Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or guinea: A cross-sectional study from the Geosentinel surveillance network

Authors:

Boggild AK, Esposito DH, Kozarsky PE, Ansdell V, Beeching NJ, Campion D, Castelli F, Caumes E, Chappuis F, Cramer JP, Gkrania-Klotsas E, Grobusch MP, Hagmann SHF, Hynes NA., Lian Lim P, Lopez-Velez R, Malvy DJM, Mendelson M, Parola P, Sotir MJ, Wu HM, Hamer DH

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.

Journal:

Annals of Internal Medicine

Year:

2015

PMID:

25961811

Hyperlink:

http://annals.org/aim/article/2292045/differential-diagnosis-illness-travelers-arriving-from-sierra-leone-liberia-guinea

Research Themes:

Clinical Surveillance