Elsevier

Travel Medicine and Infectious Disease

Volume 11, Issue 6, November–December 2013, Pages 350-356
Travel Medicine and Infectious Disease

Review
Dermatological conditions in international pediatric travelers: Epidemiology, prevention and management

https://doi.org/10.1016/j.tmaid.2013.10.002Get rights and content

Summary

With an increasing number of children traveling internationally, there has been growing interest in studying the burden of travel-associated illnesses in children. We reviewed recently published (2007–2012) studies on travel-associated illness in children, and extracted the reported spectrum of dermatological conditions in children. Dermatologic problems are among the leading health concerns affecting children during and after return from international travel. Most are mild and self-limited, but an extended spectrum of conditions has been reported from a large retrospective multicenter study. Children may be especially at risk for infections related to environmental exposures, arthropod-related problems, and animal bites. Of note are also tropical and cosmopolitan systemic infections with potential for transmission in the receiving communities. Implications for pre- and post-travel care of children are emphasized.

Introduction

Regardless of travel activity children frequently present with skin findings. Although most are not harmful and can be easily treated, clinicians who see children need to be skilled in recognizing potential life-threatening conditions that require specific treatment, and at times protective public health measures. Nowadays, families frequently travel with their children to international, and at times tropical destinations. According to a recent multicenter study of U.S. travel clinics 10% of all travelers receiving pre-travel care were children [1]. Furthermore, some children born in the U.S. or other developed nation return home after an extended sojourn in the tropical country of origin of their families, whereas other children travel for the purpose of immigrating or to live with a new family after an international adoption.

With such an increasing number of children traveling internationally, there has been growing interest to better understand the burden of travel-associated illness in children, and how it affects the range of diagnoses seen in acute and routine pediatric health care [2], [3], [4], [5], [6]. This paper will review the reported spectrum of dermatological conditions and manifestations in pediatric international travelers [2], [3], [4], [5], [6], and highlight how this range of diagnoses may differ from those reported for adult travelers. Implications for pre- and post-travel care of children are emphasized.

Section snippets

Epidemiology

Prospective observational studies of children traveling to the tropics showed that while preexisting skin problems such as eczema may frequently be present at the time of departure (11% of 157 Swiss children traveling to the tropics for a median of 16 days) and hence can potentially exacerbate during travel, an incidence rate for a “rash” (its nature was not further defined in this study) of 1.5 episodes per 100 person-weeks was calculated for the period during travel plus 4 weeks after return.

Fever and skin manifestations

Children presenting with a fever and skin manifestations need to be handled with care. Subtle skin findings may represent the only early clue to an underlying systemic disease process, may indicate a contagious disease, and may be an early sign of a life-threatening infection. Cosmopolitan bacterial skin infections are reported frequently among returning pediatric international travelers (Table 1). They are usually caused by infections with Staphylococcus aureus or Streptococcus pyogenes. Of

Parasitic skin infections

CLM also known as “creeping eruption”, caused by a skin infection with the larval stage of the dog or cat hookworm (Ancylostoma braziliense) represents the most common travel-associated skin disease acquired in the tropics among adult and pediatric travelers alike. While this infection is widely distributed in tropical and sub-tropical regions, most pediatric cases reported to GeoSentinel occurred after exposure in the Caribbean [6]. CLM is usually acquired by direct skin contact with infective

Arthropod-related dermatoses

Bites from arthropods, including mosquitos, flies, fleas, lice, ticks, and mites, can cause a wide clinical spectrum ranging from minor pruritic bites to severe systemic illness. Most travelers to the tropics, adults and children alike, report insect bites, primarily due to mosquitos, as a common reason for seeking medical care during or after travel [3], [5], [6], [29]. Frequently such bites lead to a secondary bacterial infection, hence local wound care and the use of systemic or topical

Animal bites

It is of concern that returning pediatric travelers seeking care at a GeoSentinel clinic were more likely to present with an animal bite than adult travelers. First, animal bites will often lead to wound infection. The rate of infection after cat and dog bites is up to 50% and 10–15%, respectively. Microorgnisms found in animal bites include Pasteurella spp, S. aureus, streptococci, anaerobes, Capnocytophaga spp, Corynebacterium spp and Neisseria spp. Apart from thorough wound cleansing,

Rarer but potentially acquirable tropical dermatoses

Other tropical dermatoses, some of them potentially serious, including loiasis, onchocerciasis, and leprosy have been reported in pediatric travelers seeking care at GeoSentinel clinics (Table 1). All cases of filarial infections have been reported in children returning from West Africa. While Loa Loa is transmitted by the Chrysops deer or antelope fly, presenting with transient, migratory and painful subcutaneous swellings (Calabar swelling), the main vector of onchocerciasis also known as

Conclusions

Dermatologic conditions occur frequently among pediatric international travelers to the tropics and most are mild, and self-limited. Review of multicenter post-travel data of pediatric travelers show a wide spectrum of dermatologic diagnoses and health conditions with significant skin manifestations. The top three skin conditions were dog bites requiring rabies post-exposure prophylaxis, creeping eruptions due to CLM, and arthropod bite-related problems. Compared to adult travelers pediatric

Conflict of interest

None.

References (36)

  • C. Newmann-Klee et al.

    Incidence and types of illness when traveling to the tropics: a prospective controlled study of children and their parents

    Am J Trop Med Hyg

    (2007)
  • S.F. Van Rijn et al.

    Travel-related morbidity in children: a prospective observational study

    J Travel Med

    (2012)
  • T. Hunziker et al.

    Profile of travel-associated illness in children, Zurich, Switzerland

    J Travel Med

    (2012)
  • K.H. Herbinger et al.

    Spectrum of imported infectious diseases among children and adolescents returning from the tropics and subtropics

    J Travel Med

    (2012)
  • S. Hagmann et al.

    Illness in children after international travel: analysis from the GeoSentinel Surveillance Network

    Pediatrics

    (2010)
  • P. Zanger et al.

    Import and spread of Panton-Valentine Leukocidin-positive Staphylococcus aureus through nasal carriage and skin infections in travelers returning from the tropics and subtropics

    Clin Infect Dis

    (2012)
  • N. Krishnan et al.

    Severe dengue virus infection in pediatric travelers visiting friends and relatives after travel to the Caribbean

    Am J Trop Med Hyg

    (2012)
  • CDC

    Measles – United States, 2011

    MMWR Morb Mortal Wkly Rep

    (2012)
  • View full text