Article Figures & Tables
Figures
Figure 1: Regional exposure for the cohort of returned travellers (n = 1076) with a primary travel-related dermatologic diagnosis presenting to a CanTravNet site in Canada.
Tables
- Table 1: Demographic characteristics of participants (n = 1076)
Characteristic All, no. (%)
n = 1076Purpose of travel, no. (%)* Tourism
n = 754Immigration
n = 63VFR
n = 78Missionary volunteer/researcher/aid
n = 84Business
n = 69Other†
n = 28Sex Male 448 (41.6) 300 (39.8) 36 (57.1) 32 (41.0) 28 (33.3) 34 (49.3) 18 (64.3) Female 628 (58.4) 454 (60.2) 27 (42.9) 46 (59.0) 56 (66.7) 35 (50.7) 10 (35.7) Age, yr; median (IQR) 39.7 (26–52) 39 (27–53) 36 (22.5–59.8) 39 (28–54) 29 (22.3–51) 39 (32.8–50) 25 (22–40) Patient type Inpatient 27 (2.5) 13 (1.7) 6 (9.5) 2 (2.6) 2 (2.4) 2 (2.9) 2 (7.1) Outpatient 1049 (97.5) 741 (98.3) 57 (90.5) 76 (97.4) 82 (97.6) 67 (97.1) 26 (92.9) Travel duration, d; median (IQR) 15.5 (7–31) 14 (7–27) NA 33 (16.5–79) 28 (14.8–61.3) 21 (8.8–35) 24 (9.3–111) Pretravel encounter Yes 364 (33.8) 238 (31.6) NA 18 (23.1) 60 (71.4) 32 (46.4) 16 (57.1) No 387 (36.0) 310 (41.1) NA 39 (50.0) 9 (10.7) 23 (33.3) 6 (21.4) Unknown 262 (24.3) 206 (27.3) NA 21 (26.9) 15 (17.9) 14 (20.3) 6 (21.4) CanTravNet site Montréal 619 (57.5) 447 (59.3) 26 (41.3) 38 (48.7) 60 (71.4) 34 (49.3) 14 (50.0) Toronto 277 (25.7) 192 (25.5) 16 (25.4) 31 (39.7) 11 (13.1) 25 (36.2) 2 (7.1) Montréal-CHUM 87 (8.1) 72 (9.5) 0 (0) 2 (2.6) 10 (11.9) 3 (4.3) 0 (0) Ottawa 52 (4.8) 22 (2.9) 12 (19.0) 4 (5.1) 3 (3.6) 3 (4.3) 8 (28.6) Vancouver 41 (3.8) 21 (2.8) 9 (14.3) 3 (3.8) 0 (0) 4 (5.8) 4 (14.3) Region of exposure Caribbean 242 (22.5) 206 (27.3) 2 (3.2) 6 (7.7) 16 (19.0) 10 (14.5) 2 (7.1) Central America 197 (18.3) 180 (23.9) 2 (3.2) 2 (2.6) 4 (4.8) 4 (5.8) 5 (17.9) Sub-Saharan Africa 138 (12.8) 51 (6.8) 20 (31.7) 15 (19.2) 32 (38.1) 14 (20.3) 6 (21.4) Southeast Asia 114 (10.6) 85 (11.3) 9 (14.3) 6 (7.7) 7 (8.3) 6 (8.7) 1 (3.6) Southcentral Asia 84 (7.8) 35 (4.6) 12 (19.0) 20 (25.6) 5 (6.0) 6 (8.7) 6 (21.4) South America 71 (6.6) 41 (5.4) 2 (3.2) 9 (11.5) 14 (16.7) 3 (4.3) 2 (7.1) North America 64 (5.9) 57 (7.6) 0 (0) 0 (0) 0 (0) 6 (8.7) 1 (3.6) Western Europe 24 (2.2) 19 (2.5) 0 (0) 2 (2.6) 0 (0) 3 (4.3) 0 (0) Northeast Asia 19 (1.8) 7 (0.9) 7 (11.1) 3 (3.8) 0 (0) 2 (2.9) 0 (0) Eastern Europe 13 (1.2) 2 (0.3) 1 1.6) 7 (9.0) 0 (0) 2 (2.9) 1 (3.6) North Africa 12 (1.1) 3 (0.4) 1 (1.6) 5 (6.4) 1 (1.2) 2 (2.9) 0 (0) Middle East 12 (1.1) 3 (0.4) 5 (7.9) 1 (1.3) 1 (1.2) 1 (1.4) 1 (3.6) Oceania 4 (0.4) 4 (0.5) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Australia/New Zealand 3 (0.3) 1 (0.1) 0 (0) 1 (1.3) 0 (0) 1 (1.4) 0 (0) Unknown 79 (7.3) 60 (8.0) 2 (3.2) 1 (1.3) 4 (4.8) 9 (13.0) 2 (7.1) Note: CHUM = Centre Hospitalier de l’Université de Montréal, NA = not available, VFR = visit friends and relatives. *Unless otherwise specified. †Includes students (n = 16), military personnel (n = 10) and medical tourists (n = 2).
