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Laboratory features of common causes of fever in returned travelers.
J Travel Med. 2014 Jul-Aug; 21(4):235-9.JT

Abstract

BACKGROUND

There can be considerable overlap in the clinical presentation and laboratory features of dengue, malaria, and enteric fever, three important causes of fever in returned travelers. Routine laboratory tests including full blood examination (FBE), liver function tests (LFTs), and C-reactive protein (CRP) are frequently ordered on febrile patients, and may help differentiate between these possible diagnoses.

METHODS

Adult travelers returning to Australia who presented to the Royal Melbourne Hospital with confirmed diagnosis of dengue, malaria, or enteric fever between January 1, 2000 and March 1, 2013 were included in this retrospective study. Laboratory results for routine initial investigations performed within the first 2 days were extracted and analyzed.

RESULTS

There were 304 presentations including 58 with dengue fever, 187 with malaria, and 59 with enteric fever, comprising 56% of all returned travelers with a febrile systemic illness during the study period. Significant findings included 9-fold and 21-fold odds of a normal CRP in dengue compared with malaria and enteric fever, respectively. The odds of an abnormally low white cell count (WCC) were also significantly greater in dengue versus malaria or enteric fever. Approximately one third of dengue presentations and almost half of the malaria presentations had platelet counts <100 × 10(9) /L. A normal CRP with leukopenia and/or thrombocytopenia occurred in 21% to 30% of dengue presentations, but not in malaria or enteric fever presentations.

CONCLUSIONS

There is a wide differential diagnosis for imported fever, but the non-specific findings of a normal CRP with a low WCC and/or low platelet count may provide useful information in addition to clinical clues to suggest dengue over malaria or enteric fever. Further systematic prospective studies among travelers could help define the potential clinical utility of these results in assisting the clinician when deciding for or against commencement of empiric antimicrobial therapy while awaiting confirmatory tests.

Authors+Show Affiliations

Victorian Infectious Disease Service, Melbourne Health, Parkville, Victoria, Australia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24754384

Citation

Cooper, Eden C., et al. "Laboratory Features of Common Causes of Fever in Returned Travelers." Journal of Travel Medicine, vol. 21, no. 4, 2014, pp. 235-9.
Cooper EC, Ratnam I, Mohebbi M, et al. Laboratory features of common causes of fever in returned travelers. J Travel Med. 2014;21(4):235-9.
Cooper, E. C., Ratnam, I., Mohebbi, M., & Leder, K. (2014). Laboratory features of common causes of fever in returned travelers. Journal of Travel Medicine, 21(4), 235-9. https://doi.org/10.1111/jtm.12122
Cooper EC, et al. Laboratory Features of Common Causes of Fever in Returned Travelers. J Travel Med. 2014 Jul-Aug;21(4):235-9. PubMed PMID: 24754384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laboratory features of common causes of fever in returned travelers. AU - Cooper,Eden C, AU - Ratnam,Irani, AU - Mohebbi,Mohammadreza, AU - Leder,Karin, Y1 - 2014/04/22/ PY - 2013/09/11/received PY - 2013/11/20/revised PY - 2013/12/11/accepted PY - 2014/4/24/entrez PY - 2014/4/24/pubmed PY - 2015/2/24/medline SP - 235 EP - 9 JF - Journal of travel medicine JO - J Travel Med VL - 21 IS - 4 N2 - BACKGROUND: There can be considerable overlap in the clinical presentation and laboratory features of dengue, malaria, and enteric fever, three important causes of fever in returned travelers. Routine laboratory tests including full blood examination (FBE), liver function tests (LFTs), and C-reactive protein (CRP) are frequently ordered on febrile patients, and may help differentiate between these possible diagnoses. METHODS: Adult travelers returning to Australia who presented to the Royal Melbourne Hospital with confirmed diagnosis of dengue, malaria, or enteric fever between January 1, 2000 and March 1, 2013 were included in this retrospective study. Laboratory results for routine initial investigations performed within the first 2 days were extracted and analyzed. RESULTS: There were 304 presentations including 58 with dengue fever, 187 with malaria, and 59 with enteric fever, comprising 56% of all returned travelers with a febrile systemic illness during the study period. Significant findings included 9-fold and 21-fold odds of a normal CRP in dengue compared with malaria and enteric fever, respectively. The odds of an abnormally low white cell count (WCC) were also significantly greater in dengue versus malaria or enteric fever. Approximately one third of dengue presentations and almost half of the malaria presentations had platelet counts <100 × 10(9) /L. A normal CRP with leukopenia and/or thrombocytopenia occurred in 21% to 30% of dengue presentations, but not in malaria or enteric fever presentations. CONCLUSIONS: There is a wide differential diagnosis for imported fever, but the non-specific findings of a normal CRP with a low WCC and/or low platelet count may provide useful information in addition to clinical clues to suggest dengue over malaria or enteric fever. Further systematic prospective studies among travelers could help define the potential clinical utility of these results in assisting the clinician when deciding for or against commencement of empiric antimicrobial therapy while awaiting confirmatory tests. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/24754384/Laboratory_features_of_common_causes_of_fever_in_returned_travelers_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1111/jtm.12122 DB - PRIME DP - Unbound Medicine ER -