Wilson Mary E, Weld Leisa H, Boggild Andrea, Keystone Jay S, Kain Kevin C, von Sonnenburg Frank, Schwartz Eli
Mount Auburn Hospital, Cambridge, MA, USA.
Clin Infect Dis. 2007 Jun 15;44(12):1560-8. doi: 10.1086/518173. Epub 2007 May 7.
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.
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.
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.
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.
发热是归国旅行者潜在严重疾病的一个指标。按地理区域和旅行者特征整理的发热原因信息，有助于及时进行恰当治疗和采取预防措施。
利用一个大型多中心数据库，我们评估了发热作为患病归国旅行者寻求医疗护理的主要原因的频率。我们根据暴露地点和旅行者特征来确定发热原因。
在1997年3月至2006年3月期间在地理哨兵诊所就诊的24920名归国旅行者中，6957人（28%）将发热作为寻求护理的主要原因。在发热患者中，26%住院治疗（未发热患者为3%）；35%患有发热性全身性疾病，15%患有发热性腹泻病，14%患有发热伴呼吸道疾病。疟疾是最常见的特定病因诊断，在21%的发热患病归国旅行者中发现。发热原因因访问地区和旅行后就诊时间而异。从撒哈拉以南非洲、中亚和拉丁美洲归来且旅行目的是探亲访友的患病旅行者比其他任何群体更易发热。超过17%的发热旅行者患有可通过疫苗预防的感染或恶性疟，后者可通过化学预防来预防。疟疾占发热旅行者中12例死亡病例的33%。
发热在患病归国旅行者中很常见，且常导致住院。旅行后就诊时间为确诊提供了重要线索。预防和及时治疗疟疾、提供适当疫苗以及确定在旅行者旅行前接触以探亲访友为旅行目的者的方法，可减轻旅行相关疾病的负担。
