학술논문
Doxycycline responding illnesses in returning travellers with undifferentiated non-malaria fever: a European multicentre prospective cohort study.
Document Type
Academic Journal
Author
Camprubí-Ferrer D; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.; Oteo JA; Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain.; Bottieau E; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium.; Genton B; Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.; Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland.; Balerdi-Sarasola L; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.; Portillo A; Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain.; Cobuccio L; Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.; Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland.; Van Den Broucke S; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium.; Santibáñez S; Center of Rickettsiosis and Arthropod-Borne Diseases, Hospital Universitario San Pedro-CIBIR, Logroño 26006, Spain.; Cadar D; Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Hamburg 20359, Germany.; Rodriguez-Valero N; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.; Almuedo-Riera A; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.; Subirà C; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.; d'Acremont V; Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.; Center for Primary Care and Public Health, University of Lausanne, 1011, Switzerland.; Martinez MJ; Microbiology Department, Hospital Clínic Barcelona, 08036, Spain.; Roldán M; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.; Navero-Castillejos J; Microbiology Department, Hospital Clínic Barcelona, 08036, Spain.; Van Esbroeck M; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium.; Muñoz J; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona 08036, Spain.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 9434456 Publication Model: Print Cited Medium: Internet ISSN: 1708-8305 (Electronic) Linking ISSN: 11951982 NLM ISO Abbreviation: J Travel Med Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Diagnosis of undifferentiated non-malaria fevers (NMF) in returning travellers is a great challenge. Currently, there is no consensus about the use of empirical antibiotics in returning travellers with undifferentiated NMF. Although studies in endemic areas showed that a wide range of pathogens implicated in undifferentiated NMF are treatable with doxycycline, the role of doxycycline in returning travellers with fever still has to be explored.
Methods: Prospective European multicentre cohort study of febrile international travellers (November 2017-November 2019). Immunological and molecular diagnostic techniques for doxycycline responding illnesses (DRI) agents such as Anaplasma phagocytophilum, spotted fever group Rickettsia spp., typhus group Rickettsia spp., Coxiella burnetii, Bartonella spp., Orientia tsutsugamushi, Borrelia miyamotoi, Borrelia recurrentis and Leptospira spp. were systematically performed in all patients with undifferentiated NMF. We estimated the prevalence and predictive factors of DRI in returning travellers with undifferentiated NMF.
Results: Among 347 travellers with undifferentiated NMF, 106 (30·5%) were finally diagnosed with DRI. Only 57 (53·8%) of the 106 DRI infections were diagnosed by the standard of care. The main causes of DRI were: 55 (51·9%) Rickettsia spp., 16 (15·1%) C. burnetii; 15 (14·2%) Bartonella spp.; 13 (12·3%) Leptospira spp. and 10 (9·5%) A. phagocytophilum. The only predictive factor associated with DRI was presenting an eschar (aOR 39·52, 95%CI 4·85-322·18). Features of dengue such as retro-orbital pain (aOR 0·40, 95%CI 0·21-0·76) and neutropenia (aOR 0·41, 95%CI 0·21-0·79) were negatively associated with DRI.
Conclusions: Although DRI are responsible for 30% of undifferentiated NMF cases in travellers, those are seldom recognized during the first clinical encounter. Empirical treatment with doxycycline should be considered in returning travellers with undifferentiated fever and negative tests for malaria and dengue, particularly when presenting severe illness, predictive factors for rickettsiosis or no features of dengue.
(© The Author(s) 2022. Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Methods: Prospective European multicentre cohort study of febrile international travellers (November 2017-November 2019). Immunological and molecular diagnostic techniques for doxycycline responding illnesses (DRI) agents such as Anaplasma phagocytophilum, spotted fever group Rickettsia spp., typhus group Rickettsia spp., Coxiella burnetii, Bartonella spp., Orientia tsutsugamushi, Borrelia miyamotoi, Borrelia recurrentis and Leptospira spp. were systematically performed in all patients with undifferentiated NMF. We estimated the prevalence and predictive factors of DRI in returning travellers with undifferentiated NMF.
Results: Among 347 travellers with undifferentiated NMF, 106 (30·5%) were finally diagnosed with DRI. Only 57 (53·8%) of the 106 DRI infections were diagnosed by the standard of care. The main causes of DRI were: 55 (51·9%) Rickettsia spp., 16 (15·1%) C. burnetii; 15 (14·2%) Bartonella spp.; 13 (12·3%) Leptospira spp. and 10 (9·5%) A. phagocytophilum. The only predictive factor associated with DRI was presenting an eschar (aOR 39·52, 95%CI 4·85-322·18). Features of dengue such as retro-orbital pain (aOR 0·40, 95%CI 0·21-0·76) and neutropenia (aOR 0·41, 95%CI 0·21-0·79) were negatively associated with DRI.
Conclusions: Although DRI are responsible for 30% of undifferentiated NMF cases in travellers, those are seldom recognized during the first clinical encounter. Empirical treatment with doxycycline should be considered in returning travellers with undifferentiated fever and negative tests for malaria and dengue, particularly when presenting severe illness, predictive factors for rickettsiosis or no features of dengue.
(© The Author(s) 2022. Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)