Factors associated with malaria and arboviral disease in patients with imported febrile syndrome: a retrospective cohort study. / Factores asociados con malaria y arboviriasis en pacientes con síndrome febril importado: estudio de cohortes retrospectivo.

OBJECTIVES: To identify predictors of malaria and arboviral disease in patients with febrile syndrome who seek care after traveling from tropical or subtropical locations. MATERIAL AND METHODS: Observational retrospective cohort study. We collected demographic, epidemiologic, and clinical data; laboratory findings; and the clinical and final microbiologic diagnoses. Multivariate analysis was used to calculate indices of diagnostic accuracy (sensitivity, specificity, and predictive values) and coefficients of probability of combinations of variables. RESULTS: Data for 291 patients with febrile syndrome were included; 108 had malaria (37.1%), 28 had an arboviral disease (9.6%), and 155 had other causes of fever (53.3%). Multivariate analysis showed patients most likely to have malaria were those from sub-Saharan Africa, adjusted odds ratio (aOR) of 45.85 (95% CI, 9.45-222.49); immigrants who returned to visit friends and relatives (VFR), aOR of 3.55 (95% CI, 1.21-10.46); or had platelet concentrations 150 000/mm3, aORa of 16.47 (95% CI, 5.46-49.70) or headache, aOR of 10.62 (95% CI, 3.20-35.28). The combination of these 4 variables gave a positive probability coefficient (PPC) of 23.72 (95% CI, 5.76-97.62). Patients with febrile syndrome most likely to have an arboviral disease were those from Central or South America, OR 5.07 (95% CI, 1.73-14.92), and those who had exanthems, OR 5.10 (95% CI, 1.72-17.02) or joint pain, OR 14.50 (95% CI, 3.05-68.80). The combination of these 3 variables gave a PPC of 20.66 (95% CI, 7.74-55.21). CONCLUSION: Patients with febrile syndrome with the greatest probability of having malaria are those from sub-Saharan Africa, those who are VFR, and those with platelet concentrations under 150.000/µL or headache. Arboviral disease was more likely in patients from Central and South America who had exanthems or joint pain.

OBJETIVO: Definir variables predictoras de malaria y arboviriasis en pacientes que consultan por síndrome febril tras la vuelta de un viaje a zonas tropicales/subtropicales. METODO: Estudio de cohortes retrospectivo. Se incluyeron variables demográficas, epidemiológicas, clínicas, analíticas y el diagnóstico final clínico y microbiológico. Se realizó un análisis multivariante y se calcularon los índices de exactitud diagnóstica (sensibilidad, especificidad, valores predictivos) y cocientes de probabilidad de la combinación de dichasvariables. RESULTADOS: Se incluyeron 291 pacientes con síndrome febril, 108 tenían malaria (37,1%), 28 arboviriasis (9,6%) y 155 otras causas de fiebre (53,3%). En el análisis multivariante, los pacientes con síndrome febril con más riesgo de padecer malaria fueron los que procedían de África subsahariana [odds ratio ajustado (ORa): 45,85; IC 95%: 9,45- 222,49], eran inmigrantes que visitan a familiares y amigos (VFA) (ORa = 3,55; IC 95%: 1,21-10,46), presentaban cifras de plaquetas 150.000/mm3 (ORa = 16,47; IC 95%: 5,46-49,70) o cefalea (ORa = 10,62; IC 95%: 3,20-35,28). La combinación de estas cuatro variables tiene un cociente de probabilidad positivo (CPP) de 23,72 (IC 95%: 5,76- 97,62). Los pacientes con síndrome febril que tienen más riesgo de padecer arboviriasis eran los que procedían de Centroamérica y Sudamérica (OR = 5,07; IC 95%: 1,73-14,92), presentaban exantema (OR = 5,10; IC 95%: 1,72- 17,02) o artromialgias (OR = 14,50; IC 95%: 3,05-68,80). La combinación de estas tres variables tiene un CPP de 20,66 (IC 95%: 7,74-55,21). CONCLUSIONES: Los pacientes con síndrome febril que tienen más riesgo de padecer malaria son los que procedían de África subsahariana, eran VFA, presentaban cifras de plaquetas 150.000/µl o cefalea, y tenían mayor riesgo de padecer arboviriasis si procedían de Centroamérica y Sudamérica, presentaban exantema o artromialgias.

