de Sainte Marie B, Delord M, Dubourg G, Gautret P, Parola P, Brouqui P, Lagier J C
IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France.
IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Laboratoire de Bactériologie, CHU Timone, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
Int J Infect Dis. 2015 May;34:102-4. doi: 10.1016/j.ijid.2015.03.018. Epub 2015 Mar 30.
An increasing number of travelers from western countries visit tropical regions, questioning western physicians on the prophylaxis, the diagnosis and the therapeutic management of patients with travel-associated infection. In July 2014, a French couple stayed for an adventure-travel in Columbia without malaria prophylaxis. A week after their return the woman presented with fever, myalgia, and retro-orbital pain. Three days later, her husband presented similar symptoms. In both patients, testing for malaria, arboviruses and blood cultures remained negative. An empirical treatment with doxycycline and ceftriaxone was initiated for both patients. Serum collected from the female patient yielded positive IgM for leptospirosis but was negative for her husband. Positive Real-Time PCR were observed in blood and urine from both patients, confirming leptospirosis. Three lessons are noteworthy from this case report. First, after exclusion of malaria, as enteric fever, leptospirosis and rickettsial infection are the most prevalent travel-associated infections, empirical treatment with doxycycline and third generation cephalosporin should be considered. In addition, the diagnosis of leptospirosis requires both serology and PCR performed in both urine and blood samples. Finally, prophylaxis using doxycycline, also effective against leptospirosis, rickettsial infections or travellers' diarrhea should be recommended for adventure travelers in malaria endemic areas.
越来越多来自西方国家的旅行者前往热带地区，他们就与旅行相关感染患者的预防、诊断和治疗管理问题向西方医生咨询。2014年7月，一对法国夫妇在哥伦比亚进行探险旅行，未采取疟疾预防措施。回国一周后，该女子出现发热、肌痛和眶后疼痛。三天后，她的丈夫也出现了类似症状。两名患者的疟疾、虫媒病毒检测及血培养结果均为阴性。对两名患者均开始使用强力霉素和头孢曲松进行经验性治疗。从女性患者采集的血清中钩端螺旋体IgM检测呈阳性，但其丈夫的检测结果为阴性。两名患者的血液和尿液实时PCR检测均呈阳性，确诊为钩端螺旋体病。从该病例报告中可以得到三点值得注意的经验教训。第一，排除疟疾后，由于伤寒、钩端螺旋体病和立克次体感染是最常见的与旅行相关的感染，应考虑使用强力霉素和第三代头孢菌素进行经验性治疗。此外，钩端螺旋体病的诊断需要对尿液和血液样本同时进行血清学检测和PCR检测。最后，对于疟疾流行地区的探险旅行者，建议使用强力霉素进行预防，该药对钩端螺旋体病、立克次体感染或旅行者腹泻也有效。
