University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Division of Infection, Royal London Hospital, 80 Newark Street, London E1 2ES, United Kingdom.
Travel Med Infect Dis. 2017 Sep;19:28-32. doi: 10.1016/j.tmaid.2017.09.006. Epub 2017 Sep 21.
Diagnosing the cause of fever in the returned traveller is challenging. Efforts often focus on identifying 'exotic' pathogens. Primary Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections cause clinical features that overlap with many exotic pathogens. The age-matched seroprevalence of both EBV and CMV is greater in tropical than temperate areas. We describe the clinical and laboratory features of returned travellers diagnosed with primary CMV and EBV syndromes.
Patients with laboratory-confirmed primary EBV and CMV infections who had attended the Hospital for Tropical Diseases (HTD), London between 1st October 2011 and 1st October 2016 were identified. Clinical and laboratory data were obtained and analysed.
Twenty-two patients with primary EBV infection and 31 with primary CMV infection were identified. The commonest presenting features of both infections were fever (81.1%), headache (50.9%) and arthralgia/myalgia (49.1%). Cervical lymphadenopathy was seen more frequently with EBV than with CMV (59.1% vs. 25.8%, P = 0.02). Transaminitis (79.2%) and lymphocytosis (52.8%) were the commonest laboratory abnormalities in both groups.
Primary EBV and CMV infections are important causes of febrile illness in returning travellers. Identification of these pathogens prevents unnecessary, expensive investigations for more 'exotic' pathogens and impacts clinical management for example facilitating prognostication and antimicrobial stewardship.
诊断旅行者发热的病因具有挑战性。人们通常致力于寻找“外来”病原体。原发性 EBV（Epstein-Barr 病毒）和 CMV（巨细胞病毒）感染引起的临床特征与许多外来病原体重叠。在热带地区，EBV 和 CMV 的年龄匹配血清流行率高于温带地区。我们描述了在热带病医院（HTD）确诊为原发性 CMV 和 EBV 综合征的旅行者的临床和实验室特征。
从 2011 年 10 月 1 日至 2016 年 10 月 1 日期间，确定了在伦敦热带病医院（HTD）就诊的实验室确诊的原发性 EBV 和 CMV 感染患者。收集并分析了临床和实验室数据。
确定了 22 例原发性 EBV 感染和 31 例原发性 CMV 感染患者。这两种感染最常见的首发症状是发热（81.1%）、头痛（50.9%）和关节痛/肌痛（49.1%）。EBV 比 CMV 更常出现颈淋巴结病（59.1%比 25.8%，P=0.02）。肝功能异常（79.2%）和淋巴细胞增多症（52.8%）是两组中最常见的实验室异常。
原发性 EBV 和 CMV 感染是旅行者发热的重要病因。识别这些病原体可防止对更“外来”病原体进行不必要、昂贵的检查，并影响临床管理，例如有助于预后判断和抗菌药物管理。
