One Question That Can Change the Diagnosis: Why Travel History Matters

A college student presents to the emergency department with fever, nausea, vomiting, and diarrhea after returning from a spring break humanitarian mission trip to Haiti. During the nursing assessment, the patient reports having brushed their teeth with water that might have been untreated and recalls receiving multiple mosquito bites. What might at first appear to be a routine case of gastroenteritis comes in this case with concern for dengue, malaria, typhoid fever, or cholera. The patient’s travel history changes not only the differential diagnosis but also the urgency of testing, treatment, and infection-control decisions.

One simple question can change a patient’s outcome: Have you traveled recently? According to the CDC, nearly half of travelers to low- and middle-income countries become ill during or after travel. Although many illnesses are mild, some require hospitalization, and others may not become apparent until weeks or even months after returning home. Some syndromes can present years after travel.

Why travel matters.

According to the WHO, international travel is on the rise. Millions of people are traveling for professional, personal, and humanitarian reasons. International travel exposes people to infectious diseases that may be uncommon in the United States. Contaminated food and water, insect bites, animal exposures, health care […]

2026-08-28T09:50:45-04:00August 28th, 2026|infectious diseases, Nursing, Public health|0 Comments
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Dengue Cases Are Rising: Why Every Nurse Should Be Paying Attention

A patient presents to the emergency department with fever, headache, nausea, and severe muscle pain after returning from a Caribbean cruise. A few years ago, dengue fever may not have been high on a nurse’s list of possible diagnoses. Today, it should be.

Cryoelectron microscopy renderings of mature dengue virions (DENV-1) and photo of an Aedes mosquito. (NIAID)

Dengue is the leading cause of febrile illness among travelers returning to the United States from endemic regions. According to the World Health Organization, about half of the world’s population is at risk for dengue, with an estimated 100 to 400 million infections occurring annually, although many cases likely go unreported because symptoms are mild or absent.

In a recent MMWR, 3,798 dengue cases were reported in the United States in 2024 representing a 359% increase compared to the annual average reported between 2010 and 2023. Nearly 97% of reported infections occurred in travelers, with many cases linked to destinations in the Caribbean, including Puerto Rico and the U.S. Virgin Islands. However, locally acquired cases were also identified in Florida, California, and Texas.

Cause and Challenges

Dengue, sometimes called “breakbone fever,” is caused by one of four […]

2026-07-14T11:03:15-04:00July 14th, 2026|infectious diseases, Nursing|0 Comments
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What’s in the Air? Rethinking Airflow and Infection Risk in Health Care

Image generated using Google’s Nano Banana 2, 4/20/26.

For nurses, environmental infection prevention is often framed around visible conditions such as high-touch surfaces, shared equipment, and visible dirt. In my experience, airflow and ventilation are not topics that receive significant emphasis in nursing education or orientation. While this may vary by setting, many nurses are left to learn these concepts in practice rather than through formal training.

With the recent COVID-19 and measles outbreaks, there has been more focused attention placed on contaminated air as a risk to patient safety. In my work with health care teams across settings, I’ve found that while nurses are highly attuned to cleaning and disinfection practices, airflow and ventilation are often assumed to be “handled” by the facility operations staff. In reality, these systems depend heavily on how the environment is used at the bedside. Small, routine actions—like leaving a door open or introducing a fan—can unintentionally disrupt carefully designed controls.

This gap in awareness among clinical staff matters. While the Centers for Disease Control and Prevention continues to report progress in reducing health care-associated infections (HAIs), these infections remain at a persistent risk for patients. Expanding the nurse’s focus on the environment […]

2026-04-22T12:32:28-04:00April 21st, 2026|infection control, infectious diseases, Nursing, Public health|0 Comments
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Multidrug Resistance: A Growing Threat of Carbapenem-Resistant Gram-Negative Organisms in Health Care

Nurses are well aware of the problems with multidrug-resistant organisms (MDROs) and their ubiquitous presence across health care settings. Care issues and outcomes among patients with MDROs such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and Clostridioides difficile (C. diff) have increased awareness, but MDROs remain a growing challenge in the provision of care in virtually all health care settings.

Carbapenem-resistant Gram-negative bacteria, another example of MDROs, have emerged as one of the most urgent public health challenges globally. Organisms such as carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high morbidity, mortality, prolonged hospitalization, and limited treatment options. According to the World Health Organization (WHO), carbapenem-resistant A. baumannii and carbapenem-resistant Enterobacterales are among the highest-priority pathogens due to their rapid spread and severe clinical consequences (WHO, 2024).

Mechanisms of Carbapenem Resistance

Carbapenem resistance develops when bacteria change in ways that allow them to survive despite antibiotic treatment. Nurses and other health care personnel benefit from understanding these mechanisms because they directly relate to infection prevention activities, equipment cleaning and disinfection, and antimicrobial stewardship efforts.

Examples of how resistance develops are outlined below:

  1. Bacteria Produce Enzymes That Break Down the Antibiotic (Carbapenemase production)

Some bacteria create special enzymes that destroy carbapenem antibiotics before they can work. These are called carbapenemases. Common types of these enzymes include KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi metallo-beta-lactamase), VIM (Verona integron-encoded metallo-beta-lactmase), IMP (Imipenemase metallo-beta-lactamases), and OXA-48 (Oxacillinase-48).  These enzyme abbreviations/names may be familiar, as they have been seen […]

2026-01-05T11:14:29-05:00January 5th, 2026|infectious diseases, Nursing, Public health|0 Comments
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Chagas: An Unfamiliar and Emerging Disease

Ms. Stevens is a 32-year-old humanitarian aid worker. She recently returned to the United States after spending a month volunteering in rural Guatemala, where she was assisting with community housing construction. She reports having had multiple insect bites during her stay and occasional insects in her sleeping quarters. Six months after returning to the U.S., she developed intermittent low-grade fevers, malaise, and mild right eyelid swelling.

Chagas disease—also called American trypanosomiasis—is a potentially life‑threatening infection caused by the parasite Trypanosoma cruzi. The parasite is transmitted primarily through contact with an infected “kissing bug.” Transmission occurs when an infected bug feeds at night and defecates near the bite.

The bitten individual scratches or rubs the bite site and enables the parasites to enter the skin, or the eyes if rubbed. Other transmission routes include congenital (mother‑to‑fetus), blood transfusion, organ transplantation, laboratory accidents, and foodborne outbreaks from contaminated juices or foods. Illness has an acute phase that is often mild or asymptomatic and a chronic phase that can manifest decades later with a variety of cardiac and gastrointestinal symptoms.

Global and U.S. epidemiology

WHO map of global Chagas case distribution (based on 2018 […]

2025-11-07T15:01:57-05:00November 7th, 2025|infectious diseases, Nursing, Public health|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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