title: Spectrum of disease and relation to place of exposure among ill returned travelers.
abstract: BACKGROUND
  Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s.
  
  
  METHODS
  Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world.
  
  
  RESULTS
  Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea.
  
  
  CONCLUSIONS
  When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences.
authors.affiliation: Division of Geographic Medicine, University of Alabama at Birmingham, Birmingham, USA. freedman@uab.edu
authors.forename: David O
authors.initials: DO
authors.lastname: Freedman
authors.forename: Leisa H
authors.initials: LH
authors.lastname: Weld
authors.forename: Phyllis E
authors.initials: PE
authors.lastname: Kozarsky
authors.forename: Tamara
authors.initials: T
authors.lastname: Fisk
authors.forename: Rachel
authors.initials: R
authors.lastname: Robins
authors.forename: Frank
authors.initials: F
authors.lastname: von Sonnenburg
authors.forename: Jay S
authors.initials: JS
authors.lastname: Keystone
authors.forename: Prativa
authors.initials: P
authors.lastname: Pandey
authors.forename: Martin S
authors.initials: MS
authors.lastname: Cetron
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology; D003625:Data Collection; D016208:Databases, Factual; D003715:Dengue / Q000453:epidemiology; D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010272:Parasitic Diseases / Q000453:epidemiology; D012282:Rickettsia Infections / Q000453:epidemiology*; D018571:Sentinel Surveillance; D014195:Travel; D014330:Tropical Medicine; D014481:United States / Q000453:epidemiology