encephalitis and the role of a travel clinic in guiding travelers to Asia regarding decision-making about the use of this highly protective vaccine.

Surveillance of Travel-Related Mosquito-borne Illness in Rhode Island.

Malaria and Dengue are some of the common infections occurring in persons traveling to countries endemic for these infections. Chinkungunya virus infection is another illness that can occur in people who have travelled to areas endemic for chikungunya virus infection. Herein we report cases of malaria, dengue, and chikungunya in Newport Hospital, The Miriam Hospital and Rhode Island Hospital between January 1, 2010 and December 31, 2014. [Full article available at http://rimed.org/rimedicaljournal-2016-07.asp, free with no login].

Cholera in travelers: shifting tides in epidemiology, management, and prevention.

The distribution of cholera's devastating effects has changed. While cholera is endemic in 50 countries mostly in Asia and Africa, more than half of the cases reported in 2012 were in the Western Hemisphere, predominantly Haiti. Since the current epidemic began in Haiti in 2010, there has been spread to the Dominican Republic, Cuba, and most recently Mexico. Several recent case reports document individuals returning home from affected areas with diarrhea from cholera, in some cases severe. Hopeful news reported the containment of an outbreak through the use of a Vibrio cholera vaccine. There are safe and effective oral cholera vaccines available and recommended in outbreaks and endemic areas, although they are not currently available in the USA or to travelers. This review aims to discuss the latest data to aid our current recommendations for the prevention of cholera in travelers beyond standard personal and food hygiene precautions for the prevention of travelers' diarrhea and to offer insights on the most current data available about cholera vaccine progress and potential use.

Penicillium marneffei infection in HIV-infected travelers.

Disseminated Penicillium marneffei infection is the third most common AIDS-defining illness in parts of Southeast Asia. A review of the literature now shows that penicilliosis may represent an emergent opportunistic infection in HIV-positive travelers to endemic regions as well.

Prevention and treatment of travel-related infections in compromised hosts.

PURPOSE OF REVIEW: The numbers of international travelers and complexity of their underlying medical conditions continue to increase. Traveling with compromised immunity warrants special consideration regarding the prevention and treatment of travel-related diseases, ideally with the help of a travel medicine specialist. There is a need for careful weighing of the potential health risks in persons with severe immunosuppression, including that related to HIV, use of immunomodulating agents, malignancy and cancer chemotherapy, solid organ and bone marrow transplantation, and asplenia. RECENT FINDINGS: Over the past year, a number of articles and texts have been published addressing the health risks and management strategies for travelers with underlying immune compromise, including the potential interactions between HIV and malaria, and transplant outcomes for those receiving transplants through medical tourism. SUMMARY: Tailored advice and treatment strategies for compromised travelers can help facilitate safe travel for individuals who choose risk-taking travel.

Challenging scenarios in a travel clinic: advising the complex traveler.

With adequate preparation and in consultation with a travel medicine expert, most travelers today can travel safely regardless of their age and health status. The few instances when it is prudent to alter travel plans or postpone travel altogether are not to be taken lightly. For the most part, however, most complex travelers can enjoy a healthy and rewarding travel experience.