- Table 2: Top dermatologic diagnoses and source countries for returning Canadian travellers (n = 1076) seen at a CanTravNet site, 2009–2012
Diagnosis No. (% of all dermatologic diagnoses) Top 3 source countries for diagnosis Trip duration, d; median (IQR) 1. Rash 212 (19.7) Mexico; Cuba; India, Costa Rica, Dominican Republic (tied) 15 (7–32.75) Unknown etiology, nonfebrile 77 Atopic dermatitis 40 Contact dermatitis 33 Urticaria/angioedema 28 Photosensitivity 19 Drug related 11 Sea bather’s eruption 3 Heat induced 1 2. Arthropod bites 207 (19.2) United States, Cuba, Mexico 14 (7–23) Insect bites; including stings 142 Tick bites 38 Insect bites, superinfected 24 Spider bites 3 3. Skin and soft tissue infection 156 (14.5) Cuba, India, United States 29 (10–63) Superficial 94 Skin and soft tissue 27 Skin abscess 17 Secondary infection of existing skin lesion 18 4. Cutaneous larva migrans 105 (9.8) Jamaica, Mexico, Barbados 10 (7–18.75) 5. Pruritus, unknown origin 65 (6.0) Dominican Republic, Cuba, Ghana 14 (7–29) 6. Animal bites 56 (5.2) Thailand; Indonesia; Chile, Mexico, India (tied) 22 (14.25–36) Monkey 25 Dog 18 Other* 10 Cat 3 Required rabies PEP 47 7. Fungal infection (superficial/cutaneous mycosis) 46 (4.3) Cuba, Mexico, India 22 (8–61) 8. Cutaneous leishmaniasis 36 (3.3) Costa Rica, Syrian Arab Republic, Afghanistan 35 (23.5–56.75) 9. Marine envenomation† 32 (3.0) United States, Mexico, Cuba 8 (7–14) 10. Infestations 26 (2.4) India, Panama, Dominican Republic 23 (14.25–64.5) Scabies 22 Lice 3 Mites 1 11. Myiasis 18 (1.7) Costa Rica, Belize, Uganda 16.5 (9–24) 12. Leprosy 15 (1.4) Sri Lanka, Philippines, India NA‡ 13. Psoriasis 10 (0.9) Vietnam; Thailand, Russia, Philippines, Jamaica, Cambodia (tied) 18 (4.5–29) NOTE: PEP = postexposure prophylaxis. *Includes bites from a bat, (6) tiger, (1) stingray (1) and leech. (1) †Includes envenomations from jellyfish and other cnidarians, sea anemone, stingray and venomous fish. This does not include envenomations from sea bather’s eruption, because this is otherwise classified. ‡Not applicable. The reason for travel in leprosy cases is immigration.
Region of exposure Travellers returning with dermatoses, no. Top 3 diagnoses Caribbean 242 Cutaneous larva migrans, arthropod bites, rash* Central America 197 Arthropod bites, rash,* cutaneous larva migrans Sub-Saharan Africa 138 Rash,* skin and soft tissue infections, arthropod bites Southeast Asia 114 Rabies (PEP), animal bites, skin and soft tissue infection Southcentral Asia 84 Arthropod bites, skin and soft tissue infections, rash (atopic dermatitis) South America 71 Skin and soft tissue infections, rash,* arthropod bites North America 64 Arthropod bites, skin and soft tissue infections, rash (contact dermatitis) Western Europe 24 Arthropod bites, rash (angioedema), pruritus (unknown origin) Note: PEP = postexposure prophylaxis. *Top specific rash was of unknown cause.
