Travel-related Salmonella Agama, Gabon

To the Editor: Traveler's diarrhea affects >50% of travelers to regions such as sub-Saharan Africa (1). Worldwide, enterotoxigenic Esch-erichia coli is the leading bacterial pathogen that causes traveler's diarrhea , followed by Campylobacter je-juni and then Salmonella spp., which are the causative pathogens for >25% of traveler's diarrhea in Africa (1). Nontyphoidal salmonellosis is mostly caused by the Salmonella serotypes Enteritidis and Typhimurium (2). To our knowledge, only a few cases of salmonellosis due to S. Agama have been reported in medical literature, none as a travel-related disease (3,4). S. Agama was characterized in 1956 as a new serotype of Salmonella enterica from the feces of the agama lizard (Agama agama) in Nigeria (5). Subsequently , S. Agama was isolated from geckos and mammals in Africa (4,6,7) and the United Kindgom (8,9). Human infections with S. Agama were once reported in Nigeria and related to the lizards as possible reservoirs (4). Another clinical case of S. Agama infection was described in France in a 9-month-old child with fever and diarrhea (3); fruits imported from Africa were discussed as potential source of infection. We report what is, to our knowledge, the fi rst travel-related case of salmonellosis due to Salmonella Agama experienced by a tourist who had traveled to Gabon in central Africa. A previously healthy 25-year-old man in Germany sought treatment for 2 episodes of intermittent fever <39°C, as well as headache, nausea, abdominal pain, diarrhea, arthralgia, and cough. Symptoms started the day he returned from a 1-month trip to Ga-bon, a country in central Africa, where he stayed with a friend who lives near the Albert Schweitzer Hospital in Lambaréné and took occasional excursions to other areas. Before traveling, the patient had been immunized against hepatitis A, hepatitis B, yellow fever, polio, typhoid fever, tetanus, measles, and mumps; he reported taking atova-quone-proguanil for malaria prophy-laxis during his fi rst 3 weeks in Ga-bon. While in Gabon, he frequently drank tap water, ate food sold by street vendors, and had repeated fresh water contact while swimming in the Ogo-oué River. He exhibited no symptoms during his trip. His fi rst examination was performed 2 weeks after his return to Germany and the onset of symptoms. Physical examination showed no pathologic fi ndings, malaria was excluded by repeated thick blood smears, and in the absence of abnormal laboratory fi ndings a common cold disease was assumed on clinical grounds. No specifi …