Do Not Skip Travel History, Sentinel Clinic Data Show

Laird Harrison

October 07, 2014

Primary care physicians in the United States are likely to encounter a complex array of diseases from patients who have traveled abroad, according to a review of data from sentinel clinics.

"Inquiry about recent travel needs to be considered as an important routine question in medical history-taking," write Stefan H. F. Hagmann, MD, from the Division of Pediatric Infectious Diseases, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York, and colleagues.

The researchers published their findings online September 26 in Family Practice.

Every year, 29 million US residents make approximately 60 million trips abroad, the authors note. During these trips, travelers can become infected with a variety of diseases, some of which are life-threatening or pose a dangerous risk for contagion.

In 24 countries on six continents, GeoSentinel Surveillance Network sites collect data on such infections from travelers who have crossed an international border within 10 years and who are seeking medical care.

To assemble a profile of common travel-related illnesses, Dr Hagmann and colleagues reviewed cases from patients who visited one of the 22 network clinics in the United States between January 1, 2000, and December 31, 2012. They excluded patients who had traveled for the purpose of immigration to the United States, for medical tourism, or for military activities.

The researchers counted 12,384 diagnoses among 9624 travelers returning to the United States. Most acquired their illnesses in sub-Saharan Africa (25%), Central America (including Mexico) (18%), and South America (14%).

Thirty-eight percent of the sick travelers were tourists; 25% were missionaries, volunteers, researchers, or aid workers; 16% were visiting friends and relatives; 15% were on business; and 6% were students.

Forty-five percent got medical advice before traveling. Those visiting friends and family were less likely to have sought pretravel medical advice (20%). They were also more likely to require inpatient care on return to the United States (24%) compared with 7% for the entire study population.

The illnesses most often struck the patients' gastrointestinal tracts (58%). Systemic febrile illnesses afflicted another 18%, closely followed by dermatologic disorders (17%).

Acute diarrhea struck 30%, with Giardia (12.4%), Campylobacter (4.7%), Entamoeba histolytica (3.1%), and Salmonella (1.4%) being the most common pathogens. Giardia may be disproportionately represented in the surveillance sites because travelers with diarrhea are self-treating with antibiotics, the researchers speculate.

Chronic diarrhea afflicted 11% and was more likely to be caused by postinfectious irritable bowel syndrome, with intestinal strongyloidiasis (12.1%) and schistosomiasis (5.6%) the most common culprits.

Among those presenting with fever, 27.4% had malaria and 12.0% had dengue, whereas 8.7% had mononucleosis. Other pathogens included Salmonella enterica serotype Tyhpi and Salmonella enterica serotype Parathyphi.

Among patients with skin problems, 20% had arthropod bites, 9% had bacterial infections, 7% had fungal infections, and 6% had cutaneous leishmaniasis.

"Information on purpose of travel and destination represents important determinants guiding clinicians for optimal post-travel care and may inform public health planners in developing preventive pre-travel care strategies," the researchers conclude.

The study was funded by the Centers for Disease Control and Prevention and the International Society of Travel Medicine.

Fam Pract. Published online September 26, 2014. Abstract

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