West Africa

Malaria is endemic throughout much of West Africa, and shows high transmission rates, particularly in the forested regions. Any traveler from West Africa with fever should be investigated for malaria without delay. Ear, nose, and throat diseases in HIV patients include cervical lymphadenopathy, otitis media, oral candidiasis, and tonsillar diseases. HIV should always be considered in patients with fever for more than four weeks. In patients from West Africa with chronic genitourinary infections, tuberculosis and Schistosoma haematobium infection must be considered. S. haematobium may cause hematuria and hemospermia. Infections in the immunocompromised host are similar to those in the immunocompetent host. Infections causing the greatest mortality in children under five years of age include pneumonia (21%), diarrheal disease (17%), malaria (17%), HIV/AIDS (7%), and measles (4%). These are linked directly to socioeconomic status but for pneumonia and measles, appropriate vaccine coverage would significantly reduce mortality and morbidity.