- Table 4: Top 5 dermatologic diagnoses, by reason for travel (n = 1076)
Tourism
(n = 754)Immigration
(n = 63)VFR
(n = 78)Missionary/volunteer/researcher/aid
(n = 84)Business
(n = 69)Other*
(n = 28)1. Arthropod bite
(n = 167, 22.1%)
Insect bite, including stings (n = 117)
Tick bite (n = 29)
Insect bite, superinfected (n = 18)
Spider bite (n = 3)Leprosy
(n = 15, 23.8%)Arthropod bite
(n = 15, 19.2%)
Insect bite, including stings (n = 6)
Tick bite (n = 5)
Insect bite, superinfected (n = 4)Rash
(n = 23, 27.4%)
Unknown cause, nonfebrile (n = 8)
Atopic dermatitis
(n = 4)
Urticaria/angioedema (n = 4)
Contact dermatitis
(n = 3)
Photosensitivity (n = 3)
Drug related (n = 1)Rash
(n = 17, 24.6%)
Unknown cause, nonfebrile (n = 6)
Atopic dermatitis
(n = 6)
Contact dermatitis
(n = 2)
Drug related (n = 2)
Urticaria/angioedema (n = 1)Skin and soft tissue infection
(n = 13, 46.4%)
Superficial (n = 9)
Skin and soft tissue (n = 2)
Skin abscess (n = 1)
Secondary infection of existing lesion (n = 1)2. Rash
(n = 141, 18.7%)
Unknown cause, nonfebrile (n = 50)
Contact dermatitis (n = 28)
Atopic dermatitis (n = 24)
Urticaria/angioedema (n = 18)
Photosensitivity (n = 16)
Seabather’s eruption (n = 3)
Drug related (n = 1)
Heat induced (n = 1)Rash
(n = 13, 20.6%)
Drug related (n = 6)Unknown etiology, nonfebrile (n = 4)
Atopic dermatitis (n = 2)
Urticaria/angioedema (n = 1)Rash
(n = 15, 19.2%)
Unknown cause, nonfebrile (n = 9)
Atopic dermatitis (n = 2)
Urticaria/angioedema (n = 3)
Drug related (n = 1)Skin and soft tissue infection
(n = 18, 21.4%)
Superficial (n = 12)
Skin and soft tissue (n = 2)
Skin abscess (n = 3)
Secondary bacterial infection of existing lesion (n = 1)Skin and soft tissue infection
(n = 14, 20.3%)
Superficial (n = 5)
Skin and soft tissue (n = 2)
Skin abscess (n = 3)
Secondary bacterial infection of existing lesion (n = 4)Arthropod bite
(n = 3, 10.7%)
Insect bite, including stings (n = 2)
Tick bite (n = 1)3. Cutaneous larva migrans
(n = 98, 13.0%)Pruritus, unknown origin
(n = 7, 11.1%)Skin and soft tissue infection
(n = 13, 16.7%)
Superficial (n = 9)
Skin and soft tissue (n = 3)
Secondary infection of existing lesion (n = 1)Arthropod bite
(n = 12, 14.3%)
Insect bite, including stings (n = 10)
Tick bite (n = 1)
Insect bite, superinfected (n = 1)Arthropod bite
(n = 9, 13.0%)
Insect bite, including stings (n = 6)
Tick bite (n = 2)
Insect bite, superinfected (n = 1)Leishmaniasis, cutaneous
(n = 3, 10.7%)4. Skin and soft tissue infection
(n = 92, 12.2%)
Superficial (n = 57)
Skin and soft tissue (n = 14)
Secondary infection of existing lesion (n = 11)
Skin abscess (n = 10)Leishmaniasis, cutaneous
(n = 6, 9.5%)Leishmaniasis, cutaneous
(n = 8, 10.3%)Fungal infection (superficial/cutaneous mycosis)
(n = 9, 10.7%)Fungal infection (superficial/cutaneous mycosis)
(n = 5, 7.3%)Rash
(n = 3, 10.7%)
Atopic dermatitis (n = 2)
Urticaria/angioedema) (n = 1)5. Pruritus, unknown origin
(n = 44, 5.8%)Skin and soft tissue infection
(n = 6, 9.5%)
Skin and soft tissue infection (n = 4)
Superficial (n = 2)Pruritus, unknown origin
(n = 6, 7.7%)Animal bite
(n = 7, 8.3%)
Dog (n = 4)
Other (n = 3)Pruritus, unknown origin
(n = 3, 4.3%)Myiasis
(n = 2, 7.1%)Note: VFR = visiting friends and relatives. *Includes students (n = 16), military personnel (n = 10) and medical tourists (n = 2).