gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Clinical risk assessment in febrile travellers-tentative diagnosis and agent detection rates

Klinische Risiko-Analyse bei febrilen Reiserückkehrern-Korrelation von Verdachtsdiagnosen und Erregernachweisen

Meeting Abstract

  • R. Jesche - Klinikum der Johann-Wolfgang-Goethe Universität, Schwerpunkt Infektiologie, Frankfurt, Germany
  • S. Schilling - Klinikum der Johann-Wolfgang-Goethe Universität, Schwerpunkt Infektiologie, Frankfurt, Germany
  • J.F. Drexler - Universitätsklinikum Bonn, Institut für Virologie, Bonn, Germany
  • V. Rickerts - Klinikum der Johann-Wolfgang-Goethe Universität, Schwerpunkt Infektiologie, Frankfurt, Germany
  • H.-R. Brodt - Klinikum der Johann-Wolfgang-Goethe Universität, Schwerpunkt Infektiologie, Frankfurt, Germany
  • G. Just-Nübling - Klinikum der Johann-Wolfgang-Goethe Universität, Schwerpunkt Infektiologie, Frankfurt, Germany
  • C. Drosten - Universitätsklinikum Bonn, Institut für Virologie, Bonn, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP95

DOI: 10.3205/10kit150, URN: urn:nbn:de:0183-10kit1506

Published: June 2, 2010

© 2010 Jesche et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objectives: Imported infections pose a threat to Europe as changing environmental conditions may facilitate their spread to previously non-infested areas. Thus, clinical risk assessment remains the backbone of case management when facing febrile travellers but is rarely applied in daily routine. Aim of this work was to correlate clinical risk assessment strategies and agent detection rates in febrile travellers seeking care at Frankfurt University Hospital, Germany.

Methods: Major inclusion criteria were fever within 4 days prior to consultation and a recent history of international travel (<4 weeks). Upon admission patients were categorised as “fever of bacterial origin” (FBO), “fever of viral origin” (FVO) or “fever of unknown origin” (FUO) depending on clinical and standard laboratory parameters (e.g. blood-count and C-reactive protein). Patients were classified “FUO” when conditions of “FBO” or “FVO” did not match. Consecutive blood samples were drawn and submitted to culture, serology and molecular detection methods.

Results: In total, 122 patients were included into this 19-months survey. WHO regions most often travelled were South East Asia (33.1%), Africa (30.3%) and Western Pacific (22.8%). Most patients sought medical care on day 5 of fever. Upon admission, the majority of cases was classified “FUO” (50.8%), 27.1% met criteria of “FBO” and 22.1% of “FVO”. Beside fever, myalgia (54.9%), arthralgia (53.3%) and cephalgia (53.6%) were most common reasons for consultation. Swelling of lymph nodes and cough was observed in 25% of cases each and about 20% presented with a rash. A causative agent could be identified in 62% of all cases, only, and the tentative clinical met the final laboratory diagnosis in less than one third. P. falciparum (19.5%) and Dengue virus (13.4%) were detected most frequently.

Conclusions: Clinical risk assessment strategies were of little use in identifying underlying causes of fever. As expected, Dengue and Malaria were the most common causes of fever in all patients included. Despite a broad range of methods applied causative agents remained undetectable in more than one third of all cases.