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Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network.
Ann Intern Med. 2015 Jun 02; 162(11):757-64.AIM

Abstract

BACKGROUND

The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms.

OBJECTIVE

To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread.

DESIGN

Descriptive, using GeoSentinel records.

SETTING

57 travel or tropical medicine clinics in 25 countries.

PATIENTS

805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014.

MEASUREMENTS

Frequencies of demographic and travel-related characteristics and illnesses reported.

RESULTS

The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered.

LIMITATION

Surveillance data collected by specialist clinics may not be representative of all ill returned travelers.

CONCLUSION

Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality.

PRIMARY FUNDING SOURCE

Centers for Disease Control and Prevention.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

25961811

Citation

Boggild, Andrea K., et al. "Differential Diagnosis of Illness in Travelers Arriving From Sierra Leone, Liberia, or Guinea: a Cross-sectional Study From the GeoSentinel Surveillance Network." Annals of Internal Medicine, vol. 162, no. 11, 2015, pp. 757-64.
Boggild AK, Esposito DH, Kozarsky PE, et al. Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network. Ann Intern Med. 2015;162(11):757-64.
Boggild, A. K., Esposito, D. H., Kozarsky, P. E., Ansdell, V., Beeching, N. J., Campion, D., Castelli, F., Caumes, E., Chappuis, F., Cramer, J. P., Gkrania-Klotsas, E., Grobusch, M. P., Hagmann, S. H., Hynes, N. A., Lim, P. L., López-Vélez, R., Malvy, D. J., Mendelson, M., Parola, P., ... Hamer, D. H. (2015). Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network. Annals of Internal Medicine, 162(11), 757-64. https://doi.org/10.7326/M15-0074
Boggild AK, et al. Differential Diagnosis of Illness in Travelers Arriving From Sierra Leone, Liberia, or Guinea: a Cross-sectional Study From the GeoSentinel Surveillance Network. Ann Intern Med. 2015 Jun 2;162(11):757-64. PubMed PMID: 25961811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network. AU - Boggild,Andrea K, AU - Esposito,Douglas H, AU - Kozarsky,Phyllis E, AU - Ansdell,Vernon, AU - Beeching,Nicholas J, AU - Campion,Daniel, AU - Castelli,Francesco, AU - Caumes,Eric, AU - Chappuis,Francois, AU - Cramer,Jakob P, AU - Gkrania-Klotsas,Effrossyni, AU - Grobusch,Martin P, AU - Hagmann,Stefan H F, AU - Hynes,Noreen A, AU - Lim,Poh Lian, AU - López-Vélez,Rogelio, AU - Malvy,Denis J M, AU - Mendelson,Marc, AU - Parola,Philippe, AU - Sotir,Mark J, AU - Wu,Henry M, AU - Hamer,Davidson H, AU - ,, PY - 2015/5/12/entrez PY - 2015/5/12/pubmed PY - 2015/8/4/medline SP - 757 EP - 64 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 162 IS - 11 N2 - BACKGROUND: The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. OBJECTIVE: To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread. DESIGN: Descriptive, using GeoSentinel records. SETTING: 57 travel or tropical medicine clinics in 25 countries. PATIENTS: 805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014. MEASUREMENTS: Frequencies of demographic and travel-related characteristics and illnesses reported. RESULTS: The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered. LIMITATION: Surveillance data collected by specialist clinics may not be representative of all ill returned travelers. CONCLUSION: Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/25961811/Differential_diagnosis_of_illness_in_travelers_arriving_from_Sierra_Leone_Liberia_or_Guinea:_a_cross_sectional_study_from_the_GeoSentinel_Surveillance_Network_ L2 - https://www.annals.org/aim/fullarticle/doi/10.7326/M15-0074 DB - PRIME DP - Unbound Medicine ER -