9 Our patient recounted only a single 3-day visit to an endemic area. Thirdly, the patient’s lack of peripheral eosinophilia as well as a normal IgE level probably reflects the chronicity of the infection and the modulation of the acute responses

that often occur early in infection. Lastly, the use of molecular approaches toward definitive speciation of a viable worm extracted from the patient 20 years after exposure suggests that in some cases L loa has an extremely extended lifespan. It is worth emphasizing learn more that the molecular assay used to confirm the diagnosis is not cross-reactive with M perstans,1 which is endemic to areas in this patient’s travel history and may be associated with symptoms and periorbital migration similar to L loa. The GeoSentinel Surveillance Network examined their database to identify demographic and travel characteristics associated with filarial species and L loa acquisition.6 From a total of 43,722 individual patient

encounters over 7 years at travel clinics geographically dispersed, filarial infections were diagnosed in 269 (0.62%), of which ∼25% were infected with L loa. Among the 16 travelers (not those born in Loa-endemic regions) with loiasis, only 2 (12.5%) had stays less FG-4592 purchase than 30 days. This case is unusual and should remind the travel practitioner to take a detailed travel history in the setting of swelling and/or angioedema and not be dissuaded by the lack of eosinophilia on presentation or a prolonged interval between possible exposure and clinical presentation of L loa. We would like to thank Ms Audrey Cantley for administrative assistance. The authors state they have no conflicts of interest to declare. “
“The rapid development of transport and communication, environmental exchanges, and migration of populations creates opportunities for the spread of infectious diseases. The emergence and spread of pathogenic and epidemic pathogens is a major emerging phenomenon of the past 30 years. Some species of bacteria have become resistant to multiple antibiotics and, sometimes, to all antibiotics available:

multidrug-resistant bacteria (MDR), extensively drug-resistant bacteria (XDR), or pan drug-resistant bacteria (PDR).1–3 These terminologies have drawn attention to the evolution of Baf-A1 in vitro multidrug resistance and the potential difficulties in treating bacterial infections now and in the future.4 The very high levels of resistance that are currently observed result from massive exposure to antibiotics, to which humans and animals have been subjected over the past 50 years.5 Resistance to antibiotics concerns not only pathogens but also, and probably even more importantly, the commensally bacteria colonizing individuals (humans and animals). These are less easily detected because the carriage is asymptomatic. More than 80 million foreign visitors travel in France each year. In the same period, 19.4 million French peoples travel to foreign countries, more often in Europe.6 In addition, 1.