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Antinori S, Ridolfo AL, Grande R, Galimberti L, Casalini G, Giacomelli A, Milazzo L. Loop-mediated isothermal amplification (LAMP) assay for the diagnosis of imported malaria: a narrative review. LE INFEZIONI IN MEDICINA 2022; 29:355-365. [PMID: 35146340 DOI: 10.53854/liim-2903-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 11/03/2022]
Abstract
Loop-mediated isothermal amplification (LAMP) is a molecular method to detect malaria recently introduced in the market. LAMP is simple to perform and does not require advanced equipment and training thus satisfying the qualification as a point-of-care diagnostic screening test. In this narrative review, we focus on the role of LAMP for malaria diagnosis in non-endemic settings. We searched PubMed, Embase, Scopus, and Google Scholar, using the following search terms: 'Malaria LAMP' in combination with 'imported malaria' or 'travellers' malaria' or 'non-endemic setting' or 'non-endemic region' or 'malaria screening' or 'malaria diagnosis'. References of each article were also reviewed for possible studies or reports not identified in our search. Overall, 18 studies encompassing 6289 tested samples with 1663 confirmed malaria diagnoses were retrieved. Most of these studies (13/18, 72.2%) were conducted in Europe, and almost half were retrospective. Fourteen studies (77.8%) employed real-time or nested-polymerase chain reaction as the reference method for confirming malaria diagnosis. Sensitivity of LAMP ranged from 93.9 to 100% and specificity from 93.8 to 100% with a negative predictive value of 99.6%-100%. The rate of reported invalid results requiring repeat of the test varied from 0.01% to 5.7%, but they were solved in the majority of cases with a secondary analysis. In non-endemic countries the adoption of LAMP malaria assay as the screening test for malaria diagnosis seems to perform better than conventional methods. However, blood microscopy remains essential to either identify Plasmodium species and quantify parasitaemia and adequately managing malaria cases.
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Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Romualdo Grande
- Clinical Microbiology, Virology and Bioemergency, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Giacomo Casalini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milano, Italy
| | - Andrea Giacomelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
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Evaluation of Neighborhood Socio-Economic Status, as Measured by the Delphi Method, on Dengue Fever Distribution in Jeddah City, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126407. [PMID: 34199216 PMCID: PMC8296257 DOI: 10.3390/ijerph18126407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
Abstract
Dengue fever, a mosquito-transmitted viral disease, is present in many neighborhoods in Jeddah City, Saudi Arabia. One factor likely to affect its distribution is the socio-economic status of local neighborhoods; however, the absence of socio-economic census data in Saudi Arabia has precluded detailed investigation. This study aims to develop a proxy measure of socio-economic status in Jeddah City in order to assess its relationship with the occurrence of dengue fever. The Delphi method was used to assess the socio-economic status (high, medium or low) of local neighborhoods in Jeddah City. A Geographic Information System (GIS) was applied to understand the distribution of dengue fever according to the socio-economic status of Jeddah City neighborhoods. Low-socio-economic status neighborhoods in south Jeddah City, with poor environmental conditions and high levels of poverty and population density, reported most cases of dengue fever. Nevertheless, dengue continues to increase in high socio-economic status neighborhoods in the northern part of the city, possibly due to ideal breeding conditions caused by the presence of standing water associated with high levels of construction. Moreover, the low-socioeconomic-status neighborhoods had the highest average number of cases, being 3.95 times that of high-status neighborhoods for the period 2006–2009. The Delphi approach can produce a useful and robust measure of socio-economic status for use in the analysis of patterns of dengue fever. Results suggest that there are nuances in the relationship between socio-economic status and dengue that indicate that higher status areas are also at risk. A useful additional tool for researchers in Saudi Arabia would be the development of census data or other systematic measures that allow socio-economic status to be included in spatial analyses of dengue fever and other diseases.
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Wright WF, Auwaerter PG. Fever and Fever of Unknown Origin: Review, Recent Advances, and Lingering Dogma. Open Forum Infect Dis 2020; 7:ofaa132. [PMID: 32462043 PMCID: PMC7237822 DOI: 10.1093/ofid/ofaa132] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
Fever has preoccupied physicians since the earliest days of clinical medicine. It has been the subject of scrutiny in recent decades. Historical convention has mostly determined that 37.0°C (98.6°F) should be regarded as normal body temperature, and more modern evidence suggests that fever is a complex physiological response involving the innate immune system and should not be characterized merely as a temperature above this threshold. Fever of unknown origin (FUO) was first defined in 1961 by Petersdorf and Beeson and continues to be a clinical challenge for physicians. Although clinicians may have some understanding of the history of clinical thermometry, how average body temperatures were established, thermoregulation, and pathophysiology of fever, new concepts are emerging. While FUO subgroups and etiologic classifications have remained unchanged since 1991 revisions, the spectrum of diseases, clinical approach to diagnosis, and management are changing. This review considers how newer data should influence both definitions and lingering dogmatic principles. Despite recent advances and newer imaging techniques such as 18-fluorodeoxyglucose-positron emission tomography, clinical judgment remains an essential component of care.
