TY - JOUR
T1 - Causes of fever in returning travelers: a European multicenter prospective cohort study
AU - Camprubí-Ferrer, Daniel
AU - Cobuccio, Ludovico
AU - Van Den Broucke, Steven
AU - Genton, Blaise
AU - Bottieau, Emmanuel
AU - d'Acremont, Valérie
AU - Rodriguez-Valero, Natalia
AU - Almuedo-Riera, Alex
AU - Balerdi-Sarasola, Leire
AU - Subirà, Carme
AU - Fernandez-Pardos, Marc
AU - Martinez, Miguel J
AU - Navero-Castillejos, Jessica
AU - Vera, Isabel
AU - Llenas-Garcia, Jara
AU - Rothe, Camilla
AU - Cadar, Dániel
AU - Van Esbroeck, Marjan
AU - Foque, Nikki
AU - Muñoz, Jose
N1 - FTX; © 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: [email protected].
PY - 2022
Y1 - 2022
N2 - 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 pre-defined 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.
AB - 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 pre-defined 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.
U2 - 10.1093/jtm/taac002
DO - 10.1093/jtm/taac002
M3 - A1: Web of Science-article
C2 - 35040473
SN - 1195-1982
VL - 29
JO - Journal of Travel Medicine
JF - Journal of Travel Medicine
IS - 2
M1 - taac002
ER -