Etiology and outcome of fever after a stay in the tropics

Abstract

Background: Information on epidemiology an prognosis of imported fever is scarce and almost exclusively limited to hospital settings. Methods: From 2000 to 2005, all travelers presenting at our referral outpatient and inpatient centers with ongoing fever within 12 months after a stay in the tropics were prospectively followed. Case definitions and treatment were based on international recommendations. Outcome was assessed by at least 1 follow-up consultation or telephone call within 3 months after initial contact. Results: A total of 1842 fever episodes were included, involving 1743 patients. Regions of exposure were mainly sub-Saharan Africa(68%) and the Southeast Asia-Pacific region(12%). Tropical diseases accounted for 39% of all cases and cosmopolitan infections for 34%. Diagnosis often remained unknown(24%). The pattern of tropical diseases was mainly influenced by the travel destination, with malaria (35% mainly Plasmodium falciparum) and rickettsial infection(4%) as the leading diagnoses after a stay in Africa; dengue(12%), malaria(9%),and enteric fever(4%)after travel to Asia; and dengue(8%) and malaria (4%) on return from Latin America. Disease pattern varied also according to the category of travelers, the delay between exposure and fever onset, and the setting. Hospitalization was required for 503 fever episodes(27%). Plasmodium falciparum malaria accounted for 36% of all admissions and was the only tropical cause of death(5of 9 patients). Fever of unknown cause had invariably a favorable outcome. Conclusion: The clinical spectrum of imported fever is highly destination specific but also depends on other factors. Plasmodium falciparum malaria was the leading cause of mortality in the study population.