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Affiliation(s)
- William F Wright
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Paul G Auwaerter
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
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Affiliation(s)
- Doug Fink
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Robert Serafino Wani
- Department of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Victoria Johnston
- The Hospital for Tropical Diseases, Mortimer Market Centre, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Affiliation(s)
- Rodrigo Nogueira Angerami
- Epidemiological Surveillance Section, Division of Infectious Diseases, Hospital of Clinics; University of Campinas and Department of Public Health, School of Medical Sciences, University of Campinas; Campinas São Paulo Brazil
| | - Luiz Jacintho da Silva
- Division of Infectious Diseases, Department of Internal Medicine, School of Medical Sciences; University of Campinas; Campinas São Paulo Brazil
| | - Alfonso J. Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences; Universidad Tecnologica de Pereira; Pereira Risaralda Colombia
- Infectious Diseases Research Group; Hospital Universitario de Sincelejo; Sucre Colombia
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Jazuli F, Lynd T, Mah J, Klowak M, Jechel D, Klowak S, Ovens H, Sabbah S, Boggild AK. Evaluation of a programme for 'Rapid Assessment of Febrile Travelers' (RAFT): a clinic-based quality improvement initiative. BMJ Open 2016; 6:e010302. [PMID: 27473947 PMCID: PMC4985841 DOI: 10.1136/bmjopen-2015-010302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/12/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fever in the returned traveller is a potential medical emergency warranting prompt attention to exclude life-threatening illnesses. However, prolonged evaluation in the emergency department (ED) may not be required for all patients. As a quality improvement initiative, we implemented an algorithm for rapid assessment of febrile travelers (RAFT) in an ambulatory setting. METHODS Criteria for RAFT referral include: presentation to the ED, reported fever and travel to the tropics or subtropics within the past year. Exclusion criteria include Plasmodium falciparum malaria, and fulfilment of admission criteria such as unstable vital signs or significant laboratory derangements. We performed a time series analysis preimplementation and postimplementation, with primary outcome of wait time to tropical medicine consultation. Secondary outcomes included number of ED visits averted for repeat malaria testing, and algorithm adherence. RESULTS From February 2014 to December 2015, 154 patients were seen in the RAFT clinic: 68 men and 86 women. Median age was 36 years (range 16-78 years). Mean time to RAFT clinic assessment was 1.2±0.07 days (range 0-4 days) postimplementation, compared to 5.4±1.8 days (range 0-26 days) prior to implementation (p<0.0001). The RAFT clinic averted 132 repeat malaria screens in the ED over the study period (average 6 per month). Common diagnoses were: traveller's diarrhoea (n=27, 17.5%), dengue (n=12, 8%), viral upper respiratory tract infection (n=11, 7%), chikungunya (n=10, 6.5%), laboratory-confirmed influenza (n=8, 5%) and lobar pneumonia (n=8, 5%). CONCLUSIONS In addition to provision of more timely care to ambulatory febrile returned travellers, we reduced ED bed-usage by providing an alternate setting for follow-up malaria screening, and treatment of infectious diseases manageable in an outpatient setting, but requiring specific therapy.
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Affiliation(s)
- Farah Jazuli
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Terence Lynd
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Mah
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Dale Jechel
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stefanie Klowak
- Tropical Disease Unit, Division of Infectious Diseases, UHN-Toronto General Hospital, Toronto, Ontario, Canada
| | - Howard Ovens
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Sam Sabbah
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, UHN-Toronto General Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, Ontario, Canada
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Doltario AB, Menon LJB, Bollela VR, Martinez R, de Almeida E Araújo DC, da Fonseca BAL, Santana RDC. Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region. Malar J 2016; 15:294. [PMID: 27230739 PMCID: PMC4882771 DOI: 10.1186/s12936-016-1347-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/17/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Malaria is endemic in countries located in tropical and sub-tropical regions. The increasing flow of domestic and international travellers has made malaria a relevant health problem even in non-endemic regions. Malaria has been described as the main diagnosis among travellers presenting febrile diseases after returning from tropical countries. In Brazil, malaria transmission occurs mainly in the Amazon region. Outside this area, malaria transmission is of low magnitude. METHODS This cross-sectional study aimed to describe the experience in the diagnosis of malaria in a reference centre located outside the Brazilian Amazon Region, emphasizing the differences in clinical and laboratory markers between cases of malaria and those of other febrile diseases (OFD). Medical charts from adult patients (≥18 years) who underwent a thick smear test (TST) for malaria, between January 2001 and December 2014, were retrospectively reviewed. RESULTS A total of 458 cases referred to perform the TST were included. Malaria was diagnosed in 193 (42 %) episodes. The remaining 265 episodes (58 %) were grouped as OFD. The majority of malaria episodes were acquired in the Brazilian Amazon Region. The median time between the onset of symptoms and the TST was 7 days. Only 53 (11.5 %) episodes were tested within the first 48 h after symptom onset. Comparing malaria with OFD, jaundice, nausea, vomiting, and reports of fever were more prevalent in the malaria group. Low platelet count and elevated bilirubin levels were also related to the diagnosis of malaria. CONCLUSIONS The results indicate that outside the endemic area travellers presenting febrile disease suspected of being malaria underwent diagnostic test after considerable delay. The reporting of fever combined with a recent visit to an endemic area should promptly evoke the hypothesis of malaria. In these cases, specific diagnostic tests for malaria should be a priority. For cases that jump this step, the presence of elevated bilirubin or thrombocytopaenia should also indicate a diagnosis of malaria.
