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Previous Volume 354:119-130 January 12, 2006 Number 2 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by Hill, D. R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article PubMed Citation

ABSTRACT

Background 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.

Methods 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.

Results 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.

Conclusions 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.

Source Information

From the Division of Geographic Medicine, University of Alabama at Birmingham, Birmingham (D.O.F.); the Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta (L.H.W., P.E.K., R.R., M.S.C.); the Division of Infectious Disease, Emory University, Atlanta (P.E.K., T.F.); the Department of Tropical and Infectious Diseases, University of Munich, Munich, Germany (F.S.); the Division of Infectious Diseases, University of Toronto, Toronto (J.S.K.); and CIWEC Clinic, Kathmandu, Nepal (P.P.).

Dr. Fisk is deceased.

Address reprint requests to Dr. Freedman at the Division of Geographic Medicine, 1530 Third Ave. S., BBRB 203, Birmingham, AL 35294, or at freedman{at}uab.edu.

Full Text of this Article

Related Letters:

Illness in Returned Travelers
Bishai D. M., Baker T., Freedman D. O., Weld L. H., Kozarsky P.
Extract | Full Text | PDF  
N Engl J Med 2006; 354:1851, Apr 27, 2006. Correspondence

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