New tools for diagnosis and management of febrile illness in travelers to the tropics: a cohort study

During the past decade, data collected by clinic-based multicenter surveillance systems such as Geosentinel or EuroTravNet1,2 have led to major progress in the knowledge of the epidemiology of fever after a stay in the tropics. These data also indicate that the diagnosis of systemic febrile illness in returning travelers remains unknown in 16 to 25% of cases3–5. Empiric use of antimicrobial therapy during travel, self-limiting nature of an illness, short incubation periods or limitations of routine diagnostic testing may limit the diagnostic yield of post-travel clinical evaluation. It can be assumed that the etiological spectrum of febrile illness occurring DURING travel differs from that observed in returning travelers, but this has not been studied so far. Many tropical febrile illnesses are probably underreported because of a clinical evaluation after recovery of the returned traveler. This is particularly likely to be true for infections with a short incubation period. In the past decade, new diagnostic instruments were adopted into the practice of travel medicine. When nucleic acid sequences of the causative pathogens are present in clinical specimens, polymerase chain reaction (PCR) testing usually outperforms microbiological methods for diagnosing infectious diseases. Malaria rapid diagnostic tests (RDTs) are well-established adjunctive diagnostic tools in the post-travel management of fever. But in spite of increasing demands by travelers, , these tests have not been evaluated in the field for the purpose of self-testing for malaria . By its size and research experience, the Institute of Tropical Medicine has a unique position to address these issues in travelers’ populations. The objective of this PhD research is to investigate the diagnostic yield and clinical utility of these new available diagnostic tools for tropical febrile illness in different clinical per- and post-travel scenarios. The evidence generated by this PhD thesis is expected to contribute to the management of fever in travelers during and after travel.

Keywords:B780-tropical-medicine