Spectrum of Disease and Relation to Place of Exposure among Ill Returned Travelers

Freedman, David O.; Weld, Leisa; Kozarsky, Phyllis E.; Fisk, Tamara L.; Robins, Rachel; Sonnenburg, Frank von; Keystone, Jay S.; Pandey, Prativa; Cetron, Martín S.

doi:10.1056/nejmoa051331

Cited by 952 publications

(619 citation statements)

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“…10 Surveillance data indicate that dengue is now the most common cause for fever in travellers returning from all geographical regions except sub-Saharan Africa and Central America, where malaria remains the most common cause. 11,12 Travellers returning to Europe usually acquire dengue from South-East Asia, particularly Thailand, 13 while in the USA the highest rates followed travel to Dominican Republic and Mexico. 14 Autochthonous spread has been reported from the south of France and Croatia, and in 2012 the fi rst European dengue outbreak since the 1920's occurred in Madeira, resulting in over 2,000 cases and 120 hospitalisations.…”

Section: Dengue In Non-endemic Areasmentioning

confidence: 99%

Dengue: an update for clinicians working in non-endemic areas

Yacoub

Wills

2015

Clinical Medicine

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Dengue: an update for clinicians working in non-endemic areasDengue is one of the most rapidly emerging viral infections globally, with 2.5 billion people now thought to live in dengue-endemic areas. In addition, reports of travel-related and autochthonous infections are increasing in non-endemic areas. Most patients with dengue experience a selflimiting febrile illness, but a proportion develop potentially life threatening complications around the time of fever clearance, including plasma leakage occasionally leading to shock, bleeding, and organ impairment. As dengue can present with non-specifi c symptoms of fever, headache and myalgias, the potential for misdiagnosis and inappropriate management by medical staff inexperienced with the disease is a concern. This short review will outline the latest World Health Organisation disease classifi cation, potential complications, clinical assessment and management for clinicians working in non-endemic areas.

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Section: Dengue In Non-endemic Areasmentioning

confidence: 99%

Dengue: an update for clinicians working in non-endemic areas

Yacoub

Wills

2015

Clinical Medicine

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“…In 2001, a record 69 countries reported dengue activity to WHO and in 2002, the Region of the Americas alone reported more than 1 million cases. Although there is poor surveillance and no official reporting of dengue to WHO from countries in the African and Eastern Mediterranean regions, in 2005-2006 outbreaks of suspected dengue were recorded in Pakistan, Saudi Arabia, Yemen, Sudan and Madagascar [1][2][3][4] , and a large outbreak of dengue involving >17,000 cases was documented in the Cape Verde islands in 2009 5 .Travellers from endemic areas might serve as vehicles for further spread [6][7][8][9] . Dengue epidemics can have a significant economic and health toll.…”

mentioning

confidence: 99%

Dengue: a continuing global threat

et al. 2010

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Dengue fever and dengue haemorrhagic fever are important arthropod-borne viral diseases. Each year, there are ~50 million dengue infections and ~500,000 individuals are hospitalized with dengue haemorrhagic fever, mainly in Southeast Asia, the Pacific and the Americas. Illness is produced by any of the four dengue virus serotypes. A global strategy aimed at increasing the capacity for surveillance and outbreak response, changing behaviours and reducing the disease burden using integrated vector management in conjunction with early and accurate diagnosis has been advocated. Antiviral drugs and vaccines that are currently under development could also make an important contribution to dengue control in the future.Dengue is the most important arthropod-borne viral infection of humans. Worldwide, an estimated 2.5 billion people are at risk of infection, approximately 975 million of whom live in urban areas in tropical and sub-tropical countries in Southeast Asia, the Pacific and the Americas 1 . Transmission also occurs in Africa and the Eastern Mediterranean, and rural Europe PMC Funders GroupAuthor Manuscript Nat Rev Microbiol. Author manuscript; available in PMC 2015 February 19. Published in final edited form as:Nat Rev Microbiol. 2010 December ; 8(12 0): S7-16. doi:10.1038/nrmicro2460. Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts communities are increasingly being affected. It is estimated that more than 50 million infections occur each year, including 500,000 hospitalizations for dengue haemorrhagic fever, mainly among children, with the case fatality rate exceeding 5% in some areas [1][2][3][4] . The geographical areas in which dengue transmission occurs have expanded in recent years (FIG. 1), and all four dengue virus serotypes (DENV-1-4) are now circulating in Asia, Africa and the Americas, a dramatically different scenario from that which prevailed 20 or 30 years ago (FIG. 2). The molecular epidemiology of these serotypes has been studied in an attempt to understand their evolutionary relationships 11 .This Review will provide an update on our understanding of the pathogenesis of this successful pathogen, how we diagnose and control infection and the progress that has been made in vaccine development. Dengue virus pathogenesisDengue viruses belong to the genus flavivirus within the Flaviviridae family. DENV-1-4 evolved in non-human primates from a common ancestor and each entered the urban cycle independently an estimated 500-1,000 years ago 12 . The virion comprises a spherical particle, 40-50 nm in diameter, with a lipopolysaccharide envelope. The positive singlestrand RNA genome (FIG. 3), which is approximately 11 kb in length, has a single open reading frame that encodes three structural proteins -the capsid (C), membrane (M) and envelope (E) glycoproteins -and seven non-structural proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B and NS5 [18][19][20] . ADE occurs when mononuclear phagocytes are infected through their Fc receptors by immune complexes that form between DE...