Factores asociados con malaria y arboviriasis en pacientes con síndrome febril importado: estudio de cohortes retrospectivo / Factors associated with malaria and arboviral disease in patients with imported febrile syndrome: a retrospective cohort study

Objetivos: Definir variables predictoras de malaria y arboviriasis en pacientes que consultan por síndrome febril tras la vuelta de un viaje a zonas tropicales/subtropicales. Método: Estudio de cohortes retrospectivo. Se incluyeron variables demográficas, epidemiológicas, clínicas, analíticas y el diagnóstico final clínico y microbiológico. Se realizó un análisis multivariante y se calcularon los índices de exactitud diagnóstica (sensibilidad, especificidad, valores predictivos) y cocientes de probabilidad de la combinación de dichas variables. Resultados: Se incluyeron 291 pacientes con síndrome febril, 108 tenían malaria (37,1%), 28 arboviriasis (9,6%) y 155 otras causas de fiebre (53,3%). En el análisis multivariante, los pacientes con síndrome febril con más riesgo de padecer malaria fueron los que procedían de África subsahariana [odds ratio ajustado (ORa): 45,85; IC 95%: 9,45-222,49], eran inmigrantes que visitan a familiares y amigos (VFA) (ORa = 3,55; IC 95%: 1,21-10,46), presentaban cifras de plaquetas < 150.000/mm3 (ORa = 16,47; IC 95%: 5,46-49,70) o cefalea (ORa = 10,62; IC 95%: 3,20-35,28). La combinación de estas cuatro variables tiene un cociente de probabilidad positivo (CPP) de 23,72 (IC 95%: 5,76-97,62). Los pacientes con síndrome febril que tienen más riesgo de padecer arboviriasis eran los que procedían de Centroamérica y Sudamérica (OR = 5,07; IC 95%: 1,73-14,92), presentaban exantema (OR = 5,10; IC 95%: 1,72-17,02) o artromialgias (OR = 14,50; IC 95%: 3,05-68,80). La combinación de estas tres variables tiene un CPP de 20,66 (IC 95%: 7,74-55,21). Conclusiones: Los pacientes con síndrome febril que tienen más riesgo de padecer malaria son los que procedían de África subsahariana, eran VFA, presentaban cifras de plaquetas < 150.000/μl o cefalea, y tenían mayor riesgo de padecer arboviriasis si procedían de Centroamérica y Sudamérica, presentaban exantema o artromialgias. (AU)

Objective: To identify predictors of malaria and arboviral disease in patients with febrile syndrome who seek care after traveling from tropical or subtropical locations. Methods: Observational retrospective cohort study. We collected demographic, epidemiologic, and clinical data; laboratory findings; and the clinical and final microbiologic diagnoses. Multivariate analysis was used to calculate indices of diagnostic accuracy (sensitivity, specificity, and predictive values) and coefficients of probability of combinations of variables. Results: Data for 291 patients with febrile syndrome were included; 108 had malaria (37.1%), 28 had an arboviral disease (9.6%), and 155 had other causes of fever (53.3%). Multivariate analysis showed patients most likely to have malaria were those from sub-Saharan Africa, adjusted odds ratio (aOR) of 45.85 (95% CI, 9.45-222.49); immigrants who returned to visit friends and relatives (VFR), aOR of 3.55 (95% CI, 1.21-10.46); or had platelet concentrations <150 000/mm3, aORa of 16.47 (95% CI, 5.46-49.70) or headache, aOR of 10.62 (95% CI, 3.20-35.28). The combination of these 4 variables gave a positive probability coefficient (PPC) of 23.72 (95% CI, 5.76-97.62). Patients with febrile syndrome most likely to have an arboviral disease were those from Central or South America, OR 5.07 (95% CI, 1.73-14.92), and those who had exanthems, OR 5.10 (95% CI, 1.72-17.02) or joint pain, OR 14.50 (95% CI, 3.05-68.80). The combination of these 3 variables gave a PPC of 20.66 (95% CI, 7.74-55.21). Conclusions: Patients with febrile syndrome with the greatest probability of having malaria are those from sub-Saharan Africa, those who are VFR, and those with platelet concentrations under 150.000/μL or headache. Arboviral disease wasmore likely in patients from Central and South America who had exanthems or joint pain. (AU)

Underestimation of travel-associated risks by adult and paediatric travellers compared to expert assessment: A cross-sectional study at a hospital-based family pre-travel clinic.

BACKGROUND: Travellers' perception of their risk for acquiring travel-related conditions is an important contributor to decisions and behaviors during travel. In this study, we aimed to assess the differences between traveller-perceived and expert-assessed risk of travel-related conditions in children and adults travelling internationally and describe factors that influence travellers' perception of risk. METHODS: Children and adults were recruited at the Hospital for Sick Children's Family Travel Clinic between October 2014 and July 2015. A questionnaire was administered to participants to assess their perceived risk of acquiring 32 travel-related conditions using a 7-point Likert scale. Conditions were categorized as vector-borne diseases, vaccine-preventable diseases, food and water borne diseases, sexually transmitted infections and other conditions. Two certified travel medicine experts reviewed each patient's chart and assigned a risk score based on the same 7-point Likert scale. Traveller and expert risk scores were compared using paired t-tests. RESULTS: In total, 207 participants were enrolled to participate in this study, 97 children (self-reported, n = 8; parent-reported, n = 89), and 110 adults. Travel-related risk for adults and parents answering for their children were significantly underestimated when compared to expert-assessed risk for 26 of the 32 assessed conditions. The underestimated conditions were the same for both adults and parents answering for children. Travel-related risk was not over-estimated for any condition. CONCLUSIONS: Adults underestimated their children's and their own risk for most travel-related conditions. Strategies to improve the accuracy of risk perception of travel-related conditions by travellers are needed to optimize healthy travel for children and their families.

