Campylobacter infection is a common cause of diarrhea among international travelers. We studied antibiotic resistance patterns among Campylobacter isolates obtained from international travelers according to travel destination. Three collections of isolates obtained from international travelers between 2007 and 2014 (Institute of Tropical Medicine, the “Laboratoire Hospitalier Universitaire de Bruxelles “and the Belgian National Reference Centre for Campylobacter) were used. Isolates were tested for minimal inhibitory concentration (MIC) values (E-test macromethod) for fluoroquinolones, macrolides, tetracyclines, amoxicillin–clavulanic acid, and meropenem. Single isolates from 261 travelers were available; median (IQR) age was 25.4 (4–42) years, 85.8% were symptomatic (information for 224 patients available). Overall resistance to ciprofloxacin was 60.9%, ranging from 50.8% in Africa to 75.0% in Asia. Resistance to erythromycin was 4.6%, with the highest rate observed for Southern Asia (15.2%, seven isolates, six of them recovered from patients returning from India). A total of 126 isolates (48.3%) were resistant to tetracycline. No resistance to amoxicillin–clavulanic acid or meropenem was detected. Ciprofloxacin resistance tended to increase over time (53.9% in 2007 versus 72.2% in 2014), erythromycin resistance remained stable (median annual resistance 4.2%). Most (86.2%) ciprofloxacin-resistant isolates had MIC values ≥32 mg/l, and all erythromycin-resistant isolates had MIC values ≥256 mg/l. Co-resistance to ciprofloxacin and erythromycin was observed in 11 (4.2%) isolates, seven of which came from Southern Asia. Among all regions of travel, more than half of Campylobacter isolates were resistant to ciprofloxacin. Overall resistance to erythromycin was below 5% but reached 15.2% in Southern Asia.Electronic supplementary materialThe online version of this article (doi:10.1007/s10096-017-3032-6) contains supplementary material, which is available to authorized users.

Background Diagnosis of schistosomiasis remains elusive soon after infection. We evaluated several diagnostic methods in a cluster of travelers simultaneously exposed to freshwater in South Africa. Methods Eosinophil count, schistosome antibody tests, stool and urine microscopy, and serum Dra1 PCR assays were performed at week 4-5 (w4-5, early symptomatic phase), week 7-8 (w7-8, praziquantel treatment), and week 12-14 (w12-14, post-treatment). Sequencing was done on serum of 3 patients to identify the species. Results Of the 34 travelers (16 adults, 18 children), 32 developed symptoms 2 to 6 weeks after exposure. A raised eosinophil count (>750/µL) count was seen in 12/33 at w4-5, and in 22/34 at w7-8. Schistosoma antibodies were detected in 3/33 at w4-5, in 12/34 at w7-8 and w12-14. The Dra1 PCR was positive in 24/33 travelers at w4-5, in 31/34 at w7-8, in 25/34 at w12-14, and at least once in all. Ova were absent in all urine and fecal samples obtained. Sequencing identified S. mattheei nuclear and S. haematobium mitochondrial DNA, indicative of a hybrid species. Conclusion The Dra-1 PCR confirmed diagnosis in all exposed travelers at a much earlier stage than conventional tests. The causative species is probably a S. mattheei x S. haematobium hybrid.

Context: Data on the prevalence of thyroid disorders in male subfertility remain scarce. Objective: To investigate the prevalence of thyroid dysfunction and thyroid autoimmunity in men with normal and abnormal semen characteristics. Setting: Tertiary referral center for reproductive medicine of the University Hospital AZ-VUB, Brussels, Belgium. Patients and design: Two hundred and ninety-two men were stratified according to the presence of normal (group 1; n ¼ 39) or abnormal (group 2; n ¼ 253) semen characteristics. Thyroid function was assessed by serum thyrotropin (TSH) and free thyroxine (FT4), and thyroid peroxidase antibodies (TPO-Ab) for thyroid autoimmunity (TAI or TPO-Ab . 34 kU/l); both were correlated with semen characteristics. Main outcome measures: Semen characteristics were determined by World Health Organisation criteria (rapid þ slow motility $ 50% and concentration $20 £ 10 6 ) and Kruger criteria (morphology $ 14% normal cells). Results: In group 1, the mean (^S.D.) age was 33^4 years; serum TSH was 1.6 (0.3 -29.6) mU/l (median (range)) and FT4 was 12.2 (8.8 -15.6) ng/l. In group 2, the mean age was 33^5 years, serum TSH was 1.3 (0.3-5.2) mU/l and FT4 was 12.5 (8.4-17.5) ng/l; (compared with group 1 P ¼ 0:008 for TSH and P ¼ 0:037 for FT4). In both groups, one patient had increased TSH (2.6% and 0.4%; P ¼ not significant (ns)). In group 1, one patient had TAI and in group 2 twelve patients had TAI (2.6% compared with 4.7%; P ¼ ns). FT4 was an independent determinant for semen characteristics. Conclusions: The prevalence of thyroid dysfunction and autoimmunity is comparable between men with normal and abnormal semen characteristics. On the basis of these data, we do not advise systematic screening for thyroid disorders in subfertile men consulting a tertiary referral center for reproductive medicine.

A significant decline of TB incidence in HIV patients was observed. Incident TB occurred mainly in African patients, with low CD4 upon HIV diagnosis. A significant proportion of TB cases were discovered early in follow-up which probably reflects TB already present upon HIV diagnosis. In a low endemic setting, exclusion of active TB upon HIV diagnosis remains a priority and screening for LTBI should focus on HIV patients from high risk groups such as migrants from endemic regions, especially in patients with low CD4 nadir.

Background Information on human filariasis in international travelers is scarce. We describe the epidemiology, clinical presentation and outcome of these infections in a reference travel clinic over the past decades. Methods We reviewed all cases of filariasis diagnosed at the Institute of Tropical Medicine, Antwerp, Belgium, from 1994 to 2018. Diagnosis was obtained by either parasitological methods (confirmed) or strict clinical case definitions (probable). We assessed the characteristics of cases at diagnosis and response to therapy within three to 12 months. Results A total of 320 patients (median age: 41 years; 71% males) were diagnosed with 327 filarial infections (Wuchereria bancrofti = 6; Onchocerca volvulus = 33, Loa loa = 150, Mansonella perstans = 130; unspecified species = 8). Diagnosis was confirmed in 213/320 (67%) patients. European long-term travelers accounted for 166 patients (52%) and visitors/migrants from tropical countries for another 110 (34%). Central Africa was the likely region of acquisition for 294 (92%) patients. The number of filariasis cases decreased from 21.5/year in average in the nineties to 6.3/year in the last decade, when loiasis became predominant. Cases reported symptoms in > 80% of all filarial infections but mansonellosis (45/123 single infections; 37%). Lymphatic filariasis and onchocerciasis cases responded well to conventional therapy. However, 30% of patients with loiasis and mansonellosis experienced treatment failure (with diethylcarbamazine and levamisole-mebendazole, respectively). Conclusions The burden and species distribution of filariasis in travelers evolved in the past decades. Most presentations were symptomatic. Case management would benefit from more effective therapies for loiasis and mansonellosis.