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Affiliation(s)
- Andréa Beltrami Doltario
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Lucas José Bazzo Menon
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Valdes Roberto Bollela
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Roberto Martinez
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Daniel Cardoso de Almeida E Araújo
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Benedito Antônio Lopes da Fonseca
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Rodrigo de C Santana
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, 14049-900, Brazil.
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Kariyawasam R, Lau R, Eshaghi A, Patel SN, Sider D, Gubbay JB, Boggild AK. Spectrum of Viral Pathogens in Blood of Malaria-Free Ill Travelers Returning to Canada. Emerg Infect Dis 2016; 22:854-61. [PMID: 27089008 PMCID: PMC4861526 DOI: 10.3201/eid2205.151875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Malaria is the most common specific cause of fever in returning travelers, but many other vectorborne infections and viral infections are emerging and increasingly encountered by travelers. We documented common and emerging viral pathogens in malaria-negative specimens from ill travelers returning to Canada. Anonymized, malaria-negative specimens were examined for various viral pathogens by real-time PCR. Samples were positive for herpes simplex viruses 1 or 2 (n = 21, 1.6%), cytomegalovirus (n = 4, 0.3%), Epstein-Barr virus (n = 194, 14.9%), dengue virus types 1-4 (n = 27, 2.1%), chikungunya virus (n = 5, 0.4%), and hepatitis A virus (n = 12, 0.9%). Travel-acquired viral pathogens were documented in >20% of malaria-negative specimens, of which 2.5% were infected with dengue and chikungunya viruses. Our findings support the anecdotal impression that these vectorborne pathogens are emerging among persons who travel from Canada to other countries.
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Dakić Z, Nikolić A, Lavadinović L, Pelemiš M, Klun I, Dulović O, Milošević B, Stevanović G, Ofori-Belić I, Poluga J, Djurković-Djaković2 O, Pavlović M. Imported parasitic infections in Serbia. Eur J Microbiol Immunol (Bp) 2015; 1:80-5. [PMID: 24466436 DOI: 10.1556/eujmi.1.2011.1.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Travel to the tropics is associated with a risk of parasitic infection, which is increasing in parallel with the rise in travel to these areas. We thus examined the prevalence and trend in the occurrence of parasitic infections in Serbian travelers. METHODS A retrospective analysis of the medical records of all travelers returning from tropical and subtropical areas, who presented at the Institute for Infectious and Tropical Diseases in Belgrade between January 2001 and January 2008, was performed. RESULTS Of a total of 2440 travelers, 169 (6.9%) were diagnosed with a parasitic infection, including malaria in 79, intestinal parasites in 84 (pathogenic species in 30 and non-pathogenic in 54), filariasis in four, and visceral leishmaniasis and fascioliasis in one patient each. Importantly, of the whole series only 583 (23.9%) were symptomatic, of which 19.4% were found to be infected with a parasite. The single pathogenic parasite occurring in asymptomatic patients was Giardia intestinalis. CONCLUSIONS Parasitic infection causing symptomatic disease among travelers returning from tropical areas to Serbia is not infrequent. In view of the expected increase in travel to the tropics, diagnostic protocols for tropical parasitic diseases should take these data into account.
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Syndromic Approach to Arboviral Diagnostics for Global Travelers as a Basis for Infectious Disease Surveillance. PLoS Negl Trop Dis 2015; 9:e0004073. [PMID: 26372010 PMCID: PMC4570817 DOI: 10.1371/journal.pntd.0004073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/20/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Arboviruses have overlapping geographical distributions and can cause symptoms that coincide with more common infections. Therefore, arbovirus infections are often neglected by travel diagnostics. Here, we assessed the potential of syndrome-based approaches for diagnosis and surveillance of neglected arboviral diseases in returning travelers. METHOD To map the patients high at risk of missed clinical arboviral infections we compared the quantity of all arboviral diagnostic requests by physicians in the Netherlands, from 2009 through 2013, with a literature-based assessment of the travelers' likely exposure to an arbovirus. RESULTS 2153 patients, with travel and clinical history were evaluated. The diagnostic assay for dengue virus (DENV) was the most commonly requested (86%). Of travelers returning from Southeast Asia with symptoms compatible with chikungunya virus (CHIKV), only 55% were tested. For travelers in Europe, arbovirus diagnostics were rarely requested. Over all, diagnostics for most arboviruses were requested only on severe clinical presentation. CONCLUSION Travel destination and syndrome were used inconsistently for triage of diagnostics, likely resulting in vast under-diagnosis of arboviral infections of public health significance. This study shows the need for more awareness among physicians and standardization of syndromic diagnostic algorithms.
