title: Comparison of clinical characteristics and laboratory findings of malaria, dengue, and enteric fever in returning travelers: 8-year experience at a referral center in Tokyo, Japan.
abstract: BACKGROUND
  Without specific symptoms, diagnosis of febrile illness in returning travelers is challenging. Dengue, malaria, and enteric fever are common causes of fever in returning travelers and timely and appropriate treatment is important. However, differentiation is difficult without specific diagnostic tests.
  
  
  METHODS
  A retrospective study was conducted at the National Centre for Global Health and Medicine (NCGM) from April 2005 to March 2013. Febrile travelers returning from overseas who were diagnosed with dengue, malaria, or enteric fever were included in this study. Clinical characteristics and laboratory findings were compared for each diagnosis.
  
  
  RESULTS
  During the study period, 86 malaria, 85 dengue, and 31 enteric fever cases were identified. The mean age of the study cohort was 33.1 ± 12 years and 134 (66.3%) study participants were male. Asia was the most common area visited by returning travelers with fevers (89% of dengue, 18.6% of malaria, and 100% of enteric fever cases), followed by Africa (1.2% of dengue and 70.9% of malaria cases). Clinical characteristics and laboratory findings were significantly different among each group with each diagnosis. Decision tree models revealed that returning from Africa and CRP levels <10 mg/L were factors specific for diagnosis of malaria and dengue fever, respectively.
  
  
  CONCLUSIONS
  Clinical manifestations, simple laboratory test results, and regions of travel are helpful to distinguish between dengue, malaria, and enteric fever in febrile returning travelers with non-specific symptoms.
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan. Electronic address: sonare.since1192@gmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kutsuna
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fujiya
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Mawatari
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Takeshita
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Kanagawa
authors.affiliation: National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Ohmagari
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D003715:Dengue / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014041:Tokyo / Q000453:epidemiology; D014195:Travel / Q000706:statistics & numerical data*; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Dengue fever; Enteric fever; Malaria; Typhoid fever