A full immunisation history is essential as it will alter the approach to diagnosis in ill patients.
A 36-year-old man returned from the Ivory Coast to Germany with a febrile illness, jaundice and bleeding diathesis. He was initially thought to have Lassa fever and was nursed accordingly until his death. The cause of death was determined to be yellow fever, which had been thought unlikely as the patient had claimed, incorrectly, to have been immunised against yellow fever (Schmetzer, 1999).
Yellow fever vaccination is extremely effective, but cases continue to be imported to Europe and North America from both Africa and South America by travellers who have not been immunised. Active immunisations against hepatitis A and B are both more than 90% effective, whereas currently licensed vaccines against typhoid only have 70% or less protective efficacy. The effectiveness of antimosquito bite measures and antimalarial chemoprophylaxis is variable and highly dependent on adherence by travellers.
Concurrent medication for underlying illness may cause or exacerbate symptoms. For example, aspirin taken to prevent travel-related thrombosis may cause or worsen gastrointestinal bleeding, and diuretic therapy increases the dehydration associated with diarrhoeal illness. Mouth ulcers are common in patients taking proguanil; chloroquine can exacerbate psoriasis; prophylactic doxycycline is associated with vaginal thrush and with photosensitive rashes; and mefloquine use has been linked with various neuropsychiatric effects (Nosten and van Vugt, 1999).
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