Howells Phillip, Laird Steven, Johnston Andrew McD, Billyard Thomas
Department of Anaesthesia and Critical Care Medicine, Harefield Hospital, London, UK.
Department of Microbiology, University Hospital Coventry, Coventry, UK.
J Intensive Care Soc. 2022 Feb;23(1):87-92. doi: 10.1177/1751143721991955. Epub 2021 Feb 8.
A 70 year old man, who had recently travelled in rural Iraq, presented with fevers, rigors, and developed multiorgan failure. An extensive range of diagnostic tests was undertaken in an attempt to identify the cause. He was treated with multi-organ support and a number of antibiotics. Critical illness in the returning traveller presents a number of challenges on the ICU: obtaining adequate history, the potentially broad differential diagnosis, the requirement for numerous and sometimes specialised investigations and risks of infection transmission to staff and other patients. Travellers are more often elderly, more likely to have comorbidities and immunosuppression whilst global disease patterns are changing. Particular consideration should be given to unusual infections and venous thromboembolic disease from prolonged immobility whilst in transit, alongside more commonly encountered diseases. Antimicrobial resistance may be encountered and appropriate infection control is essential for the protection of patients, staff and others. Specialist support is available in the UK via the Imported Fever Service, especially for High Consequence Infectious Diseases. Consideration of non-infectious causes of fever and critical illness in returning travellers is also warranted. Crucially, a multidisciplinary team approach with thorough information gathering, repeated clinical review and judicious use of investigations are essential for optimal patient care.
一名70岁男性，近期曾前往伊拉克农村地区，出现发热、寒战，并发展为多器官功能衰竭。为确定病因进行了广泛的诊断检查。他接受了多器官支持治疗及多种抗生素治疗。归国旅行者的危重病在重症监护病房带来了诸多挑战：获取充分的病史、潜在的广泛鉴别诊断、需要进行大量且有时是专门的检查以及感染传播给医护人员和其他患者的风险。旅行者往往年龄较大，更易患有合并症和免疫抑制，而全球疾病模式正在发生变化。在考虑更常见疾病的同时，应特别关注不寻常感染以及因旅途长时间不动导致的静脉血栓栓塞性疾病。可能会遇到抗菌药物耐药性问题，适当的感染控制对于保护患者、医护人员和其他人至关重要。在英国，可通过输入性发热服务获得专科支持，尤其是针对高后果传染病。对归国旅行者发热和危重病的非感染性病因也应予以考虑。至关重要的是，采用多学科团队方法，全面收集信息、反复进行临床评估并明智地使用检查手段，对于实现最佳患者护理至关重要。
