With the summer holidays here and people jetting off all around the world it seems a good time to mention the potential dangers of exotic travel. Now don’t get me wrong I am a big fan of foreign travel but it is important to be aware of any potential risks associated with your destination.

A patient had been referred into hospital because they had a very high temperature, severe muscle and joint pains and headache, she has recently returned from a holiday in Thailand. The patient had attended a pre-travel clinic, been given the appropriate vaccinations including for typhoid and had taken her Malaria prophylaxis. When she was seen on the ward she had developed a rash on her chest. The team thought the patient might have typhoid or paratyphoid (the vaccine is 70% effective for typhoid but has no effect on
paratyphoid). They had excluded malaria with blood tests, which is an essential component of the management of any traveller with a fever who has returned from a country where malaria is endemic. The patient’s blood tests showed a profoundly low white blood cell count and a slightly low platelet count. The patient’s kidney and liver function was within normal ranges.

I read with interest the poll and associated article in the latest edition of the British Medical Journal, Does adding routine antibiotics to animal feed pose a serious risk to human health (BMJ 2013; 347: f4214). The debate is
very topical given the recent publication of the Chief Medical Officers report on antimicrobial resistance as well as a
Department of Health five year strategy for combating antimicrobial resistance.

Having spent the weekend in London watching people enjoying the glorious weather, I am reminded of a patient whose method to “cool off” lead to an unusual infection.

The patient presented to the hospital with a high fever, headache and conjunctivitis. The medical team called me (the microbiologist) concerned that this patient might be developing some odd form of meningitis because of his headache. The patient clearly looked “sporty” and on detailed questioning it turned out that a few days earlier he had been rowing on the River Thames and had decided to jump into the water to cool down. The evening before the patient presented to the hospital he began to get sore, red eyes, which streamed a lot but had no purulent discharge. He then developed a fever of 39°C, muscle pains in the legs and hips, and a headache. By the time I saw him he had developed a widespread rash.