Antinori Spinello, Galimberti Laura, Gianelli Erika, Calattini Sara, Piazza Manuela, Morelli Paola, Moroni Mauro, Galli Massimo, Corbellino Mario
Institute of Infectious and Tropical Diseases, L. Sacco Hospital, University of Milan, Via GB Grassi 74, 20157 Milan, Italy.
J Travel Med. 2004 May-Jun;11(3):135-42. doi: 10.2310/7060.2004.18557.
An estimated 50 million people each year from industrialized countries visit tropical areas: 3% to 11% of these travelers report a febrile illness on their return. We conducted a 5-year prospective observational study on the causes of fever in patients admitted to a university teaching hospital after returning from the tropics.
We enrolled in this study all consecutive patients admitted to the Division of Infectious Diseases of the University of Milan, Italy, between January 1997 and December 2001 presenting with fever (oral temperature > or =37.5 degrees C) and a history of travel to a tropical country in the previous 6 months.
Seven percent (147/2,074) of all hospital admissions in the study period were due to fever in travelers and migrants returning from the tropics. Malaria accounted for 47.6 % of all admissions (70/147), followed by presumed self-limiting viral infections (12%). Pretravel screening and vaccination strategies could have prevented a considerable number of hospitalizations (e.g., hepatitis A and typhoid fever). The most useful investigations were blood examination and PCR for malaria, which gave positive results in 65% of cases in which they were performed.
During a 5-year period, the number of patients returning from tropical areas who were admitted with fever to a university hospital in northern Italy remained stable; malaria was the most frequent diagnosis, and should be considered in any febrile patient returning from the tropics. With the exception of hepatitis A and dengue fever infections, in a real-world setting serology is of modest utility and is probably overused.
工业化国家每年估计有5000万人前往热带地区：这些旅行者中有3%至11%在回国后报告出现发热性疾病。我们对从热带地区回国后入住大学教学医院的患者发热原因进行了一项为期5年的前瞻性观察研究。
我们纳入了1997年1月至2001年12月期间连续入住意大利米兰大学传染病科且发热（口腔温度≥37.5摄氏度）且在过去6个月内有前往热带国家旅行史的所有患者。
在研究期间，所有住院患者中有7%（147/2074）是由从热带地区回国的旅行者和移民的发热所致。疟疾占所有入院病例的47.6%（70/147），其次是推测为自限性病毒感染（12%）。旅行前筛查和疫苗接种策略本可预防相当数量的住院病例（如甲型肝炎和伤寒热）。最有用的检查是血液检查和疟疾PCR检测，在进行这些检查的病例中，65%的结果呈阳性。
在5年期间，从热带地区回国后因发热入住意大利北部一家大学医院的患者数量保持稳定；疟疾是最常见的诊断，任何从热带地区回国的发热患者都应考虑疟疾。除甲型肝炎和登革热感染外，在实际临床中血清学的作用不大，可能存在过度使用的情况。
