Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
J Travel Med. 2015 May-Jun;22(3):168-73. doi: 10.1111/jtm.12187. Epub 2015 Jan 21.
In 2011, a patient was admitted to our hospital with acute schistosomiasis after having returned from Madagascar and having bathed at the Lily waterfalls. On the basis of this patient's indication, infection was suspected in 41 other subjects. This study investigated (1) the knowledge of the travelers about the risks of schistosomiasis and their related behavior to evaluate the appropriateness of prevention messages and (2) the diagnostic workup of symptomatic travelers by general practitioners to evaluate medical care of travelers with a history of freshwater exposure in tropical areas.
A questionnaire was sent to the 42 travelers with potential exposure to schistosomiasis. It focused on pre-travel knowledge of the disease, bathing conditions, clinical presentation, first suspected diagnosis, and treatment.
Of the 42 questionnaires, 40 (95%) were returned, among which 37 travelers (92%) reported an exposure to freshwater, and 18 (45%) were aware of the risk of schistosomiasis. Among these latter subjects, 16 (89%) still reported an exposure to freshwater. Serology was positive in 28 (78%) of 36 exposed subjects at least 3 months after exposure. Of the 28 infected travelers, 23 (82%) exhibited symptoms and 16 (70%) consulted their general practitioner before the information about the outbreak had spread, but none of these patients had a serology for schistosomiasis done during the first consultation.
The usual prevention message of avoiding freshwater contact when traveling in tropical regions had no impact on the behavior of these travelers, who still went swimming at the Lily waterfalls. This prevention message should, therefore, be either modified or abandoned. The clinical presentation of acute schistosomiasis is often misleading. General practitioners should at least request an eosinophil count, when confronted with a returning traveler with fever. If eosinophilia is detected, it should prompt the search for a parasitic disease.
2011 年，一位从马达加斯加旅行回来并在莉莉瀑布洗澡的患者被收入我院，诊断为急性血吸虫病。基于该患者的情况，我们怀疑还有其他 41 名患者感染了血吸虫病。本研究旨在：（1）了解旅行者对血吸虫病风险的认知以及他们在旅行中的相关行为，以评估预防信息的适宜性；（2）评估初级保健医生对有淡水暴露史的旅行后出现症状的旅行者的诊疗过程，以评估对前往热带地区旅行者的医疗服务。
我们向 42 名有潜在血吸虫病感染风险的旅行者发送了一份调查问卷，重点关注他们对该病的旅行前认知、洗澡条件、临床表现、最初怀疑的诊断和治疗情况。
在回收的 42 份问卷中，有 40 份（95%）有效，其中 37 名旅行者（92%）报告了与淡水的接触，18 名旅行者（45%）知晓血吸虫病的风险。在这 18 名知晓风险的旅行者中，仍有 16 名（89%）有接触淡水。在至少接触后 3 个月，36 名有暴露史的旅行者中 28 名（78%）的血清学检查呈阳性。28 名感染者中，23 名（82%）出现症状，16 名（70%）在疫情信息传播之前就已咨询初级保健医生，但这些患者在首次就诊时均未进行血吸虫病血清学检查。
避免在热带地区旅行时接触淡水的常规预防信息并未影响这些旅行者的行为，他们仍在莉莉瀑布游泳。因此，这种预防信息要么需要修改，要么需要摒弃。急性血吸虫病的临床表现常常具有误导性。当遇到有发热症状的返回旅行者时，初级保健医生至少应要求检查嗜酸性粒细胞计数。如果嗜酸性粒细胞增多，应提示寻找寄生虫病。
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