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The compromised traveler
1Department of Medicine, Brown University, Providence, Rhode Island, USA.
Abstract:
Compromised travelers represent a diverse and challenging group of individuals. They include HIV-infected patients who are at risk for potentially adverse reactions to immunizations, and new exposures to enteric water-borne opportunistic pathogens associated with chronic infections. Such travelers may encounter unfamiliar opportunistic fungi and classical tropical infections, such as leishmaniasis, whose pathogenesis can be enhanced by the presence of prior HIV infection. Other immunocompromised groups include those who are functionally or anatomically asplenic, and patients who are iatrogenically immunosuppressed from medications utilized for solid organ transplantation, chemotherapy, or treatment of malignancies. This population of travelers also includes those with diabetes mellitus who may require adjustments in their dosing, administration, and possibly even the types of insulin used on their trips. These patients are also at greater risk for acquisition of tuberculosis, severe community-acquired pneumonia, urinary tract infections, and pyomyositis. Older travelers present both the infectious disease and travel medicine specialist with issues such events, malignancy-related infections, myocardial infarction, and other forms of cardiopulmonary compromise, which the authors address in this article.
Insights
Travelers with compromised immune systems, including those with HIV or diabetes, face unique health risks abroad. This article addresses infectious disease and travel medicine challenges for these vulnerable populations.
Area of Science:
- Travel Medicine
- Infectious Diseases
- Immunocompromised Individuals
Background:
- Compromised travelers encompass diverse groups with specific health vulnerabilities.
- Individuals with HIV, asplenia, or iatrogenic immunosuppression are at increased risk.
- Travelers with diabetes mellitus also present unique challenges and risks.
Purpose of the Study:
- To outline the infectious disease and travel medicine considerations for immunocompromised travelers.
- To highlight the risks of immunizations, opportunistic infections, and tropical diseases.
- To address the specific needs of travelers with diabetes and older adults.
Main Methods:
- Review of existing literature and clinical guidelines.
- Analysis of risks associated with various immunocompromised states.
- Discussion of specific infections and management strategies for travelers.
Main Results:
- HIV-infected travelers risk adverse reactions, opportunistic infections, and tropical diseases.
- Asplenic and iatrogenically immunosuppressed individuals face heightened infection risks.
- Diabetic travelers require careful management of insulin and are prone to infections like tuberculosis and pneumonia.
Conclusions:
- Immunocompromised travelers require specialized pre-travel planning and medical advice.
- Addressing the unique risks of HIV, diabetes, asplenia, and older age is crucial for safe travel.
- Integrated infectious disease and travel medicine approaches are essential for this population.