Table 3.
Top diagnoses and source countries for specific etiologies within syndromic chief complaints among 3943 ill returned travellers with definitive travel-related diagnoses
| Diagnosis | No. (%) of patients with chief complaint* | Total no. of patients in database with travelrelated diagnosis† | Top 3 source countries for diagnosis‡ |
|---|---|---|---|
| Chief complaint fever (n = 675) | |||
| Malaria | 80 (11.9) | 94 | |
| Plasmodium falciparum | 47 (7.0) | 56 | Ghana, Burkina Faso, Guinea (includes data for severe and cerebral malaria, as well as P. falciparum malaria) |
| Severe noncerebral | 3 (0.4) | 5 | |
| Severe cerebral | 3 (0.4) | 3 | |
| Plasmodium vivax | 17 (2.5) | 17 | India, Honduras, Pakistan |
| Plasmodium ovale | 5 (0.7) | 5 | Uganda, Malawi, Ghana (includes data for P. malariae malaria and unspecified malaria, as well as P. ovale malaria) |
| Plasmodium malariae | 1 (0.1) | 2 | |
| Dengue fever | 48 (7.1) | 61 | India, Indonesia, Nicaragua, Haiti |
| Active tuberculosis | 47 (7.0) | 123 | India, China, Philippines |
| Pulmonary | 34 (5.0) | 82 | |
| Extrapulmonary | 13 (1.9) | 41 | |
| Enteric fever | 28 (4.1) | 33 | India, Bolivia, Tanzania, Pakistan, Bangladesh |
| Salmonella enterica serotype Paratyphi | 11 (1.6) | 13 | |
| Typhoid fever, unspecified | 9 (1.3) | 11 | |
| Salmonella enterica serotype Typhi | 8 (1.2) | 9 | |
| Upper respiratory tract infection | 17 (2.5) | 49 | India, Mexico, Ghana |
| Pneumonia | 16 (2.4) | 23 | Mexico, Canada, United States |
| Lobar | 11 (1.6) | 16 | |
| Atypical | 5 (0.7) | 7 | |
| Influenza-like illness | 12 (1.8) | 15 | Tanzania, Panama, Brazil |
| Acute urinary tract infection | 10 (1.5) | 25 | Mexico, India, Cameroon |
| Chikungunya fever | 6 (0.9) | 9 | India, Indonesia, Malaysia |
| Brucellosis | 6 (0.9) | 7 | India, Syria |
| Rickettsioses, spotted fever§ | 5 (0.7) | 6 | South Africa, Swaziland |
| Chief complaint gastrointestinal (n = 1950) | |||
| Chronic diarrhea | 254 (13.0) | 254 | Mexico, Cuba, India |
| Acute diarrhea|| | 235 (12.1) | 241 | India, Mexico, Cuba |
| Post-infectious irritable bowel syndrome | 229 (11.7) | 235 | India, Mexico, Cuba, Dominican Republic |
| Giardiasis | 84 (4.3) | 96 | India, Mexico, Costa Rica |
| Dientamoebiasis | 59 (3.0) | 62 | Mexico, India, Thailand |
| Campylobacteriosis | 22 (1.1) | 24 | Peru, India |
| Cryptosporidiosis, cyclosporiasis | 16 (0.8) | 17 | Philippines, Mexico, India |
| Amoebiasis due to Entamoeba histolytica¶ | 11 (0.6) | 12 | India, Sri Lanka, Honduras |
| Chief complaint dermatologic (n = 865) | |||
| Rash | 128 (14.8) | 138 | Mexico, Cuba, Peru |
| Atopic dermatitis | 19 (2.2) | 21 | |
| Contact dermatitis | 21 (2.4) | 21 | |
| Drug reaction | 4 (0.5) | 8 | |
| Photosensitivity reaction | 11 (1.3) | 12 | |
| Unknown rash | 51 (5.9) | 54 | |
| Urticarial | 18 (2.1) | 18 | |
| Arthropod bite | 123 (14.2) | 128 | United States, Cuba, Mexico |
| Insect** | 99 (11.4) | 104 | |
| Tick or spider | 24 (2.8) | 24 | |
| Skin and soft-tissue infection†† | 112 (12.9) | 122 | India, Cuba, Costa Rica |
| Cutaneous larva migrans | 61 (7.1) | 62 | Jamaica, Mexico, Barbados |
| Animal bite‡‡ | 26 (3.0) | 29 | Thailand, India, Honduras |
| Cutaneous leishmaniasis | 21 (2.4) | 21 | Syria, Libya, Costa Rica, Belize, Afghanistan |
| Marine envenomation | 17 (2.0) | 19 | Cuba, United States, Mexico |
Percentages are calculated in relation to the category of chief complaint. An ill returned traveller could present with more than one chief complaint.
Number of patients in the database who had the specific travel-related diagnosis, including those who did and those who did not have the corresponding chief complaint.
Where 4 or 5 countries are listed, there was a 2-way or 3-way tie, respectively, for third place.
I ncludes infection with Rickettsia africae, R. conorii, and R. rickettsii.
Includes acute bacterial, parasitic, and viral diarrhea, as well as acute diarrhea of unspecified cause.
Includes both intestinal and extraintestinal amoebiasis.
Includes lice, fleas, true bugs, mosquitoes, flies, and midges.
Includes erysipelas, cellulitis, furunculosis, carbuncles, skin abscess, pyoderma, ecthyma, impetigo, and superficial fungal skin infections.
Includes bites by cats, dogs, monkeys, and other animals.