ACUTE HEPATITIS A IN A JAPANESE TRAVELER AFTER OCCURRENCE OF DENGUE FEVER DURING STAY IN INDIA

We report a case of acute hepatitis A that developed following an occurrence of dengue fever during a stay in India. The patient was a 52-year-old Japanese man who visited Delhi, India, from September 29 to October 20, 2010. During that stay, he developed a high fever and rash, with thrombocytopenia and slight liver dysfunction (platelet count 7.0×10＾4/μl, AST 94 IU/ml, ALT 63 IU/ml), then was diagnosed with dengue fever on October 14. Soon after returning to Japan, the patient was well, with anti-HA IgM, hepatitis B surface antigen, and anti-hepatitis C all negative, though liver dysfunction transiently worsened. The DENV genome-sequence was not amplified, while IgM and IgG antibodies were detected. In mid-December 2010, one month after returning from India, he noted fatigue and appetite loss. When the patient came to us on January 12, 2011, jaundice was apparent. A laboratory examination revealed highly elevated aminotransferase levels (AST 4002 IU/ml ALT 4715 IU/ml) and positivity for anti-HA IgM, and we made a diagnosis of acute hepatitis A. The clinical course of acute hepatitis A showed smooth improvement without adverse symptoms. By the end of March 2012, the total bilirubin and aminotrasferase levels were completely normalized. We recommend that non-immune individuals be pre-immunized with HA-vaccine and be fully aware of potential health risks at their intended destinations before traveling to endemic countries

Ancylostoma ceylanicum, novel etiological agent for traveler’s diarrhea—report of four Japanese patients who returned from Southeast Asia and Papua New Guinea

Abstract Background Countries in the Southeast Asia region have a high prevalence of soil-transmitted helminth, such as roundworm, whipworm, and hookworms [Ancylostoma duodenale, Necator americanus, Ancylostoma ceylanicum]. Recent molecular-based surveys have revealed that A. ceylanicum, a zoonotic hookworm, is likely the second most prevalent hookworm species infecting humans in that part of the world, while others have noted that this infection is an emerging public health risk not only for indigenous people but also for visitors from other countries. Case presentation We recently encountered four cases of A. ceylanicum infection in Japanese individuals who returned from Southeast Asia and Papua New Guinea. Case 1 was a 25-year-old male who stayed in a rainforest in Malaysia for 4 weeks, where he developed abdominal pain and diarrhea in the third week. Eleven adult worms (five males, six females) were expelled after treatment with pyrantel pamoate and identified as A. ceylanicum based on morphological characteristics and DNA sequences of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Case 2 was a 26-year-old male who spent 2 years as an overseas cooperation volunteer for agriculture in Papua New Guinea. He did not note any symptoms at that time, though eggs were detected in feces samples at a medical check-up examination after returning. Although collection of adult worms was unsuccessful, DNA analysis of the eggs for cox1 and the ribosomal internal transcribed spacer (ITS)-1 and ITS-2 genes demonstrated that they were A. ceylanicum. Case 3 was a 47-year-old male who spent 1 month in a rural village in Lao People’s Democratic Republic and began suffering from watery diarrhea from the third week. A total of nine adult worms (three males, six females) were collected by endoscopic procedures and following treatment with pyrantel pamoate. Morphological examination and molecular analyses of the cox1 gene showed that they were A. ceylanicum. Case 4 was a 27-year-old male who participated in group travel to India for 5 days. Three weeks after returning, he developed abdominal pain and diarrhea. Hookworm eggs were found in feces samples and developed into larvae in culture, which were identified as A. ceylanicum based on molecular analysis of the cox1 gene. Eosinophilia was observed in all of the cases prior to treatment. Conclusions A. ceylanicum should be recognized as an important etiologic pathogen of hookworm diseases in travelers to countries in the Southeast Asia and West Pacific Ocean regions

Additional file 1: of Ancylostoma ceylanicum, novel etiological agent for traveler’s diarrhea—report of four Japanese patients who returned from Southeast Asia and Papua New Guinea

Table S1. List of gene-specific primers used for PCR. (PDF 60 kb