Following greater attention and follow-up of patients with treated pulmonary tuberculosis (TB), it has emerged that infections are more likely to occur in this cohort of patients. This comes as no surprise, as pulmonary TB is a destructive process that leads to cicatrization, alteration of parenchyma, bronchiectasis, and scarring of the lung, with reduction of lung volumes and an impact on pulmonary function. In addition to relapse and re-infection with TB, other pathogens are increasingly recognized in post-TB patients. This paper serves as a summary and guide on how to approach the post-TB patient with new signs and symptoms of pulmonary infection in order to ensure optimal management and rehabilitation.

bacteraemias related to urosepsis could have been prevented by better empirical treatment and targeted prophylaxis. Urinary catheter quality improvement programmes should contribute to a further reduction. For patients undergoing high-risk urinary or biliary tract procedures or device manipulation, we advocate single-dose amikacin prophylaxis.

Healthcare workers (HCWs) carry a substantial risk of harm from infectious disease, particularly, but not exclusively, during outbreaks. More can be done by healthcare institutions to identify risks, quantify the current burden of preventable infectious disease amongst HCWs and identify opportunities for prevention. We suggest that institutional obligations should be clarified with respect to the mitigation of infectious disease risks to staff, and question the duty of HCWs to care while healthcare institutions persist with a reactive rather than proactive attitude to infectious disease threats.

No abstract

Infectious diseases are transmitted either directly from person to person via direct contact or droplet exposure, or indirectly through a vector organism (mosquito or tick) or a non-biological physical vehicle (soil or water). Vector-borne infectious diseases are highly influenced by climate factors such as temperature, precipitation, altitude, sunshine duration, and wind. Therefore, climate change is a major threat for the emergence and re-emergence of infectious diseases, e.g. re-emergence of dengue fever in some parts of southern Europe. The natural reservoirs of infectious diseases are either humans (anthroponoses) or animals (zoonoses). Population movement due to travel or civil unrest risks introducing non-immune populations to regions that are endemic for certain infectious diseases. By contrast, global trade contributes to the movement of animals or arthropods across the world and this poses a major risk for introducing infectious diseases to previously non-endemic settings, e.g. rats on board commercial ships and the global spread of hantaviruses; international trade in used car tyres and the risk of introducing flavivirus-infected mosquitoes into non-endemic settings; and the contribution of migratory birds to the introduction and the spread of West Nile virus in the United States. The unprecedented growth of international travel facilitates the swift movement of pathogens by travellers from one region to another. The main determinants of travel-related infections are destination country, activities undertaken during travel, and pre-existing morbidities. Therefore, the pre-travel consultation aims to assess potential health hazards associated with the trip, give advice on appropriate preventative measures, and educate the traveller about their own health. Attitudes towards seeking pre-travel health advice vary by the type of traveller. For example, those visiting friends and relatives (VFRs) in their country of origin are less likely to seek pre-travel health advice compared to tourists and therefore stand a higher chance of presenting with preventable infections such as malaria. The key aspects of a pre-travel consultation include: ● comprehensive risk assessment based on the demographic and clinical background of the traveller as well as the region of travel and itinerary.

Travel-related problems have been reported in up to two-thirds of travellers to developing countries and approximately 10% of them seek medical advice during or after return from abroad. Furthermore, global migration from the developing to the developed world has increased over the past decades and these individuals may present with tropical infections soon after arrival in non-endemic settings. Fever, with or without localizing symptoms or signs, is a common presenting symptom in returning travellers. Most unwell travellers seek medical attention within one month of return from abroad. Travellers who visit friends and relatives (VFRs) in their countries of origin are disproportionately affected by the burden of imported infections, e.g. 70% of patients with imported malaria in the United Kingdom (UK) are VFRs. While most febrile travellers have common infections such as respiratory or urinary tract infection, it is of paramount importance not to miss potentially life-threatening tropical infections. Evaluation of fever in returning travellers requires an understanding of the geographical distribution of infectious diseases, risk factors for acquisition, incubation periods, and major clinical syndromes of travel-associated infections. The following points should be considered when assessing febrile international travellers: A. Travel dates: the relationship between the timing of the onset of symptoms and travel dates should be assessed. B. Geography: ● travel destination: a detailed itinerary is required. ● local setting: urban vs rural locations; type of accommodation, e.g. air-conditioned hotel room, outdoor camping, etc. C. Risk factors for acquiring infectious diseases: ● purpose of travel: visiting friends and family; social gatherings (e.g. funerals and weddings); mass gatherings (e.g. Hajj pilgrimage, Kumbh Mela religious festival, Olympic games, etc.); tourism; business; voluntary work. ● contact with unwell individuals. ● activities while abroad (examples): ■ food consumption: street food, seafood, raw food, unpasteurized dairy products, exotic foods, bush meat, etc. ■ contact with animals: visits to game parks, farms, caves, bites or scratches by bats or terrestrial animals, visits to ‘wet markets’, birding events, etc. ■ bites: ticks, insects, snakes, spiders, etc. ■ use of local healthcare system: dental or surgical procedures, blood transfusion, dialysis, tattoos, acupuncture.

No abstract