Table 2.
Diagnosis groups, selected subgroup and aetiologic diagnoses and proportion of hospitalization for 9624 ill-returning US international travellers
| Diagnosisa | N (%) of US traveller | (%) hospitalized |
|---|---|---|
| Acute diarrhoeab | 2897 (30.1) | 2.9 |
| Unspecified aetiology | 1081 (37.3) | 1.7 |
| Bacterial aetiology | 897 (31.0) | 2.5 |
| Parasitic aetiology | 650 (22.4) | 3.2 |
| Chronic diarrhoeac | 1008 (10.5) | 0.5 |
| Post-infectious IBS | 591 (58.6) | 0.2 |
| Nondiarrhoeal gastrointestinal disorderd | 1709 (17.8) | 4.0 |
| Strongyloidiais, simple intestinal | 206 (12.1) | 5.3 |
| Schistosomiasise | 96 (5.6) | 6.5 |
| Systemic febrile illness, allf | 1748 (18.2) | 23.8 |
| Malariag | 479 (27.4) | 48.6 |
| Viral syndrome | 324 (18.5) | 4.0 |
| Dengueh | 209 (12.0) | 18.3 |
| Mononucleosis syndromei | 152 (8.7) | 2.1 |
| Enteric feverj | 106 (6.1) | 34.9 |
| Rickettsial infectionsk | 82 (4.7) | 6.1 |
| Dermatologic disorder, alll | 1594 (16.6) | 4.0 |
| Arthropod bites | 319 (20.0) | 1.3 |
| Bacterial skin infections | 150 (9.4) | 10.7 |
| Fungal skin infections | 107 (6.7) | 1.0 |
| Cutaneous leishmaniasism | 98 (6.1) | 3.1 |
| Respiratory disorder, alln | 1042 (10.8) | 6.8 |
| Hyperactive airway diseaseo | 271 (26.0) | 5.0 |
| Upper respiratory tract infection | 286 (27.4) | 1.1 |
| Nonspecific | 578 (6.0) | 4.7 |
| Chronic disease | 250 (2.6) | 11.4 |
| Neurologic disorder | 204 (2.1) | 14.0 |
| Genitourinary/STDp | 245 (2.5) | 11.4 |
| Psychologic | 229 (2.4) | 3.2 |
| Injury | 226 (2.3) | 11.2 |
| Tissue parasitesq | 149 (1.5) | 9.0 |
| Oral/dental disorder | 139 (1.4) | 3.7 |
| Vaccine-preventable diseaser | 178 (1.8) | 28.1 |
IBS, irritable bowel syndrome, STD, sexually transmitted diseases.
Three deaths were reported during the study period, the associated diagnoses were acute respiratory infection and sepsis. No associated diagnosis was reported for the third case.
Specific diagnoses included infections with Giardia spp. (n = 359), Campylobacter spp. (n = 136), Entamoeba histolytica (n = 89), Salmonella spp. (n = 40), Shigella spp. (n = 16), Cryptosporidium spp. (n = 42) and Dientamoeba fragilis (n = 37) and Clostridium difficile-associated disease (n = 54).
Includes travellers with pre-existing (n = 32) and new onset (n = 13) inflammatory bowel disease.
Includes travellers with acute hepatitis [n = 69; hepatitis A virus (n = 26), hepatitis E virus (n =7), hepatitis B virus (n = 5), hepatitis C virus (n = 1), unspecified (n = 30)], echinococcosis (n = 9) and intestinal ascaris (n = 45).
Most identified species were Schistosoma mansoni (n = 92) and S. japonicum (n = 4).
Rare specific diagnosis were histoplasmosis (n = 21), acute brucellosis (n = 19), leptospirosis (n = 18), extrapulmonary infection with Mycobacterium tuberculosis (n = 13), relapsing fever (n = 2), Chikungunya fever (n = 11), acute HIV infection (n = 7), Q fever (n = 5), coccidiomycosis (n = 3) and African trypanosomiasis (n = 3).
Includes cases of severe and complicated malaria (n = 26). Malaria was caused by infections with Plasmodium falciparum (n = 328), P. vivax (n = 61), P. ovale (n = 14) and P. malariae (n = 8).
Dengue cases were reported as uncomplicated (n = 205) and complicated (i.e. Dengue hemorrhagic fever and Dengue shock syndrome, according to the WHO criteria (n = 4).
Includes infections with Epstein–Barr virus (n = 79), cytomegalovirus (n = 30) and Toxoplasma gondii (n = 18).
Enteric fever was caused by infections with S. Typhi (n = 58), S. Paratyphi (n = 16) and unspecified species (n = 32).
Rickettsial infections were mostly due to tick-borne-spotted fever-associated species (n = 68), or to flea-borne Rickettsia typhi (n = 4).
Less common specific diagnoses were animal bites (n = 96), scabies (n = 51), myiasis (n = 47), cutaneous larva migrans (n = 45), leprosy (n = 5) and tungiasis (n = 15).
Most cases were acquired in Costa Rica (n = 22) and Peru (n = 12).
Other less common specific diagnoses were acute sinusitis (n = 100), bacterial (lobar) pneumonia (n = 91), and pulmonary infection with Mycobacterium tuberculosis (n = 25).
Hyperactive airway disease represents the diagnoses of asthma, acute and chronic bronchitis and bronchospasm.
Includes infections with S. haematobium (n = 49).
Tissue parasites represent mostly filarial infections (n = 90), and infections with schistosomiasis, human species not further specified (n = 37).
The most common diagnoses included enteric fever [n = 106, S. Typhi (n = 58), S. Paratyphi (n = 16), unspecified (n = 32), acute viral hepatitis (n = 31), hepatitis A virus (n = 26), hepatitis B virus (n = 5) and influenza [n = 29, influenza A virus (n = 21), influenza 2009 H1N1 virus (n = 6), influenza B virus (n = 2)].