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      Serologic Analysis of Returned Travelers with Fever, Sweden

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          Abstract

          We studied 1,432 febrile travelers from Sweden who had returned from malaria-endemic areas during March 2005–March 2008. In 383 patients, paired serum samples were blindly analyzed for influenza and 7 other agents. For 21% of 115 patients with fever of unknown origin, serologic analysis showed that influenza was the major cause.

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          Spectrum of disease and relation to place of exposure among ill returned travelers.

          David O Freedman, Leisa Weld, Phyllis E. Kozarsky … (2006)
          Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s. Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world. Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea. When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences. Copyright 2006 Massachusetts Medical Society.
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            Fever in returned travelers: results from the GeoSentinel Surveillance Network.

            , J S Keystone, L. Weld … (2007)
            Fever is a marker of potentially serious illness in returned travelers. Information about causes of fever, organized by geographic area and traveler characteristics, can facilitate timely, appropriate treatment and preventive measures. Using a large, multicenter database, we assessed how frequently fever is cited as a chief reason for seeking medical care among ill returned travelers. We defined the causes of fever by place of exposure and traveler characteristics. Of 24,920 returned travelers seen at a GeoSentinel clinic from March 1997 through March 2006, 6957 (28%) cited fever as a chief reason for seeking care. Of patients with fever, 26% were hospitalized (compared with 3% who did not have fever); 35% had a febrile systemic illness, 15% had a febrile diarrheal disease, and 14% had fever and a respiratory illness. Malaria was the most common specific etiologic diagnosis, found in 21% of ill returned travelers with fever. Causes of fever varied by region visited and by time of presentation after travel. Ill travelers who returned from sub-Saharan Africa, south-central Asia, and Latin America whose reason for travel was visiting friends and relatives were more likely to experience fever than any other group. More than 17% of travelers with fever had a vaccine-preventable infection or falciparum malaria, which is preventable with chemoprophylaxis. Malaria accounted for 33% of the 12 deaths among febrile travelers. Fever is common in ill returned travelers and often results in hospitalization. The time of presentation after travel provides important clues toward establishing a diagnosis. Preventing and promptly treating malaria, providing appropriate vaccines, and identifying ways to reach travelers whose purpose for travel is visiting friends and relatives in advance of travel can reduce the burden of travel-related illness.
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              Leptospirosis in “Eco-Challenge” Athletes, Malaysian Borneo, 2000

              James J. Sejvar, Elizabeth Bancroft, Kevin L Winthrop … (2003)
              Adventure travel is becoming more popular, increasing the likelihood of contact with unusual pathogens. We investigated an outbreak of leptospirosis in “Eco-Challenge” multisport race athletes to determine illness etiology and implement public health measures. Of 304 athletes, we contacted 189 (62%) from the United States and 26 other countries. Eighty (42%) athletes met our case definition. Twenty-nine (36%) case-patients were hospitalized; none died. Logistic regression showed swimming in the Segama River (relative risk [RR]=2.0; 95% confidence interval [CI]=1.3 to 3.1) to be an independent risk factor. Twenty-six (68%) of 38 case-patients tested positive for leptospiral antibodies. Taking doxycycline before or during the race was protective (RR=0.4, 95% CI=0.2 to 1.2) for the 20 athletes who reported using it. Increased adventure travel may lead to more frequent exposure to leptospires, and preexposure chemoprophylaxis for leptospirosis (200 mg oral doxycycline/week) may decrease illness risk. Efforts are needed to inform adventure travel participants of unique infections such as leptospirosis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): November 2009
                Volume: 15
                Issue: 11
                Pages: 1805-1808
                Affiliations
                [1]Karolinska Institute, Stockholm, Sweden (H.H. Askling, K. Ekdahl)
                [2]Karolinska University Hospital, Stockholm (H.H. Askling, U. Bronner, U. Hellgren)
                [3]Swedish National Board of Health and Welfare, Stockholm (B. Lesko, A. Tegnell)
                [4]Swedish Institute for Infectious Disease Control, Stockholm (B. Lesko, S. Vene, A. Berndtson, J. Struwe)
                [5]Malmö University Hospital, Malmö, Sweden (P. Björkman)
                [6]Lund University Hospital, Lund, Sweden (J. Bläckberg)
                [7]Linköping University Hospital, Linköping, Sweden (P. Follin)
                [8]County Hospital Ryhov, Jönköping, Sweden (M. Palmerus)
                [9]European Centre for Disease Prevention and Control, Stockholm (K. Ekdahl)
                [1 ]These authors contributed equally to this article.
                Author notes
                Address for correspondence: Helena H. Askling, Department of Medicine, Karolinska Institute and Karolinska University Hospital, SE17176 Stockholm, Sweden; email: helena.hervius-askling@ 123456karolinska.se
                Article
                Publisher ID: 09-1157
                DOI: 10.3201/eid1511.091157
                PMC ID: 2857261
                PubMed ID: 19891870
                SO-VID: 5405e4f9-e4e2-4f7e-9a68-de92e55e3d18
                History
                Categories
                Subject: Dispatch

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: fever,bacteria,dengue,influenza,rickettsia,dispatch,traveler,viruses,leptospirosis,serology
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: fever, bacteria, dengue, influenza, rickettsia, dispatch, traveler, viruses, leptospirosis, serology

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