Management of infections in critically ill returning travellers in the intensive care unit—I: considerations on infection control and transmission of resistance

Abstract

Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. On return to their home countries, such travellers may require intensive care. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and more recently Ebola haemorrhagic fever, has highlighted the risks. Other well-known communicable pathogens such as methicillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae have been described previously. However, malaria remains by far the most important cause of death. The issues related to imported antibiotic resistance and protection from highly contagious diseases are reviewed here. Surveillance strategies based on epidemiological data (country visited, duration of travel, and time elapsed since return) and clinical syndromes, together with systematic search policies, are usually mandatory to limit the risk of an outbreak. Single-bed hospital rooms and isolation according to symptoms should be the rule while awaiting laboratory test results. Because person-to-person contact is the main route of transmission, healthcare workers should implement specific prevention strategies.

Outbreak of Middle East respiratory syndrome coronavirus in Saudi Arabia: a retrospective study

“…Fever with cough and SOB, then fever with cough were the most common symptoms among patients (20.5% and 15.3%, respectively). These findings are consistent with previous reports [21,22,38,[42][43][44][45][46][47]. Notably, the clinical features of MERS-CoV infection ranged from asymptomatic or mild disease to acute respiratory distress syndrome and multi-organ failure, which is consistent with the findings of previous studies from various countries [33,34,40,43,47,48].…”

“…Dromedary camels have been implicated due to reports that some confirmed cases were exposed to camels. In the Middle East, confirmed cases of MERS-CoV have arisen as sporadic, familial, or hospital clusters [13,[22][23][24][25][26]. Although human-to-human transmission of MERS-CoV has been identified in many European, African, and Middle Eastern countries, [27][28][29][30] a genomic analysis of the Riyadh MERS-CoV isolates suggested that there were three genetically distinct lineages of MERS-CoV; therefore, it was unlikely that the Riyadh infections were the result of a single, continuous chain of human-to-human transmission [15,31,32].…”

“…A recent study provided further evidence of non-sustainable transmission among humans and suggested that transmission within Saudi Arabia was dependent on contact with an animal reservoir or animal products [14]; however, no animal reservoir has yet been identified. While contact with camels has been reported, these reports were limited to only the primary cases [22,[33][34][35][36][37]. The MERS-CoV was related with a strain of severe acute respiratory syndrome coronavirus (SARS-CoV) that caused an outbreak in 29 countries in 2002-2003.…”

Signos de alarma al regresar de un viaje

“…En caso de no evidenciarse hemorragia espontánea hay que iniciar el tratamiento de soporte vital y farmacológico empírico sin esperar a los primeros resultados microbiológicos 11 . Además de la corrección hemodinámica con cristaloides/coloides, hay que tener en cuenta lo siguiente:…”

Pneumonia in the tropics: Report from the Task Force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine

“…In adults, respiratory viruses account for 10% to 40% of CAP and the most common of these are influenza, parainfluenza, adenovirus and respiratory syncytial viruses (RSV) [1,2]. Influenza viruses which are classified by their core proteins (i.e.…”