Spectrum of disease and relation to place of exposure among ill returned travelers
Spectrum of disease and relation to place of exposure among ill returned travelers
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DOI：
10.1056/nejmoa051331
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发表时间：
2006-01-12
影响因子：
158.5
通讯作者：
Cetron, MS
中科院分区：
文献类型：
--
作者：
Freedman, DO;Weld, LH;Cetron, MS
背景：大约8%前往发展中国家的旅行者在旅行期间或旅行后需要医疗护理。目前对患病回国旅行者发病率的了解是基于20世纪80年代的有限数据。方法：30个GeoSentinel站点，这些站点是六大洲的专业旅行或热带医学诊所，提供了17，353名患病回国旅行者的基于临床医生的哨点监测数据。我们比较了从六个发展中地区的世界。结果：显着的区域差异的比例发病率在16个21个广泛的综合征类别的旅行者返回之间的每一个诊断的发生频率。在前往GeoSentinel站点的旅行者中，从撒哈拉以南非洲或东南亚返回的旅行者中不成比例地发生全身性发热疾病，从南亚返回的旅行者中发生急性腹泻，从加勒比海或中美洲或南美洲返回的旅行者中发生皮肤病问题。在具体诊断方面，疟疾是每个地区旅行者中全身性发热疾病的三个最常见原因之一，尽管除撒哈拉以南非洲和中美洲外，每个地区的旅行者确诊或可能确诊登革热的频率高于疟疾。在从撒哈拉以南非洲返回的旅行者中，立克次体感染，主要是蜱传斑点热，比伤寒或登革热更常见。来自所有地区的旅行者，除东南亚提出寄生虫引起的腹泻更经常比细菌性diarrheum.CONCLUSIONS：当患者前往专门诊所后，前往发展中国家，旅游目的地与某些疾病的诊断概率。诊断方法和经验疗法可以由这些目的地特异性差异来指导。
BACKGROUND:Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s.METHODS:Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world.RESULTS:Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea.CONCLUSIONS:When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences.