FEVER AFTER TRAVEL – HOSPITAL VIEW Simin-Aysel Florescu, Corneliu Petru Popescu, Mihaela Zaharia, Elena Nedu, Andreea Toderan, Maria Nica, Emanoil Ceausu, Petre Calistru BACKGROUND Due to increasing human mobility overseas, in tropical regions, imported diseases remain an important pathology, which must be sought and asked about in almost every traveler. Fever is an important sign that determine hospital referrals of travelers after the journey OBJECTIVES We studied the main symptoms and signs of the patients admitted in our hospital with imported tropical diseases, self referred or referred from other medical facilities, during the last 10 years. METHODS. The source of data was represented by patient records; the diagnosis was based on rapid tests, thin and thick film, bone marrow smear, PCR from blood, stool smear and other microscopic examination, serology. RESULTS IMPORTANCE Total number of cases: 266 Febrile diseases: 252 (95%) Nonfebrile diseases: 14 (5%) - Treatable diseases - Transmissible diseases – risk for emergence or reemergence - Life –threatening diseases - Ebola lesson - Severe malaria-deaths - Late diagnosed visceral leishmaniasis Risk categories: VFR - more exposure - less care for prophylaxis Long term travelers (missioners, immigrants) - Less prophylaxis - Local pattern of diseases Table 1. Main Sign for Hospital Refferal SIGN Fever (252) Other (14) Malaria 201 - Dengue 17 Leishmaniasis (visceral form) 20 Leishmaniasis (cutanat form) 3 Zika Myasis 11 Fever tif/paratif 5 Amoebiasis Schistosomiasis Table 4 Fever onset   Acute Fever Malaria, Dengue, LV, Zika, tif/paratif, Amoebiasis, Schistosomiasis Prolonged fever Leishmaniasis (visceral form) Table 3. Main Source of Infection Patology Continent/ area Malaria Sub-Saharean Africa Dengue Asia Leishmaniasis (visceral) Mediteranean area Leishmaniasis (Cutanat) Middle East Fever tif/paratif Schistosomiasis Table 2. Distribution of Main Diagnosis Leading to Post-Travel Hospitalization Patology no. cases % Malaria 201 76% Leishmaniasis 23 9% Dengue 17 6% Myasis 11 4% Fever tif/paratif 5 2% Zika 3 1% Amoebiasis Schistosomiasis Total 266 100% Table 5 Other relevant signs   Malaria headache, myalgia, resp distress, coma Dengue rash, hemorrhagic signs Leishmaniasis (visceral) pancytopenia Algorithm for evaluation of febrile travelers Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes” Febrile patient, history of travel at tropics in the last year Clinical evaluation+routine blood tests  Malaria testing   negative positive   + rash: test - Dengue, Treatment -Chikungunya +diahorrea: test- typhoid fever, -cholera, -travellers’ diahorrea +respiratory signs of infection: test -MERS-Cov, -influenza +neurological signs: test -encephalitis, -meningitis +pancytopenia: test visceral leishmaniasis CONCLUSIONS Diagnosis of the ill returned traveler is complex and should regard the epidemiological aspects of the travel . Fever is the most common sign that determines the hospitalization, along with the severe evolution risk factors. Febrile returned traveler patients should be referred to specialized clinics to avoid the delay of diagnosis and treatment