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Aldea M, García-Basteiro AL, Muñoz J, Gascón J, Aldasoro E, Bardají A, Vilella A. Factors associated with risk behavior in travelers to tropical and subtropical regions. Int Health 2014; 7:272-9. [DOI: 10.1093/inthealth/ihu076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 09/19/2014] [Indexed: 11/14/2022] Open
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Cleton N, Reusken C, Murk JL, de Jong M, Reimerink J, van der Eijk A, Koopmans M. Using routine diagnostic data as a method of surveillance of arboviral infection in travellers: A comparative analysis with a focus on dengue. Travel Med Infect Dis 2014; 12:159-66. [DOI: 10.1016/j.tmaid.2013.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 11/26/2022]
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Botelho-Nevers E, Laurencin S, Delmont J, Parola P. Imported malaria in pregnancy: a retrospective study of 18 cases in Marseilles, France. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 99:715-8. [PMID: 16212804 DOI: 10.1179/136485905x65099] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- E Botelho-Nevers
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille Cedex 20, France
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Abstract
Liver disease is an important source of morbidity among ill returning travelers. Jaundice is one of the most common and obvious symptoms of liver disease, the differential diagnosis of which is extensive, especially in travelers. Jaundice in travelers can arise from both infectious and noninfectious causes. We herein summarize the most common parasitic etiologies that may lead to jaundice in the returned traveler, visitors of friends and relatives, or new immigrants, and describe the etiology, epidemiology, and pathogenesis of clinical features of each.
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Affiliation(s)
- Wilson W Chan
- Calgary Laboratory Services, Calgary, Alberta, Canada
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Beltrame A, Angheben A, Casolari S, Castelli F, Magnani G, Gaiera G, Brillo F, Cattani G, Anselmi M, Tomasoni L, Prati F, Norberto C, Socolovschi C, Bisoffi Z, Raoult D, Parola P. Imported rickettsioses in Italy. Travel Med Infect Dis 2012; 10:201-4. [DOI: 10.1016/j.tmaid.2012.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 05/23/2012] [Accepted: 05/28/2012] [Indexed: 11/26/2022]
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[Travel-related fever]. Rev Med Interne 2011; 32 Suppl 2:S224-30. [PMID: 22035804 DOI: 10.1016/j.revmed.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Boggild A, Ghesquiere DW, McCarthy DA. Fever in the Returning International Traveller Initial Assessment Guidelines: Committee to Advise on Tropical Medicine and Travel (CATMAT). CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2011; 37:1-15. [PMID: 31682659 PMCID: PMC6802436 DOI: 10.14745/ccdr.v37i00a03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Regarding: “Influenza-Like Illness as an Atypical Presentation of Falciparum Malaria in a Traveler from Africa”. J Emerg Med 2011; 41:82-3; author reply 83-4. [DOI: 10.1016/j.jemermed.2010.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/28/2010] [Indexed: 11/20/2022]
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Siikamäki HM, Kivelä PS, Sipilä PN, Kettunen A, Kainulainen MK, Ollgren JP, Kantele A. Fever in travelers returning from malaria-endemic areas: don't look for malaria only. J Travel Med 2011; 18:239-44. [PMID: 21722234 DOI: 10.1111/j.1708-8305.2011.00532.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Returning travelers with fever pose challenges for clinicians because of the multitude of diagnostic alternatives. Case data in a Finnish tertiary hospital were analyzed in order to define the causes of fever in returned travelers and to evaluate the current diagnostic approach. METHODS A retrospective study of patient records comprised 462 febrile adults who, after traveling in malaria-endemic areas, were admitted to the Helsinki University Central Hospital (HUCH) emergency room from 2005 to 2009. These patients were identified through requests for malaria smear. RESULTS The most common groups of diagnoses were acute diarrheal disease (126 patients/27%), systemic febrile illness (95/21%), and respiratory illness (69/15%). The most common specific main diagnosis was Campylobacter infection (40/9%). Malaria was diagnosed in 4% (20/462). Blood culture was positive for bacteria in 5% of those tested (21/428). Eight patients were diagnosed with influenza. HIV-antibodies were tested in 174 patients (38%) and proved positive in 3% of them (5/174, 1% of all patients). The cause of fever was noninfectious in 12 (3%), remaining unknown in 116 (25%). Potentially life-threatening illnesses were diagnosed in 118 patients (26%), the strongest risk factors were baseline C-reactive protein (CRP) ≥100 (OR 3.6; 95% CI 2.0-6.4) and platelet count ≤140 (OR 3.8; 95% CI 2.0-7.3). Nine patients (2%) were treated in high dependency or intensive care units; one died of septicemia. Forty-five patients (10%) had more than one diagnosis. CONCLUSION The high proportion of patients with more than one diagnosis proves the importance of careful diagnostics. Every fourth returning traveler with fever had a potentially life-threatening illness. Septicemia was as common as malaria. The proportion of HIV cases exceeded the prevalence in population for which Centers for Disease Control and Prevention, USA (CDC) recommends routine HIV testing. Both blood cultures and HIV tests should be considered in febrile travelers.
