SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

9/20/06

Disease spectrum in ill returned travelers to the developing world

Summary
Background – About 8% of travelers to developing countries require medical care during or after such travel. The current understanding of the morbidity profiles in such ill-returned travelers (IRT) has been based on limited data obtained in the 1980’s.

Findings – Freedman et al in the Geosentinel Surveillance Network, (specialized Travel Medicine clinics on 6 continents) contributed findings in 17,353 IRT. Systemic febrile illnesses without localizing findings were found mainly in IRT returning from sub-Saharan Africa or Southeast Asia. Acute diarrhea was seen commonly in those returning from South Central Asia (e.g. – Indo-Pakistan area). Dermatologic problems were present more in those returning from the Caribbean or Central/South America. Malaria was one of the 3 most frequent causes of systemic febrile illnesses among IRT from every region. However, dengue was more common than malaria in IRT from every region except Central America and sub-Saharan Africa. In IRT from sub-Saharan Africa, tick-borne rickettsial infections were more common than dengue or typhoid. Diarrhea in IRT was more commonly due to parasitic than to bacterial infections.

Reference
N Engl J Med 2006;354:119-30

Editor's Comments
I have reviewed this report because it provides unique new information not generally available. Most physicians see IRT occasionally on their practice in these days of such common international travel, including trips to developing countries. The profiles described above are not “carved in stone” so that the region from which the IRT returns makes a diagnosis by itself. However, such information guides the physician about what conditions to first suspect in an IRT.

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