introduction

Infectious Diseases of Refugees and Immigrants: Introduction

This section of Refugee Health ~ Immigrant Health covers (with a few exceptions), only diseases that are less likely to be familiar to Western providers. Thus a patient with anemia, for example, would be a candidate for more diagnoses than those given here under anemia (i.e., we do not cover malignancy, cirrhosis, pregnancy, etc.).

More than 110 diseases or conditions are discussed in this site. Diseases and conditions are presented in four ways: (1) major or presenting signs & symptoms; (2) area of the world from which the patient comes, has traveled to (or a family member has traveled to); (3) alphabetically; (4) more complete discussions of major diseases. Diseases or conditions with the notation "See full discussion" are discussed in greater depth (including primary distribution, agent and vector, incubation, signs and symptoms, complications, laboratory findings, diagnosis, differential diagnosis, treatment, and references) in separate files. Where applicable, author experiences are inserted under "notes from the field." This format incorporates most of the variables that should be considered in the approach to the patient who has or may have a parasitic infection. Additional information of particular importance includes dietary history/risks, other exposure histories, and immune status (Weller, 1998).

The concept and some of the information in the search by major signs and symptoms and area of world were taken from Halstead & Warren, 1988. This site is sponsored by the Texas Department of Health. The site was developed for two reasons:

Emerging and re-emerging infectious diseases are increasingly recognized as a major health problem in both the developing and the developed world (Mayer, 2000). Emerging infectious diseases are one of the ten critical current and future public health challenges identified by the Centers for Disease Control and Prevention (Koplan & Fleming, 2000).
Many medical providers are unfamilar with at least some of these diseases and conditions.

Complacency in the developed world about infectious diseases was shattered with the rise of HIV (Wilkins, 2000). Other factors leading to increased concern about infectious diseases include the discovery of major etiological agents in infectious diseases (35 such agents discovered since 1972), the rise of multi-drug resistant (MDR) tuberculosis and other MDR diseases, the realization that the infectious disease burden in the developing world is showing little decline, and increased understanding of the ecological web of causation (Desselberger, 2000; Mayer, 2000; Shears, 2000).

As this is written, refugees are tending to present in countries of second asylum with more chronic and common illnesses such as hypertension and arthritis. However, we continue to see refugee patients with more exotic diseases. Increased risk factors for infectious diseases in both the developing and the developed world (Boots & Sasaki, 1999; Dedet & Pratlong, 2000; Kemp & Rasbridge, 1999; Kumate, 1997; Martens & Hall, 2000; Mayer, 2000; Sheik-Mohamed & Velema, 1999) include:

Lengthy incubation periods of some illness.
Mutated, new, or newly discovered pathogens.
Multidrug resistant (MDR) pathogens.
Mass movement of large numbers of refugees in various parts of the world, widespread immigration (more than 70 million immigrants are estimated to be on the move at any one time [Cohen, 2000]), and travel of nomads within countries and across borders.
Rapid and widespread air travel (and enclosed airplane environments).
Tendency for refugees and immigrants to attempt to conceal illnesses and historical (health) information.
Increased numbers of immunodeficient people (resulting from disease or disease treatment).
Lifestyles (vectors and hosts) prone to infectious pathology, e.g., urbanization and megacities, child and adult day care centers, intravenous drug use, indiscriminate sexual behavior, nomadic traditions.
Environmental disturbances (global warming leading to geographic spread of tropical diseases, redirection of water leading to changes in water-borne parasitic environments deforestation, widespread use of pesticides, fertilizers, and antimicrobials in food production and animal husbandry).
Widespread natural/social disasters, poverty, violence, and deprivation with resultant late diagnosis and/or difficulty in diagnosing illnesses.

From 1975-2000, there were 2,284,956 refugees legally admitted to the U.S. (U.S. Department of State, 2000). A much greater number of legal and illegal immigrants have also arrived in the U.S. in recent years. Although refugees and immigrants tend to be at higher risk for infectious diseases, people who live in the U.S. and other developed nations are at risk through through international travel and because of factors noted above (Kemp, 2000).

Indepth discussions of tuberculosis and HIV are conspicuously absent from this site, as they are well-covered in the literature.

Authors: Charles Kemp, FNP & Amy Roberts, FNP

Top

References

Boots, M. & Sasaki, A. (1999). 'Small worlds' and the evolution of virulence: Infection occurs locally and at a distance. Proceedings of the Royal Society of Biological Sciences, 266(1432), 1933-1938.

Centers for Disease Control and Prevention. (1999). Amebiasis infection. Retrieved January 9, 2000, from the World Wide Web: http://www.cdc.gov/ncidod/dpd/amebias.htm.

Cohen, R. (7/2/2000). Europe tries to turn a tide of migrants chasing dreams. New York Times. Retrieved July 2, 2000, from the World Wide Web: http://www.nytimes.com.

Dedet, J-P. & Pratlong, F. (2000). Leishmania, trypanosoma, and monoxenous trypanosomatids as emerging opportunistic agents. Journal of Eukaryotic Microbiology, 47(1), 37-39.

Desselberger, U. (2000). Emerging and re-emerging infectious diseases. Journal of Infection, 40(2000), 3-15.

Kemp, C. & Rasbridge, L. (1999). Refugee and Immigrant health: A guide for health care and refugee agency staff. Austin, Texas: Texas Department of Health.

Koplan, J.P & Fleming, D.W. (2000). Current and future public health challenges. Journal of the American Medical Association, 284(13, 1696-1698.

Kumate, J. (1997). Infectious diseases in the 21st Century. Archives of Medical Research, 28(2), 155-161.

Martens, P. & Hall, L. (2000). Malaria on the move: Human population movement and malaria transmission. Emerging Infectious Diseases, 6(2), 103-109.

Mayer, J.D. (2000). Geography, ecology and emerging infectious diseases. Social Science and Medicine, 50(2000), 937-952.

Shears, P. (2000). Emerging and re-emerging infections in Africa: The need for improved laboratory services and disease surveillance. Microbes and Infection, 2(2000), 489-495.

Sheik-Mohamed, A. & Velema, J.P. (1999). Where health care has no access: The nomadic populations of sub-Saharan Africa. Tropical Medicine and International Health, 4(10), 695-707.

U.S. Department of State Bureau of Population, Refugees, and Migration (2000). Refugee admissions and resettlement. Retrieved April 23, 2000, from the World Wide Web: http://www.state.gov/www/global/prm/index.html .

Weller, P.F. (1998). Approach to the patient with parasitic infection. In A.S. Fauci, E. Braunwald, K.J. Isselbacher, J.D. Wilson, J.B. Martin, D.L. Kasper, S.L. Hauser, & D.L. Longo (Eds.). Harrison's principles of internal medicine (14th ed.) (pp. 1163-1165). New York: McGraw-Hill.

Wilkins, E. (2000). Introduction to the mini-series on emerging infectious diseases. Journal of Infection, 40(2), 2.