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Affiliation(s)
- Heli M Siikamäki
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Ansart S, Perez L, Thellier M, Danis M, Bricaire F, Caumes E. Predictive factors of imported malaria in 272 febrile returning travelers seen as outpatients. J Travel Med 2010; 17:124-9. [PMID: 20412180 DOI: 10.1111/j.1708-8305.2009.00382.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We conducted a prospective study to evaluate the aetiologies of fever in returning travelers and to identify the clinical and laboratory factors predictive of malaria in travelers returning from tropical areas with fever. METHODS We included those consulting for fever appearing less than 3 months after return. Destinations were classified according to the visited continent (America including Caribbean, Asia, Africa, Oceania). We prospectively included all returning travelers consulting our department between November 2002 and May 2003 for health problems and investigated those presenting fever within 3 months after return from a tropical country. We then conducted a case control study to identify factors predictive of malaria. Control group was defined as febrile travelers without malaria. RESULTS A total of 272 febrile travelers were included. They were 152 tourists (55.9%), 58 immigrants (21.3%), 33 expatriates (12.1%), and 29 business travelers (10.7%). Besides malaria (54 cases), the main diagnosis in the 218 controls were bacterial enteritis, bacterial pneumonia, infectious cellulitis, pyelonephritis, prostatis, dengue fever, primary viral infection (HIV, EBV, CMV, parvovirus B19), and tuberculosis. Multivariate regression analysis showed correlations between malaria and travel to Africa (OR = 11.9), abdominal pain (OR = 14.1), vomiting (OR = 19.4), myalgia (OR = 6.3), inadequate prophylaxis (OR = 10.1), and platelets <150,000/microL (OR = 25.2). CONCLUSIONS Our results suggest that no single clinical or biological feature had both good sensitivity and specificity to predict malaria in febrile travelers seen as outpatients within 3 months after returning from the tropics.
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Affiliation(s)
- Séverine Ansart
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Pitié-Salpêtrière, Paris, France.
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Askling HH, Lesko B, Vene S, Berndtson A, Björkman P, Bläckberg J, Bronner U, Follin P, Hellgren U, Palmerus M, Ekdahl K, Tegnell A, Struwe J. Serologic analysis of returned travelers with fever, Sweden. Emerg Infect Dis 2010; 15:1805-8. [PMID: 19891870 PMCID: PMC2857261 DOI: 10.3201/eid1511.091157] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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Affiliation(s)
- Helena H Askling
- Department of Medicine, Karolinska Institute and Karolinska University Hospital, SE17176 Stockholm, Sweden.
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Nic Fhogartaigh C, Hughes H, Armstrong M, Herbert S, McGregor A, Ustianowski A, Whitty CJM. Falciparum malaria as a cause of fever in adult travellers returning to the United Kingdom: observational study of risk by geographical area. QJM 2008; 101:649-56. [PMID: 18586767 DOI: 10.1093/qjmed/hcn072] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The probability that a returned traveller with a history of fever has malaria is likely to vary by geographical area, but this has not been quantified in travellers. AIM To collect data on prevalence of malaria in outpatients returning with a fever or history of fever from malaria-endemic countries, at the point of presentation for a malaria test. DESIGN Observational retrospective study. Consecutive patients presenting to an unselected 'walk-in' clinic for returned travellers. RESULTS Of 2867 patients meeting inclusion criteria, 337 (11.8%) had malaria, 89.5% originating in sub-Saharan Africa. Of travellers returning from sub-Saharan Africa excluding South Africa with fever/history of fever, 291/1497 had malaria (19.4%, 95% CI 17-21%). A high proportion was visiting friends and relatives. In those from other areas the proportions were: 16/707 (2.3%, 95% CI 1.5-3.8) from Indian subcontinent/Southeast Asia; 2/143 (1.4%) from Southern America; 4/129 (3.1%) from South Africa; 1/44 (2.3%) from North Africa; and 8/41 (19.5%) from Oceania. Compared to other malaria-endemic regions, African travel gave an adjusted odds ratio of 7.8 (95% CI 5.4-11.2, P < 0.0001). Only 45.1% of malaria cases had a fever (> or =37.5 degrees C) at the time of presentation. Only 3% of all diagnoses of malaria had no history of fever. In 28% of cases parasite count increased in the initial 24 h of antimalarial treatment. CONCLUSION The likelihood that a patient with fever returning from Africa has malaria is high (around 1 in 5), and is significantly lower from other areas. Absence of fever at presentation does not exclude malaria.
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Affiliation(s)
- C Nic Fhogartaigh
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London WC1E 6AU, UK
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24
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Leder K, Wilson ME, Freedman DO, Torresi J. A comparative analysis of methodological approaches used for estimating risk in travel medicine. J Travel Med 2008; 15:263-72. [PMID: 18666927 DOI: 10.1111/j.1708-8305.2008.00218.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Karin Leder
- Victorian Infectious Diseases Service, Centre for Clinical Research Excellence, Royal Melbourne Hospital, Victoria, Australia.
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A retrospective study of 230 consecutive patients hospitalized for presumed travel-related illness (2000-2006). Eur J Clin Microbiol Infect Dis 2008; 27:1137-40. [PMID: 18548294 PMCID: PMC7087768 DOI: 10.1007/s10096-008-0555-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 05/12/2008] [Indexed: 11/27/2022]
Abstract
A good knowledge of morbidity profiles among ill-returned travelers is necessary in order to guide their management. We reviewed the medical charts of 230 patients hospitalized in one infectious diseases department in France for presumed travel-related illnesses. The male-to-female ratio was 1.6 and the median age was 33 years (interquartile range [IQR], 25–50). Most patients (70.9%) were returning from sub-Saharan Africa. The median duration of travel was 28 days (IQR, 15–60) and the median time from return of travel to hospitalization was 13 days (IQR, 7–21). Malaria was the most frequent diagnosis (49.1%), which was especially encountered in patients returning from sub-Saharan Africa (95.6%), without adequate chemoprophylaxis (78.2%). Imported diseases at risk of secondary transmission were also diagnosed, including pulmonary tuberculosis (n = 8), viral hepatitis (n = 8), typhoid fever (n = 6), human immunodeficiency virus (HIV) (six new diagnosis), non-typhoid salmonellosis (n = 5), severe acute respiratory syndrome, and Crimean-Congo hemorrhagic fever. This study underlines the need to maintain tropical expertise for infectious diseases physicians, even in Europe.
