title: Differential diagnosis of illness in travelers arriving from Sierra Leone, Liberia, or Guinea: a cross-sectional study from the GeoSentinel Surveillance Network.
abstract: BACKGROUND
  The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms.
  
  
  OBJECTIVE
  To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread.
  
  
  METHODS
  Descriptive, using GeoSentinel records.
  
  
  METHODS
  57 travel or tropical medicine clinics in 25 countries.
  
  
  METHODS
  805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014.
  
  
  METHODS
  Frequencies of demographic and travel-related characteristics and illnesses reported.
  
  
  RESULTS
  The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered.
  
  
  CONCLUSIONS
  Surveillance data collected by specialist clinics may not be representative of all ill returned travelers.
  
  
  CONCLUSIONS
  Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality.
  
  
  BACKGROUND
  Centers for Disease Control and Prevention.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Boggild
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Esposito
authors.forename: Phyllis E
authors.initials: PE
authors.lastname: Kozarsky
authors.forename: Vernon
authors.initials: V
authors.lastname: Ansdell
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Beeching
authors.forename: Daniel
authors.initials: D
authors.lastname: Campion
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.forename: Eric
authors.initials: E
authors.lastname: Caumes
authors.forename: Francois
authors.initials: F
authors.lastname: Chappuis
authors.forename: Jakob P
authors.initials: JP
authors.lastname: Cramer
authors.forename: Effrossyni
authors.initials: E
authors.lastname: Gkrania-Klotsas
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.forename: Stefan H F
authors.initials: SH
authors.lastname: Hagmann
authors.forename: Noreen A
authors.initials: NA
authors.lastname: Hynes
authors.forename: Poh Lian
authors.initials: PL
authors.lastname: Lim
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
authors.forename: Denis J M
authors.initials: DJ
authors.lastname: Malvy
authors.forename: Marc
authors.initials: M
authors.lastname: Mendelson
authors.forename: Philippe
authors.initials: P
authors.lastname: Parola
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sotir
authors.forename: Henry M
authors.initials: HM
authors.lastname: Wu
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000175:diagnosis; D058872:Epidemics; D005260:Female; D016701:Guinea; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000175:diagnosis; D007988:Liberia; D008288:Malaria / Q000175:diagnosis*; D016778:Malaria, Falciparum / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000175:diagnosis; D018571:Sentinel Surveillance; D012807:Sierra Leone; D014195:Travel; D014552:Urinary Tract Infections / Q000175:diagnosis; D055815:Young Adult