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Skin and Soft Tissue Infections in Returning Travelers

Skin and soft tissue infections (SSTI) are a leading cause of cutaneous problems in travelers. Sixty travelers who presented with an SSTI were prospectively included over a 20-month period. Bacterial analysis and research for Panton-Valentine leukocidine (PVL) were performed according to clinical and bacterial presentation. The SSTI appeared abroad in 73% and were predominantly localized on lower limbs (75%). The main clinical forms were impetigo (35%) and cutaneous absess (23%). Insect bites were significantly associated with impetigo and ecthyma. Methicillin-susceptible Staphylococcus aureus (MSSA) was identified in 15 patients (43%), Group A Streptococcus (GAS) in 12 patients (34%), and an association of both in 8 (23%) among the 35 patients for whom bacteria were identified. The MSSA producing PVL were found in 4 patients. Travelers should be advised on how to prevent arthropod exposure and susceptibility testing should be recommended considering that methicillin-resistant S. aureus (MRSA) is increasingly reported, although not identified in our study.

Received June 2, 2008. Accepted for publication December 2, 2008.

^* Address correspondence to Patrick Hochedez, Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, 47–83 Boulevard de l’Hôpital, 75013 Paris, France. E-mail: patrick.hochedez{at}free.fr

Authors’ addresses: Patrick Hochedez, Ana Canestri, Nadia Valin, François Bricaire, and Eric Caumes, Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, 47–83 Boulevard de l’Hôpital, 75013 Paris, France, Tel: 33-1-42-16-01-14, Fax: 33-1-42-16-01-65, E-mails: patrick.hochedez{at}free.fr, ana.canestris{at}psl.aphp.fr, nadia.valin{at}sat.aphp.fr, francois.bricaire{at}psl.aphp.fr, and eric.caumes{at}psl.aphp.fr. Maryline Lecso, Service de Bactériologie, Hôpital Pitié-Salpêtrière, 47–83 Boulevard de l’Hôpital, 75013 Paris, France, Tel: 33-1-42-16-20-71, Fax: 33-1-42-16-20-72, E-mail: maryline.lecso{at}psl.aphp.fr.

Reprint requests: Eric Caumes, Service de Maladies infectieuses et tropicales, Hôpital Pitié-Salpêtrière, 47–83 Boulevard de l’Hôpital, 75013 Paris, France, E-mail: eric.caumes{at}psl.aphp.fr.