RESUMO
BACKGROUND: Respiratory tract infections frequently occur in ill returned travelers, a minority of whom present with pneumonia. The most accurate and cost-effective diagnostic work-up remains an area of uncertainty. In this retrospective cohort study, the utility of routine chest radiography was evaluated. METHODS: This study was performed at the Institute for Tropical Diseases in Rotterdam and included all returned travelers in the period between 2007 and 2009 that were ill with symptoms lasting less than 1 month and had chest radiography on admission. Travelers' demographic (including travel history), clinical, and laboratory data were collected on admission and evaluated for their diagnostic power to predict radiographic evidence of a pulmonary infiltrate. RESULTS: Fifty-three (7%) of 750 ill returned travelers had radiographic evidence of a pulmonary infiltrate. Presentation with cough (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.46-5.38), or elevated C-reactive protein values (OR 1.13, 95% CI 1.09-1.17), and white blood cell count (OR 1.08, 95% CI 1.05-1.17) strongly correlated with the presence of a pulmonary infiltrate. Recursive partitioning analysis identified a subset of 384 patients presenting with both cough and fever, or C-reactive protein values in excess of 23 mg/L that would optimally benefit from chest radiography. CONCLUSION: The results of this study indicate that a more judicious use of chest radiography in the routine work-up of ill returned travelers is warranted.
RESUMO
BACKGROUND: Upper respiratory tract problems, eg, acute sinusitis are frequently occurring illnesses in returned travelers. The most accurate and cost-effective method for diagnosing these upper respiratory tract illnesses in hospital-based settings remains an area of uncertainty. In the present retrospective cohort study, the usefulness of routine sinus radiography in the diagnostic work-up of ill returned travelers was evaluated. METHODS: This study was done at the Institute for Tropical Diseases in Rotterdam, and included all returned travelers who were ill with symptoms lasting less than one month in the period 2007-2009 and had sinus radiography on admission. Traveler demographic (including travel history), clinical, and laboratory data were collected on admission, and sinus radiography findings evaluated for their diagnostic power to predict sinusitis. RESULTS: One hundred and sixty-five (22%) of 765 ill returned travelers had abnormal sinus radiography; more than half of the abnormal radiographic findings comprised mucosal membrane thickening of the sinuses. More than half of the travelers with abnormal sinus radiography had no upper respiratory tract symptoms at admission, which raises doubt about the clinical relevance of abnormal radiographic findings. Travelers with abnormal sinus radiography were more likely to receive nasal decongestants (relative risk 18.2, confidence interval 9.4-35.1) but not antibiotics. CONCLUSION: The results of the present study indicate that there is no additional value for routine sinus radiography in the diagnostic work-up of ill returned travelers.