Interest in global health (GH) among medical students worldwide is measurably increasing. There is a concomitant emphasis on emphasizing globally-relevant health professions education. Through a structured literature review, expert consensus recommendations, and contact with relevant professional organizations, we review the existing state of GH education in US medical schools for which data were available. Several recommendations from professional societies have been developed, along with a renewed emphasis on competencies in global health. The implementation of these recommendations was not observed as being uniform across medical schools, with variation noted in the presence of global health curricula. Recommendations for including GH in medical education are suggested, as well as ways to formalize GH curricula, while providing flexibility for innovation and adaptation

Our current knowledge of the clinical characteristics of enteric fever is drawn mainly from population-based studies in disease-endemic countries, and there are limited data published on cases in returning travelers. We report the clinical characteristics of enteric fever in 92 travelers returning to London, United Kingdom. Salmonella typhi and S. paratyphi resulted in an almost indistinguishable clinical picture. Rose spots and relative bradycardia were found only in a few patients. A total of 91% of the patients had a normal leukocyte count, which was associated with a markedly increased level of alanine aminotransferase in 82%. A total of 57% of the S. typhi isolates had decreased susceptibility to ciprofloxacin and resistance to nalidixic acid; these isolates were from southern Asia. Thirty percent were multidrug resistant; all were from southern Asia and Nigeria. None of the paratyphoid isolates were multidrug resistant but rates of decreased susceptibility to fluoroquinolones were higher than in S. typhi (74%).

Schistosomiasis is found in a significant proportion of returning travellers and immigrants to Britain. This study is a retrospective review of 1107 consecutive cases of schistosomiasis from Africa diagnosed by microscopy or serology presenting to the Hospital for Tropical Diseases, London, UK. 50.4% of cases were asymptomatic. The most common symptom which resolved on treatment was tiredness. Serology was positive in 951 (86%), and ova seen in 45%. Urine dipstick testing was positive for blood in 21% and protein in 15%, with eosinophilia in 44%. In this population urine dipstick, full blood count and serology were all insufficient screening tools used alone. Among patients with full follow-up data 3 months or more after treatment with praziquantel, definite treatment failure occured in 4 of 271 (1.5%), restricting the analysis to those with ova seen at diagnosis. There was no significant difference in treatment failure between 1 and 3 days of treatment. Antibody level was the same or higher than at treatment in 55% of cases seen after about 3 months and 38% after 1 year, confirming it is probably of limited clinical use in detecting treatment failure.

Giardia lamblia is discussed as the most important parasitic cause of travellers' diarrhoea. The parasitology of this flagellate protozoan is discussed with respect to route of infection, threshold infecting dose, and incubation period. The geographic distribution of giardiasis is widespread, being common in tropical and sub-tropical regions and endemic at a low level in European and North American countries. The predisposing factors are detailed together with clinical manifestations, pathogenesis and diagnosis. Effective therapy may be quinacrine t.i.d. for 5-10 days, metronidazole 200 mg t.i.d. for 14 days or 2 g once daily over 3 days, or a single dose of 1.5 g of tinidazole. Although Entamoeba histolytica is distributed world-wide, it rarely causes travellers' diarrhoea. However, the clinical features, diagnosis and treatment of amoebiasis-related travellers' diarrhoea are detailed.

A comparative evaluation was made of immunofluorescent serum antibodies against Giardia lamblia and enterobacteria isolated from the upper intestine of patients with severe giardiasis. The study was carried out on sera from 51 patients belonging to seven intestinal disease groups. Antibodies against Giardia and against some enterobacteria were present in all eight cases of giardiasis with malabsorption, and absent in all five cases of invasive amoebiasis and in six normal control sera. Bacterial antibodies were found in the other five groups of intestinal disease, in 29 out of 38 cases. Giardia antibodies were found in only two of the other groups, tropical sprue (two cases) and coeliac disease (two cases). Thus Giardia antibodies may not signify active giardiasis but they were of restricted distribution and were sometimes present at relatively high titre. Bacterial antibodies were widely distributed but always at low titre. Absorption experiments indicated that the two types of antibody did not cross-react.

Journal Article A Colour Atlas of Tropical Medicine and Parasitology Get access A Colour Atlas of Tropical Medicine and Parasitology By W. Peters and H. M. Gilles. 2nd edn. Pp. 400, illustrated. Wolfe Medical Publications, London; Year Book Medical Publications, New York, 1981. £22.00. S G Wright S G Wright Hospital for Tropical Diseases, London NW1 0PE Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, Volume 58, Issue 678, April 1982, Page 252, https://doi.org/10.1136/pgmj.58.678.252-a Published: 01 April 1982

Journal Article Giardiasis and malabsorption Get access S.G. Wright S.G. Wright Dept. of Clinical Tropical Medicine, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT U.K. Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 74, Issue 4, 1980, Pages 436–437, https://doi.org/10.1016/0035-9203(80)90045-0 Published: 01 January 1980

Nine of 14 cases of giardiasis and severe malabsorption were found to have numerous bacteria adjacent to the mucosa and within luminal fluid samples from the upper jejunum. Three species of enterobacteria (Klebsiella pneumoniae, Enterobacter cloacae and E. hafniae) were cultured from eight patients and from only one were Bacteroides isolated. Enterobacteria were not cultured from seven of eight patients who had giardiasis but only mild malabsorption (of xylose only) nor from seven patients without malabsorption. Intestinal colonization by enterobacteria may make an important contribution to the development of malabsorption in patients with giardiasis.

Malabsorption was present in 29 of 40 symptomatic patients with giardiasis. Twenty-three had impaired D-xylose absorption; in 20 vitamin B12 absorption was low, and 15 patients had steatorrhoea. More severe malabsorption was associated with more marked histological abnormalities. Metronidazole, 2-0 g as a single daily dose on three successive days, produced a parasitological cure rate of 91%. In contrast, the standard course of mepacrine, 100 mg thrice daily for 10 days, eradicated the parasite in only 63% of patients. Improvements in absorption and jejunal morphology followed anti-giardial treatment. Tetracycline in eight patients failed to eradicate the parasite, intestinal absorption was unaltered, and histological appearances of the jejunal mucosa often deteriorated.