Safety of care
It's a small world after all! Foreign travel, exotic diseases and your practice
An article for physicians by physicians
Originally published April 2002 / Revised August 2008
Physicians may find it prudent to seek assistance from credible sources when patients seek pre-travel advice about, or later present with symptoms after travel.
Of interest to physicians dealing with infectious diseases
The ever-increasing growth in international travel and immigration sets the stage for the potential transmission of serious infectious diseases that were once considered exotic to Canada.
Consider the following case. A family physician, who had some experience in tropical medicine much earlier in his career, prescribed chloroquine prior to the visit of a family to an area with known chloroquine resistant malaria. One member of the family later died from cerebral malaria. A legal action was brought against the physician.
As is often the case, when well-known guidelines for prophylaxis and immunization have not been followed and a poor clinical outcome has ensued, medical experts could not support the care given. Accordingly the case was settled with CMPA making a payment to the patient's family on behalf of the physician.
Consider the following questions. Are you aware of recent changes in antimalarial prophylaxis for those travelling to endemic areas with chloroquine and/or mefloquine resistance that has been well documented? How familiar are you with making the diagnosis and managing a case of echinococcus, leishmaniasis, schistosomiasis or Chagas disease? Could that persistent cough in a recently-returned traveller be a case of multi-drug resistant TB?
There is a wealth of information on these topics available from infectious disease physicians, government agencies, privately-operated travel clinics and, of course, the Internet. When presented with patients who intend to travel to areas where exotic diseases are endemic, or who have recently returned from foreign travel and have an unexplained illness, it may be useful for physicians who have little, or perhaps outdated, expertise in these areas to seek out appropriate information and advice.
Such prudent practice may go a long way toward protecting patients from the consequences of ineffectual prophylaxis/immunization or from delayed diagnosis when serious illness occurs during or after foreign travel.