Management of septic shock and severe infections in migrants and returning travelers requiring critical care

Abstract

During the past decade, global human movement created a virtually "borderless world". Consequently, the developed world is facing "forgotten" and now imported infectious diseases. Many infections are observed upon travel and migration, and the clinical spectrum is diverse, ranging from asymptomatic infection to severe septic shock. The severity of infection depends on the etiology and timeliness of diagnosis. While assessing the etiology of severe infection in travelers and migrants, it is important to acquire a detailed clinical history; geography, dates of travel, places visited, type of transportation, lay-overs and intermediate stops, potential exposure to exotic diseases, and activities that were undertaken during travelling and prophylaxis and vaccines either taken or not before travel are all important parameters. Tuberculosis, malaria, pneumonia, visceral leishmaniasis, enteric fever and hemorrhagic fever are the most common etiologies in severely infected travelers and migrants. The management of severe sepsis and septic shock in migrants and returning travelers requires a systematic approach in the evaluation of these patients based on travel history. Early and broad-spectrum therapy is recommended for the management of septic shock comprising broad spectrum antibiotics, source control, fluid therapy and hemodynamic support, corticosteroids, tight glycemic control, and organ support and monitoring. We here review the diagnostic and therapeutic routing of severely ill travelers and migrants, stratified by the nature of the infectious agents most often encountered among them.

Correspondence

“…Infections may become clinically apparent after long latency periods and recommended diagnostic tools include culture (special media), tissue biopsies, serology and polymerase chain reaction from bone marrow and peripheral blood 16 . Recent reports indicate that visceral leishmaniasis has become a frequent cause of critical illness in migrants and returning travellers 17 . Indeed, we recently treated a young migrant from Eritrea with septic shock.…”

Community acquired infections among refugees leading to Intensive Care Unit admissions in Turkey

“…Poor living conditions, including living in open fields, has resulted in the deterioration in health of many individuals and numerous serious medical problems. 2,3 Some studies have been reported in the literature, referring to refugees acquiring diseases requiring ICU admission, or highlighting specific infections in refugees. 4,5 In general medical practice, patients with CA infectious diseases comprise 20% of the cases in ICUs.…”

Spread of carbapenem-resistant international clones of Acinetobacter baumannii in Turkey and Azerbaijan: a collaborative study

“…Traveling and population dynamics have caused intensified spreading of communicable diseases. Many infections have been diagnosed during and after travel and migration, along with the fact that there is a large number of Turkish communities living across Europe who could carry these infectious clones while visiting Turkey [21]. More observational studies are required in order to investigate European and other epidemic clones with hospitals across bordering cities and areas closer to Syria and Iraq.…”