Fever in returned travellers: a prospective review of hospital admissions for a 21/2 year period

Abstract

Aim: To identify causes of fever, treatable diseases, and the most helpful investigations in febrile children, who had travelled to the tropics or subtropics in the preceding year. Methods: Prospective observational study of all admissions to children's wards in a district general hospital in Birmingham between January 1997 and July 1999. Children with fever >37.5°C and a history of travel to the tropics or subtropics in the preceding 12 months were included. Data were available on 153/162 children; median age was 5 years (range 0.1-15). A total of 133 (85%) children had visited South Asia; only 18/135 had received malarial prophylaxis. Median time to presentation after travel was four weeks. Children were investigated with full blood count, blood film, and stool culture. Other investigations were performed at the discretion of the admitting paediatrician. Results: Diarrhoeal illness (n = 41) and malaria (n = 22) were the most common diagnoses. A treatable cause for the febrile illness was identified in 70 (46%) children. One or more investigations were positive in 60% of children. Stool culture (17% positive) and blood film (14% positive) were the most helpful investigations. Platelet counts greater than 190 × 10 9 /l had a negative predictive value of 97% for malaria in this population. Conclusions: Children who present with fever and have travelled to the tropics or subtropics in the preceding year, often have a treatable infection. They should have a full blood count, blood film for malarial parasites, stool culture, blood culture, and chest x ray.

Illness in Children After International Travel: Analysis From the GeoSentinel Surveillance Network

“…Previous surveys of travelers, including children, also reported that febrile illnesses and diarrhea were leading causes of morbidity, although they did not identify dermatologic conditions as a common cause of morbidity. [6][7][8]11 This likely reflects the focus of previous work on hospitalized children, among whom dermatologic complaints may be underrepresented.…”

“…Most published literature on pediatric travel-related morbidity originated from singlecenter studies that reported only on hospitalized patients or focused on specific diseases (eg, malaria). [6][7][8][9][10][11] This study reports clinical and epidemiological characteristics of 1591 children who were ill after international travel and sought medical care at a GeoSentinel Surveillance Network clinic. This study offers the first systematic evaluation of the demographic characteristics, health care use, and travelrelated morbidities of children after international travel.…”

Aetiology and epidemiology of fever in children presenting to the emergency department of a French paediatric tertiary care centre after international travel

“…Few data, coming mainly from studies of hospitalised children, are available on the frequency and types of illness diagnosed in febrile children after international travel 10–12…”

Influenza Virus Infection in Travelers to Tropical and Subtropical Countries

“…Posttravel monitoring of hospital admissions identified respiratory tract infections, including influenza, as a common cause of illness in returned travelers, but thus far, the attack rate and incidence of influenza in travelers have not been assessed [12][13][14]. Thus, we performed a seroepidemiological cohort study to determine the attack rate and incidence of influenza virus infection among Swiss residents traveling to subtropical and tropical countries, the proportion of symptomatic and asymptomatic cases, and geographic areas and seasons with particular risk.…”