In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described.
Strongyloidiasis is an intestinal parasitic infection that is particularly relevant in immunosuppressed patients because it can cause severe disseminated disease. This review discusses the recent advances in the diagnosis of strongyloidiasis. We suggest clinical and epidemiologic criteria for the diagnosis and screening of strongyloidiasis, taking into account different epidemiologic contexts. The state of the art of the diagnosis of strongyloidiasis is discussed including parasitologic methods that are commonly used despite having low sensitivity; serology, which has demonstrated better sensitivity (with some exceptions such as travelers or immunosuppressed patients), and molecular biology methods, which have virtually 100 % specificity. Finally, we discuss different strategies to follow up patients after treatment, highlighting the importance of having accurate and reliable follow-up markers when assessing treatment efficacy both in a clinical and research context.
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