Wilson Mary E, Freedman David O
Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Infect Dis. 2007 Oct;20(5):449-53. doi: 10.1097/QCO.0b013e3282a95e27.
Many potentially life-threatening infections cause fever. Several recent large studies help to define causes of fever in returned travelers.
The destination of travel determines the relative likelihood of the different major causes of fever. Systemic febrile illness occurs disproportionately among ill travelers returning from sub-Saharan Africa. Malaria remains the most important overall cause of systemic febrile illness in travelers to tropical regions; dengue fever is now the most prominent cause of fever in travelers to certain regions, most notably Asia. Chikungunya fever has emerged as a major cause of fever in travelers to Indian Ocean islands off Africa and to India itself. Causes of fever vary by the time of presentation after travel. Vivax malaria is an important cause of fever with onset more than a month after return; recently studies have shown that parasites causing relapse are genetically distinct from those causing primary infection. At expert referral centers up to 25% of febrile patients have no specific cause of fever determined.
Knowledge of predominant causes of febrile infections by geographic region, traveler characteristics, and time of presentation can assist the clinician in guiding posttravel diagnosis and empiric therapy of ill returned travelers and is also valuable in pretravel preparation.
许多潜在的危及生命的感染都会引起发热。近期的几项大型研究有助于明确归国旅行者发热的病因。
旅行目的地决定了不同主要发热病因的相对可能性。在从撒哈拉以南非洲归国的患病旅行者中，全身性发热疾病的发生率不成比例地偏高。疟疾仍然是前往热带地区的旅行者全身性发热疾病最重要的总体病因；登革热现在是前往某些地区（最显著的是亚洲）的旅行者发热的最主要病因。基孔肯雅热已成为前往非洲附近印度洋岛屿及印度本土的旅行者发热的主要病因。发热病因因旅行后出现症状的时间而异。间日疟是旅行归来一个多月后发热的重要病因；最近的研究表明，导致复发的疟原虫在基因上与引起初次感染的疟原虫不同。在专家转诊中心，高达25%的发热患者未确定发热的具体病因。
了解按地理区域、旅行者特征及出现症状时间划分的发热感染主要病因，有助于临床医生指导对患病归国旅行者进行旅行后诊断及经验性治疗，在旅行前准备中也很有价值。