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“…Embora inexistam no Brasil dados oficiais sobre o número de casos de doença do viajante, o aumento de viagens internacionais deve servir de alerta para o risco de zoonoses exóticas [1][2][3][4] . O caso fatal suspeito de febre hemorrágica viral procedente da África do Sul, cujo diagnóstico foi febre maculosa causada por Rickettsia conorii 6 no Brasil e, mais recentemente, a febre hemorrágica fatal por Marburg em uma viajante que retornou da África para Holanda confirmam a importância deste alerta 9 .…”

Section: Discussão Suporte Financeiro Referênciasunclassified

“…Finalmente, com a realização da Copa do Mundo na África do Sul em 2010, é imprescindível que as empresas de turismo, sob a coordenação do Ministério da Saúde, apresentem programas de orientação e medidas que possam reduzir a ocorrência de doenças como rickettsioses, em especial a febre maculosa, cuja importância e frequência como doença do viajante nas últimas décadas em turistas que retornam da África do Sul têm superado as doenças infecciosas como dengue e febre tifóide [1][2][3] .…”

Section: Discussão Suporte Financeiro Referênciasunclassified

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Febre do viajante associada com adenite cervical e sororreatividade para Bartonella sp em paciente brasileira, após retorno da África do Sul

Lemos

Mares-Guia

Almeida

et al. 2010

Rev. Soc. Bras. Med. Trop.

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RESUMOUm grande número de viajantes visita anualmente, por estudo, turismo ou trabalho o continente africano. Um caso de adenomegalia cervical e hepatoesplenomegalia associado à febre de duas semanas de duração com teste sorológico positivo para Bartonella sp em uma paciente de 22 anos do sexo feminino que retornou da África do Sul após realização de trabalho de campo com primatas em área silvestre é apresentado. Palavras-chaves: Doença febril do viajante. Adenomegalia. Bartoneloses. ABSTRACTA large number of travelers visit the African continent annually for studying, tourism or business reasons. The authors report a case of cervical adenomegaly, hepatomegaly and splenomegaly associated with a two-week history of fever and seropositivity for Bartonella sp in a 22-year-old female patient who returned from South Africa after field work with primates in a wild area. Key-words: Fever in traveler. Adenomegaly. Bartonellosis. Embora a maioria dos casos febris procedentes dos países tropicais tenha a malária, a dengue ou a febre tifóide como diagnósticos mais comuns, nas duas últimas décadas, as rickettsioses, em especial na África do Sul, têm sido mais frequentemente notificadas. Dados disponíveis na literatura científica e nos sítios GeoSentinel, especializados em medicina do viajante, mostram mais de 450 casos confirmados de rickettsioses, com maior concentração na África SubSaariana 1-3 .Rickettsioses são doenças infecciosas transmitidas por artrópodes, causadas por rickettsias que ocorrem, exceto o tifo epidêmico, como pequenos surtos ou casos isolados. Sob o aspecto taxonômico, embora sejam consideradas como grupo de doenças causadas por proteobacterias do subgrupo α1, Bartonella sp e Coxiella burnetti, pertencentes ao subgrupo α 2 e subgrupo g, respectivamente, ainda permanecem sendo estudadas no campo da rickettsiologia 4 .Quanto às bartoneloses, até 1993, Bartonella bacilliformis, causadora da doença de Carrion, era considerada a única do gênero, mas, após a reorganização taxonômica e a identificação de novas espécies, um amplo espectro clínico da doença tem sido identificado desde adenomegalia à endocardite 5 .O objetivo deste relato de caso é alertar para a ocorrência das rickettsioses lato sensu como doença importada, em especial, da África do Sul, e enfatizar que as rickettsioses devem ser consideradas mesmo na ausência de exantema e de lesão de inoculação.Paciente do sexo feminino, branca, 22 anos, estudante, natural do Rio de Janeiro, com início da doença em 28/08/2009 com dor na região cervical e mal-estar. Em 06/09/2009, percebeu adenomegalia cervical direita associada com febre alta (não aferida), cefaléia, mialgia, anorexia, astenia, apatia, náuseas e vômitos. Recém chegada da África do Sul, onde, por 60 dias, realizou trabalho em área silvestre com coleta de fezes de macacos, a paciente se automedicou com doxiciclina (200mg/dia), pois dois casos de febre maculosa foram confirmados em membros da equipe, 10 dias antes do seu retorno para o Brasil. Sem resposta à doxiciclina, procurou assistência médi...

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Spectrum of Disease and Relation to Place of Exposure among Ill Returned Travelers

Abstract: When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences.

Cited by 952 publications

References 21 publications

Dengue: an update for clinicians working in non-endemic areas

Dengue: an update for clinicians working in non-endemic areas

Dengue: a continuing global threat

Febre do viajante associada com adenite cervical e sororreatividade para Bartonella sp em paciente brasileira, após retorno da África do Sul

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