Infectious diseases are still among the leading causes of death worldwide due to their persistence, emergence, and reemergence. As the recent Ebola virus disease and MERS-CoV outbreaks demonstrate, the modern epidemics and large-scale infectious outbreaks emerge and spread quickly. Air transportation is a major vehicle for the rapid spread and dissemination of communicable diseases, and there have been a number of reported outbreaks of serious airborne diseases aboard commercial flights including tuberculosis, severe acute respiratory syndrome, influenza, smallpox, and measles, to name a few. In 2014 alone, over 3.3 billion passengers (a number equivalent to 42% of the world population) and 50 million metric tons of cargo traveled by air from 41,000 airports and 50,000 routes worldwide, and significant growth is anticipated, with passenger numbers expected to reach 5.9 billion by 2030. Given the increasing numbers of travelers, the risk of infectious disease transmission during air travel is a significant concern, and this chapter focuses on the current knowledge about transmission of infectious diseases in the context of both transmissions within the aircraft passenger cabin and commercial aircraft serving as vehicles of worldwide infection spread.

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images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 372;7 nejm.org february 12, 2015 649A 23-year-old man presented to the emergency department with rapidly progressive left arm pain and erythema. He had felt well until the previous night, when his left third finger was injured during a lacrosse game. Overnight, the finger became increasingly painful, with erythema spreading to the wrist, which prompted him to seek medical care. On presentation, the temperature was 36.7°C (98.1°F), the heart rate 64 beats per minute, and the blood pressure 139/85 mm Hg. The physical examination revealed a small blister or abscess on the left third finger with surrounding warmth, tenderness, erythema, and linear streaking to the elbow. Within hours, the streaking progressed to the axilla. Minimal drainage from the finger was cultured. The patient quickly underwent incision and drainage of the lesion, and empirical antibiotic treatment with cefazolin and vancomycin was initiated. Culture data ultimately revealed Streptococcus pyogenes, and antibiotics were changed to intravenous penicillin G. By the second day of hospitalization, the erythema had improved, and the patient was discharged while receiving oral penicillin V potassium for 12 days. At follow-up 1 week after discharge, he had full range of motion in the affected finger, and the erythema was substantially improved.

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Although rare, severe consequences can result from Bartholin gland abscesses in pregnant patients, including sepsis and septic arthritis. Close clinical follow-up should be considered in pregnant patients undergoing abscess drainage.