Neuropsychiatric Symptoms in Travelers
April 15, 2000 2 minutes read
Updates By Carol A. Kemper, MD, FACP
Neuropsychiatric Symptoms in Travelers
Source: Potasman I, et al. J Travel Med 2000;7:5-9.
Much has been made about the possible neuropsychiatric side ef-fects of mefloquine, which may occur in anywhere from 1-27% of travelers receiving this agent for malaria prophylaxis. Potasman and associates in Israel surveyed 2500 travelers to tropical countries regarding their use of antimalarial drugs, neuropsychiatric complaints, and use of recreational drugs. A total of 1340 travelers responded to the questionnaire. Most were young (mean age, 24 years), healthy, and had just finished two to three years of compulsory military service. Just more than half were female. The mean duration of travel was 5.3 months (range, 0.5-24 months). Three-fourths received malaria prophylaxis (71% mefloquine and 5% chloroquine), and 22% admitted to using recreational drugs, such as marijuana, hashish, ecstasy, speed, or mushrooms, although another 12% declined to respond to this portion of the questionnaire.
Remarkably, 11.3% indicated they had experienced some kind of neuropsychiatric symptoms during their trip, ranging from sleep disturbances (52%), fatigue (49%), vivid dreams (48%), dizziness (39%), and inability to function (28%) to frank depression in 0.5%. Severe symptoms were experienced by 2.5%, and 1.2% had prolonged symptoms (> 2 months); none of these patients had any previously identified neuropsychiatric problems. Mefloquine use was significantly more frequent and of greater duration in patients with neuropsychiatric symptoms (P < 0.001). Although the use of recreational drugs could not be eliminated as a possible factor in some patients, Potasman et al believe that mefloquine played a significant role in the development of neuropsychiatric complaints in these young travelers. In addition, the extremely long serum half-life of mefloquine (~21 days) may have contributed to the long duration of symptoms in several patients. Patients receiving mefloquine should be forewarned of the possible neuropsychiatric effects, including the possibility of prolonged symptoms after returning home. Sleep disturbances, including nightmares, were common in young people receiving mefloquine while traveling.
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