Volume 27, Issue 6, August 2020

The themes of this special issue of the Journal of Travel Medicine are wilderness and adventure travel. We hope that the wilderness medicine and travel medicine communities can work together on these areas of mutual interest.

Pathogen-based rapid diagnostic tests (RDTs) can identify the presence or absence of infection, but do not indicate who will have a self-limited infection versus a life-threatening one. An RDT that incorporates disease severity markers could facilitate the triage and management of travellers and migrants presenting with fever.

For adventure travel to high altitude and low latitude locations as well as to areas with depleted ozone or snow cover, travelers should use clothing that blocks UV radiation and should liberally apply a broad spectrum sunscreen with an SPF of 50 or 50+ to exposed skin.

Medical students on elective offer a workforce that may become essential when local healthcare services in resource-limited countries become overwhelmed. We argue they should not be cancelled, and instead should be offered on a voluntary basis to allow students the opportunity to support struggling health systems during the COVID-19 pandemic.

In addition to moving people and goods, ships can spread disease. Vessel trajectory data from ship Automatic Identification Systems (AIS) is available online and can be extracted and analyzed, as we illustrate in the case of the current coronavirus epidemic. This data should be included in epidemiological models of disease transmission to complement air traffic data and inform operational responses.

The effects of COVID-19 on the global economy have been and will be, catastrophic. However, the full global impact, in both economic and health terms, remains unknown. The consequences in Low- and Middle-Income countries, such as Nepal, where national economies rely on a small number of services and industries, are deeply worrying.

Skin infection with atypical mycobacteria can occur following inoculation by tattooing. It may be seen in clinical practice with increasing frequency due to the popularity of tattooing among travellers. Diagnosis requires fresh tissue biopsy requested for mycobacterial culture, and treatment involves prolonged combination antimicrobial therapy guided by sensitivities.

We present a returning traveler with acute generalized exanthematous pustulosis after atovaquone/proguanil prophylaxis. Diagnosis was confirmed with biopsy and allergy testing, symptoms resolved after steroid treatment. Atovaquone/proguanil prophylaxis is generally well tolerated, however, some patients may present severe adverse events that require prompt medical evaluation and treatment.

We report an outbreak of Paederus dermatitis in tourists from Zanzibar. This is characterized by linear and round skin lesions with burning and itching sensation, caused by the toxin pederin released by beetles. Contact with beetle very often goes unnoticed. Rarely observed in travellers, Paederus dermatitis is easily misdiagnosed.

Malaria due to Plasmodium falciparum (Pf) may be missed if patients present with symptoms outside of the expected incubation period. We describe two patients who developed Pf malaria more than one year after visiting malaria-endemic countries. Both worked at an international airport, but no source of infection was identified.

Hookworm-related cutaneous larva migrans occurs in endemic areas but also amongst travelers. Although this disease usually presents as a single pruritic raised erythematous track, misleading clinical presentations are not uncommon. This particularly extensive, follicular presentation of larva migrans should warn clinicians about atypical forms of this emerging tropical disease.

Stingrays stings are becoming an increasingly common marine injury. Stingray spine extraction is a complicated maneuver without a precise method: we present here a novel approach to safely remove a penetrating stingray sting. This procedure is easy and does not require specialized medical devices.

COVID-19 and dengue co-infection in a returning traveller