Illness in the Returned International Traveler

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Key points

  • Illness is common in travelers to low-income nations: between 20% and 70% of travelers to low-income nations become ill during or after their trip.

  • The most common 3 categories of illness in international travelers are gastrointestinal, fever, and dermatoses.

  • Familiarity with the epidemiology, mode of transmission, and risk factors for acquisition for common infectious illnesses can facilitate work-up of illness in returned international travelers.

Pathophysiology

Diarrhea is the most common illness reported in returned international travelers.5 Traveler’s diarrhea (TD) is defined as 3 or more unformed stools per day plus other gastrointestinal symptoms, such as abdominal pain, associated with travel. Risk factors include young age, adventurous travel (trekking, camping, and safaris), travel to tropical climates, higher socioeconomic status, and medical conditions resulting in immunocompromised state or decreased gastric acidity.6 Attack rates of TD

Fever

Fever is reported by 2% to 3% of US and European travelers who visit low-income nations.14, 15 According to data from GeoSentinel, a network of 59 travel clinics around the world, the most common cause of fever is malaria (29%), followed by dengue fever (15%). Malaria is disproportionately diagnosed in those returned from Africa, whereas dengue fever is more common in those returning from Southeast Asia, Latin America, and the Caribbean. Other common causes of fever include enteric fever

Dermatoses

Common causes of dermatologic symptoms in international travelers returned from the tropics include cutaneous larva migrans (CLM), pyodermas, arthropod-related pruritic dermatitis, myiasis, tungiasis, cutaneous leishmaniasis, scabies, and cutaneous fungal infections. A study of 784 US travelers to low-income nations found that 8% (63) developed skin disorders: 14 were related to insect bites or stings, 10 to sun exposure, 7 to dermatophytes, 7 to contact allergy, and 5 to infectious cellulitis.

Other causes of illness in returned international travelers

After gastrointestinal disorders, fever, and dermatoses, the 3 most common categories of illnesses in returned international travelers are respiratory or pharyngeal disorders (11%); genitourinary, sexually transmitted infections, and gynecologic disorders (3%); and neurologic disorders (2%.) The most common respiratory and pharyngeal illnesses are nonspecific upper respiratory infections, influenza, influenza-like illnesses, bronchitis, and pneumonia. The most common neurologic disorder in

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