1. 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