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Camps M, Vilella A, Marcos MA, Letang E, Muñoz J, Salvadó E, González A, Gascón J, Jiménez de Anta MT, Pumarola T. Incidence of respiratory viruses among travelers with a febrile syndrome returning from tropical and subtropical areas. J Med Virol 2008; 80:711-5. [PMID: 18297697 PMCID: PMC7166809 DOI: 10.1002/jmv.21086] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fifty million people are estimated to travel from industrial countries to the tropics annually. In spite of exhaustive studies and widely different diagnosis among returned patients, some cases of febrile illnesses remain without an etiological diagnosis, suggesting that these cases could be due to viral respiratory tract infections. From August 2005 to October 2006, 118 febrile patients without a specific diagnosis in their first visit at the Center for International Health of the Hospital Clínic of Barcelona were included. In all of them, in order to study respiratory viruses, a nasopharyngeal swab was collected. Clinical and radiological features and epidemiological data, as well as other samples for microbiologic studies, were also collected during consultation. Based on the physician's judgment at the time of consultation, patients were classified into four groups: respiratory symptoms (62%), febrile syndrome with nonspecific symptoms (24%), digestive symptoms (10%), and patients presenting both respiratory and digestive symptoms (4%). A pathogen microorganism was detected in 61 patients (52%). Respiratory viruses were detected in 44 out of 118 (37%) travelers included in the study, representing 56% of the patients with respiratory symptoms. The most frequently viruses detected were influenza virus (38%), rhinovirus (23%), adenovirus (9%), and respiratory syncytial virus (9%). Respiratory viruses have been shown to play an important role in imported fever. In light of the fact that international tourism is an increasing phenomenon, new strategies to prevent the spread of respiratory viruses should be considered, specially for influenza when a vaccine is available. J. Med. Virol. 80:711–715, 2008. © 2008 Wiley‐Liss, Inc.
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Affiliation(s)
- M Camps
- Department of Microbiology, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain.
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Speil C, Mushtaq A, Adamski A, Khardori N. Fever of unknown origin in the returning traveler. Infect Dis Clin North Am 2008; 21:1091-113, x. [PMID: 18061090 DOI: 10.1016/j.idc.2007.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The returning traveler with fever presents a diagnostic challenge for the health care provider. When evaluating such a patient, the highest priority should be given to diseases that are potentially fatal or may represent public health threats. A good history is paramount and needs to include destination, time and duration of travel, type of activity, onset of fever in relation to travel, associated comorbidities, and any associated symptoms. Pretravel immunizations and chemoprophylaxis may alter the natural course of disease and should be inquired about specifically. The fever pattern, presence of a rash or eschar, organomegaly, or neurologic findings are helpful physical findings. Laboratory abnormalities are nonspecific but when corroborated with clinical and epidemiologic data may offer a clue to diagnosis.
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Affiliation(s)
- Cristian Speil
- Division of Infectious Diseases, Department of Internal Medicine and Medical Microbiology/Immunology, Southern Illinois School of Medicine, Springfield, IL 62794-9636, USA
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Wilson ME, Schwartz E. Fever. TRAVEL MEDICINE 2008. [PMCID: PMC7152452 DOI: 10.1016/b978-0-323-03453-1.10053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wilson ME, Weld LH, Boggild A, Keystone JS, Kain KC, von Sonnenburg F, Schwartz E. Fever in returned travelers: results from the GeoSentinel Surveillance Network. Clin Infect Dis 2007; 44:1560-8. [PMID: 17516399 DOI: 10.1086/518173] [Citation(s) in RCA: 235] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Accepted: 02/21/2007] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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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Gkrania-Klotsas E, Lever AML. An update on malaria prevention, diagnosis and treatment for the returning traveller. Blood Rev 2007; 21:73-87. [PMID: 16815604 DOI: 10.1016/j.blre.2006.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The diagnosis of malaria needs to be considered for every returning traveller with a fever. Compliance with prevention, both pharmaceutical and non-pharmaceutical, is essential for every traveller. New tests for diagnosis are now available. Treatment options have recently expanded to include the artemisinin derivatives that used to be unavailable in the western countries.
