학술논문
Causes of fever in returning travelers: a European multicenter prospective cohort study.
Document Type
Academic Journal
Author
Camprubí-Ferrer D; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Cobuccio L; Swiss Tropical and Public Health Institute, Basel, Switzerland.; Center for Primary Care and Public Health, University of Lausanne, Switzerland.; Van Den Broucke S; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.; Genton B; Swiss Tropical and Public Health Institute, Basel, Switzerland.; Center for Primary Care and Public Health, University of Lausanne, Switzerland.; Bottieau E; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.; d'Acremont V; Swiss Tropical and Public Health Institute, Basel, Switzerland.; Center for Primary Care and Public Health, University of Lausanne, Switzerland.; Rodriguez-Valero N; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Almuedo-Riera A; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Balerdi-Sarasola L; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Subirà C; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Fernandez-Pardos M; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Martinez MJ; Microbiology Department, Hospital Clínic Barcelona, Spain.; Navero-Castillejos J; Microbiology Department, Hospital Clínic Barcelona, Spain.; Vera I; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.; Llenas-Garcia J; Internal Medicine - Infectious Diseases, Vega Baja Hospital, Orihuela, Alicante, Spain.; Clinical Medicine Department, University Miguel Hernández, Elche, Alicante, Spain.; Rothe C; Division of Infectious Diseases and Tropical Medicine, University Hospital LMU, Munich, Germany.; Cadar D; Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Hamburg, Germany.; Van Esbroeck M; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.; Foque N; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.; Muñoz J; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, 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: Etiological diagnosis of febrile illnesses in returning travelers is a great challenge, particularly when presenting with no focal symptoms [acute undifferentiated febrile illnesses (AUFI)], but is crucial to guide clinical decisions and public health policies. In this study, we describe the frequencies and predictors of the main causes of fever in travelers.
Methods: Prospective European multicenter cohort study of febrile international travelers (November 2017-November 2019). A predefined diagnostic algorithm was used ensuring a systematic evaluation of all participants. After ruling out malaria, PCRs and serologies for dengue, chikungunya and Zika viruses were performed in all patients presenting with AUFI ≤ 14 days after return. Clinical suspicion guided further microbiological investigations.
Results: Among 765 enrolled participants, 310/765 (40.5%) had a clear source of infection (mainly traveler's diarrhea or respiratory infections), and 455/765 (59.5%) were categorized as AUFI. AUFI presented longer duration of fever (p < 0.001), higher hospitalization (p < 0.001) and ICU admission rates (p < 0.001). Among travelers with AUFI, 132/455 (29.0%) had viral infections, including 108 arboviruses, 96/455 (21.1%) malaria and 82/455 (18.0%) bacterial infections. The majority of arboviral cases (80/108, 74.1%) was diagnosed between May and November. Dengue was the most frequent arbovirosis (92/108, 85.2%). After 1 month of follow-up, 136/455 (29.9%) patients with AUFI remained undiagnosed using standard diagnostic methods. No relevant differences in laboratory presentation were observed between undiagnosed and bacterial AUFI.
Conclusions: Over 40% of returning travelers with AUFI were diagnosed with malaria or dengue, infections that can be easily diagnosed by rapid diagnostic tests. Arboviruses were the most common cause of AUFI (above malaria) and most cases were diagnosed during Aedes spp. high season. This is particularly relevant for those areas at risk of introduction of these pathogens. Empirical antibiotic regimens including doxycycline or azithromycin should be considered in patients with AUFI, after ruling out malaria and arboviruses.
(© 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 multicenter cohort study of febrile international travelers (November 2017-November 2019). A predefined diagnostic algorithm was used ensuring a systematic evaluation of all participants. After ruling out malaria, PCRs and serologies for dengue, chikungunya and Zika viruses were performed in all patients presenting with AUFI ≤ 14 days after return. Clinical suspicion guided further microbiological investigations.
Results: Among 765 enrolled participants, 310/765 (40.5%) had a clear source of infection (mainly traveler's diarrhea or respiratory infections), and 455/765 (59.5%) were categorized as AUFI. AUFI presented longer duration of fever (p < 0.001), higher hospitalization (p < 0.001) and ICU admission rates (p < 0.001). Among travelers with AUFI, 132/455 (29.0%) had viral infections, including 108 arboviruses, 96/455 (21.1%) malaria and 82/455 (18.0%) bacterial infections. The majority of arboviral cases (80/108, 74.1%) was diagnosed between May and November. Dengue was the most frequent arbovirosis (92/108, 85.2%). After 1 month of follow-up, 136/455 (29.9%) patients with AUFI remained undiagnosed using standard diagnostic methods. No relevant differences in laboratory presentation were observed between undiagnosed and bacterial AUFI.
Conclusions: Over 40% of returning travelers with AUFI were diagnosed with malaria or dengue, infections that can be easily diagnosed by rapid diagnostic tests. Arboviruses were the most common cause of AUFI (above malaria) and most cases were diagnosed during Aedes spp. high season. This is particularly relevant for those areas at risk of introduction of these pathogens. Empirical antibiotic regimens including doxycycline or azithromycin should be considered in patients with AUFI, after ruling out malaria and arboviruses.
(© 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.)