Genetic Diversity of SARS-CoV-2 among Travelers Arriving in Hong Kong.

We sequenced 10% of imported severe acute respiratory syndrome coronavirus 2 infections detected in travelers to Hong Kong and revealed the genomic diversity of regions of origin, including lineages not previously reported from those countries. Our results suggest that international or regional travel hubs might be useful surveillance sites to monitor sequence diversity.

Autochthonous dengue in two Dutch tourists visiting Département Var, southern France, July 2020.

We report dengue virus (DENV) infection in two Dutch tourists who visited Département Var, southern France, in July and August 2020. As some autochthonous dengue cases have occurred in Europe in recent years, awareness among physicians and public health experts about possible intermittent presence of DENV in southern Europe is important to minimise delay in diagnosis and treatment. Quick diagnosis can lead to timely action to contain the spread of vector-borne diseases and minimise transmission.

Siblings with typhoid fever: An investigation of intrafamilial transmission, clonality, and antibiotic susceptibility.

BACKGROUND: Typhoid fever usually manifests as an acute disease. However, asymptomatic carriage with Salmonella Typhi may occur. This study investigated a family setting of severe typhoid fever in Switzerland months after return from Bangladesh. METHOD: Standard microbiological procedures were performed. Testing for S. Typhi IgM antibodies was done using a novel immunochromographic lateral flow assay. Whole genome sequencing (WGS) followed by comparative core genome multilocus sequence typing (cgMLST) was performed on the S. Typhi isolates. RESULTS: Four months after returning from a visit to Bangladesh sibling 1 (9 months) was diagnosed with a S. Typhi meningitis and sibling 3 (8 years) was identified as asymptomatic S. Typhi carrier. Sibling 2 (2 years) was retrospectively diagnosed with typhoid fever by IgM serology at the time point of admission to the hospital. Parents were asymptomatic and culture-negative. WGS analysis of family S. Typhi isolates showed clonality and strongest homology with S. Typhi strains occurring in Bangladesh. The S. Typhi strain showed resistance against fluoroquinolones. A 4-week course of ceftriaxone resulted in full recovery of sibling 1. S. Typhi was eradicated from sibling 3 following azithromycin treatment for 14 days. CONCLUSION: S. Typhi, acquired from a visit to Bangladesh, was most likely transmitted within the family from one brother as asymptomatic shedder to his 9-month-old brother who manifested S. Typhi meningitis as a very rare and life-threatening presentation of typhoid fever. S. Typhi infection should be considered even in case of uncommon manifestations and irrespective of the interval between disease presentation and travel to an endemic area.

The older traveller.

All over the world there has been a sudden increase in the number of international travels, mostly for touristic purposes. According to the World Tourism Organisation, the number of international journeys exceeded 1.323 billion in 2017 and it continues to grow. Of the growing number of travellers more and more are the elderly (> 65 years), this fact can be attributed to longer life expectancy and a better quality of life, especially in the developed countries. The article lists the main destinations chosen by senior tourists and their reasons for travel, it also discusses physiological changes in organs and systems affecting the elderly, which are the result of travelling across time zones and to areas with different environment. The article looks at various groups of patients affected by chronic diseases and examines health-related consequences of travel, including the most common complications. The general health prevention measures, with emphasis on vaccinations and antimalarial chemoprophylaxis, have also been discussed.

Postinfectious irritable bowel syndrome after travelers' diarrhea--a cohort study.

BACKGROUND: There is sound evidence for the role of gastrointestinal infections in the development of postinfectious irritable bowel syndrome (PI-IBS), but understanding the interaction between mental factors and the infection remains incomplete. This study aims to (i) assess the occurrence of PI-IBS in a cohort of patients with self-reported travelers' diarrhea (TD), (ii) assess risk factors for PI-IBS development, and (iii) investigate the prognosis of PI-IBS after 1 year. METHODS: Patients consulting the travel clinic at the University Hospital Tuebingen, Germany (in 2009 and 2010) were identified from records and questioned in follow-ups in 2011 and 2012. We used the Rome III modular questionnaire to assess IBS, the Hospital Anxiety and Depression Scale to assess anxiety and depression, and the Patient Health Questionnaire to assess somatization. KEY RESULTS: We identified 529 eligible subjects from the clinical records. Of 135 subjects (age: 36.6 ± 14.6 years, 58.5% female) included in the study sample 6.7% (95% CI 3.0-11.1) had PI-IBS. We found more females (88.9% vs 56.3%, p = 0.08) and younger age subjects (mean 29.3 vs 37.1 years, p = 0.02) among the PI-IBS subjects. A multivariable regression model revealed vomiting at baseline and high somatization scores as strong and independent PI-IBS risk factors. One year later PI-IBS occurrence decreased to 3.3% (three cases of 90). CONCLUSIONS & INFERENCES: Our findings underline the close linkage of mental and somatic processes for the manifestation of PI-IBS. Screening for psychiatric comorbidities in patients with severe gastrointestinal infections may allow identifying groups at high risk for PI-IBS.