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31
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Parola P, Soula G, Gazin P, Foucault C, Delmont J, Brouqui P. Fever in travelers returning from tropical areas: prospective observational study of 613 cases hospitalised in Marseilles, France, 1999-2003. Travel Med Infect Dis 2006; 4:61-70. [PMID: 16887726 PMCID: PMC7106190 DOI: 10.1016/j.tmaid.2005.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 01/06/2005] [Accepted: 01/10/2005] [Indexed: 11/25/2022]
Abstract
Background Febrile travelers may pose a diagnostic challenge for Western physicians who are frequently involved in the assessment of these patients but unfamiliar with tropical diseases. Evaluation of this situation requires an understanding of the common etiologies, which are associated with the demographics of travelers and the destinations. Methods We conducted a 5-year prospective observational study on the etiologies of fever in travelers returning from the tropics admitted to the infectious and tropical diseases unit of a university teaching hospital in Marseilles, France. Results A total of 613 patients were enrolled, including 364 migrants (59.4%), 126 travelers (20.6%), 37 visitors (6%), 24 expatriates (3.9%), and 62 patients (10.1%) who could not be classified. Malaria was the most common diagnosis (75.2%), with most cases (62%) acquired by migrants from the Comoros archipelago and who had traveled to these islands to visit friends and relatives. Agents of food-borne and water-borne infections (3.9%) and respiratory tract infections (3.4%) were also frequently identified as the cause of fever. Other infections included emerging diseases such as gnathostomiasis, hepatitis E infection and rickettsial diseases, as well as common infections or exotic diseases. Conclusions Although we have identified here various causes of imported fever, 8.2% of the fevers remained unexplained. An improved approach to diagnosis may allow for the discovery of new diseases in travelers in the future.
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Affiliation(s)
- Philippe Parola
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Laboratoire de Parasitologie et Mycologie, INSERM U399, IFR 48, 27 Bd. Jean Moulin, 13385 Marseille Cedex 5, France
| | - Georges Soula
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Centre de Formation et Recherche en Médecine et Santé Tropicales, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Marseille cedex 20, France
| | - Pierre Gazin
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Centre de Formation et Recherche en Médecine et Santé Tropicales, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Marseille cedex 20, France
| | - Cedric Foucault
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
| | - Jean Delmont
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Centre de Formation et Recherche en Médecine et Santé Tropicales, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, 13916 Marseille cedex 20, France
| | - Philippe Brouqui
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, 13015 Marseille, France
- Corresponding author. Tel.: +33 491 96 89 35; fax: +33 491 96 89 38.
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O'Brien DP, Leder K, Matchett E, Brown GV, Torresi J. Illness in returned travelers and immigrants/refugees: the 6-year experience of two Australian infectious diseases units. J Travel Med 2006; 13:145-52. [PMID: 16706945 DOI: 10.1111/j.1708-8305.2006.00033.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data comparing returned travelers and immigrants/refugees managed in a hospital setting is lacking. METHODS We prospectively collected data on 1,106 patients with an illness likely acquired overseas who presented to two hospital-based Australian infectious diseases units over a 6-year period. RESULTS Eighty-three percent of patients were travelers and 17% immigrants/refugees. In travelers, malaria (19%), gastroenteritis/diarrhea (15%), and upper respiratory tract infection (URTI) (7%) were the most common diagnoses. When compared with immigrants/refugees, travelers were significantly more likely to be diagnosed with gastroenteritis/diarrhea [odds ratio (OR) 8], malaria (OR 7), pneumonia (OR 6), URTI (OR 3), skin infection, dengue fever, typhoid/paratyphoid fever, influenza, and rickettsial disease. They were significantly less likely to be diagnosed with leprosy (OR 0.03), chronic hepatitis (OR 0.04), tuberculosis (OR 0.05), schistosomiasis (OR 0.3), and helminthic infection (OR 0.3). In addition, travelers were more likely to present within 1 month of entry into Australia (OR 96), and have fever (OR 8), skin (OR 6), gastrointestinal (OR 5), or neurological symptoms (OR 5) but were less likely to be asymptomatic (OR 0.1) or have anaemia (OR 0.4) or eosinophilia (OR 0.3). Diseases in travelers were more likely to have been acquired via a vector (OR 13) or food and water (OR 4), and less likely to have been acquired via the respiratory (OR 0.2) or skin (OR 0.6) routes. We also found that travel destination and classification of traveler can significantly influence the likelihood of a specific diagnosis in travelers. Six percent of travelers developed a potentially vaccine-preventable disease, with failure to vaccinate occurring in 31% of these cases in the pretravel medical consultation. CONCLUSIONS There are important differences in the spectrum of illness, clinical features, and mode of disease transmission between returned travelers and immigrants/refugees presenting to hospital-based Australian infectious diseases units with an illness acquired overseas.
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Affiliation(s)
- Daniel P O'Brien
- Victorian Infectious Diseases Service, Centre for Clinical Research Excellence, Royal Melbourne Hospital, Victoria, Australia.
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Abstract
BACKGROUND The incidence of imported disease within the emergency department (ED) is not known, but a significant number of patients present to medical services after return from traveling. Unless practitioners in ED are aware of the potential for nonendemic disease in the population of patients they attend, there is a possibility that imported diseases will not be diagnosed in the acute setting. METHOD A questionnaire was sent to all medical practitioners involved in assessing patients presenting to the EDs of hospitals. This questionnaire consisted of five clinical scenarios describing acute presentations of imported diseases but without a travel history included. Responses were requested to ascertain whether practitioners would elucidate the travel history and consequently establish the correct diagnosis. RESULTS A response rate of 96% was achieved. When presented with a clinical scenario suggesting imported disease, travel history is only elicited in 16% of cases by the acute care practitioners. A correct diagnosis was given in 22% of responses. Interestingly, there was generally no significant correlation between eliciting a travel history and establishing the correct diagnosis. CONCLUSIONS When presented with a clinical scenario that describes an imported disease, medical practitioners in EDs do not routinely establish a travel history or consider the diagnosis of imported disease. There may be a high potential for imported disease to be missed in the ED.
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Affiliation(s)
- Simon M Smith
- Emergency Department, Wycombe Hospital, High Wycombe, UK
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34
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Colomba C, Saporito L, Infurnari L, Tumminia S, Titone L. Typhoid fever as a cause of opportunistic infection: case report. BMC Infect Dis 2006; 6:38. [PMID: 16504150 PMCID: PMC1413535 DOI: 10.1186/1471-2334-6-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 02/27/2006] [Indexed: 02/02/2023] Open
Abstract
Background Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica subspecies enterica serotype typhi, which is acquired by ingestion of contaminated food and water. Each year the disease affects at least 16 million persons world-wide, most of whom reside in the developing countries of Southeast Asia and Africa. In Italy the disease is uncommon with a greater number of cases in Southern regions than in Northern ones. Case presentation We report on a 57-year-old Sri-Lankan male affected by typhoid fever, the onset of which was accompanied by oropharyngeal candidiasis. This clinical sign was due to a transient cell-mediated immunity depression (CD4+ cell count was 130 cells/mm3) probably caused by Salmonella typhi infection. Human immunodeficiency virus infection was ruled out. Diagnosis of typhoid fever was made by the isolation of Salmonella typhi from two consecutive blood cultures. The patient recovered after a ten days therapy with ciprofloxacin and his CD4+ cell count improved gradually until normalization within 3 weeks. Conclusion Our patient is the first reported case of typhoid fever associated with oropharyngeal candidiasis. This finding suggests a close correlation between Salmonella typhi infection and transitory immunodepression.
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Affiliation(s)
- Claudia Colomba
- Istituto di Patologia Infettiva e Virologia, Università di Palermo, Piazza Montalto 8, 90134 Palermo, Italy
| | - Laura Saporito
- Istituto di Patologia Infettiva e Virologia, Università di Palermo, Piazza Montalto 8, 90134 Palermo, Italy
| | - Laura Infurnari
- Istituto di Patologia Infettiva e Virologia, Università di Palermo, Piazza Montalto 8, 90134 Palermo, Italy
| | - Salvatore Tumminia
- Unità Operativa di Malattie Infettive, Azienda Ospedaliera Universitaria Policlinico, Palermo, Italy
| | - Lucina Titone
- Istituto di Patologia Infettiva e Virologia, Università di Palermo, Piazza Montalto 8, 90134 Palermo, Italy
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Abstract
OBJECTIVES The incidence and prevalence of imported disease within the emergency department is not known. It is known, however, that a significant number of patients attend medical practitioners after they return from travelling. If practitioners working in emergency departments are unaware of the potential for nonendemic disease in the population of patients they attend, there is a possibility that imported diseases will remain undiagnosed in the acute setting. METHODS The medical records of all patients attending a medium-sized accident and emergency department over the period of a week were reviewed to ascertain whether a travel history was recorded in patients who potentially have an imported disease, and whether imported diseases were considered in the differential diagnosis. RESULTS A travel history was recorded in only 2% of all patients attending the accident and emergency department (5.3% of those with a potential of having imported disease). This figure is unchanged if only patients with nontraumatic conditions are considered, or if those patients with low risk of imported disease are removed from the calculations. CONCLUSIONS It appears that medical practitioners in emergency departments do not routinely establish a travel history, or consider the diagnosis of imported disease, when presented with a clinical scenario that describes a possible imported disease. Consequently, there is a high potential for imported disease to be missed in the emergency department.
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Affiliation(s)
- Simon M Smith
- Emergency Department, Wycombe Hospital, High Wycombe, UK.
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36
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Magill AJ. Malaria: Diagnosis and treatment of falciparum malaria in travelers during and after travel. Curr Infect Dis Rep 2006; 8:35-42. [PMID: 16448599 DOI: 10.1007/s11908-006-0033-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Plasmodium falciparum is responsible for most of the mortality in travelers related to imported malaria. Problems that occur during travel include the inaccuracy of a microscopic diagnosis of malaria, both false positives and false negatives, when ill travelers seek care while abroad. A false positive diagnosis can result in unnecessary parenteral injections that carry a risk of transmission of blood-borne pathogens, receipt of potentially dangerous drugs such as halofantrine, or receipt of fake, counterfeit drugs. Increased morbidity and mortality are associated with delays in diagnosis and initiation of prompt treatment for falciparum malaria. Availability of expert microscopy to confirm the diagnosis of malaria is limited. The presence of splenomegaly and thrombocytopenia are strongly associated with malaria and would justify empiric treatment. The availability of atovaquone-proguanil, a safe and well tolerated oral drug, should prompt a reconsideration of current treatment recommendations that discourage empiric treatment on clinical suspicion alone.
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Affiliation(s)
- Alan J Magill
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA.
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Antinori S, Morelli P. A 57-year-old man with a 6-day headache and fatigue. Am J Med 2005; 118:1441; author reply 1441-2. [PMID: 16378812 DOI: 10.1016/j.amjmed.2005.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 04/19/2005] [Indexed: 10/25/2022]
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