title: Elevated Values of C-Reactive Protein Induced by Imported Infectious Diseases: A Controlled Cross-Sectional Study of 11,079 Diseased German Travelers Returning from the Tropics and Subtropics.
abstract: The present controlled cross-sectional study aimed to assess elevated values of C-reactive protein (CRP), a positive acute-phase protein, induced by imported infectious diseases (IDs) seen in patients consulting the University of Munich (1999-2015) after being in the tropics/subtropics. The analysis investigated data sets from 11,079 diseased German travelers (cases) returning from Latin America (1,986), Africa (3,387), and Asia (5,706), and from 714 healthy Germans who had not recently traveled (controls). The proportions of elevated values of CRP (> 0.5 mg/dL) were significantly larger among cases (44.3%) than among controls (20.7%). Among cases, this proportion was largest among males (49.2%) in comparison to females (39.9%), among travelers with short travel duration of 1-14 days (49.6%) in comparison to travelers with a travel duration of > 180 days (30.8%), and with travel destination in Africa (47.0%) in comparison to Asia (44.2%) and Latin America (39.9%), among all-inclusive travelers (47.4%) in comparison to business travelers (46.7%) and backpackers (44.1%), and among patients presenting with fever (70.9%) and arthralgia (54.3%). The study identified various imported IDs with significantly larger proportions of elevated values of CRP including viral (cytomegalovirus infection [94.7%], influenza [88.9%], infectious mononucleosis [71.8%]), bacterial (typhoid fever [100%], paratyphoid fever [92.9%], shigellosis [76.8%], rickettsiosis [74.2%], Salmonella enteritis [71.3%], Campylobacter infection [68.7%]), and protozoan (vivax malaria [100%], ovale malaria [100%], falciparum malaria [95.4%], noninvasive Entamoeba infection [65.9%]) IDs. This study demonstrates that elevated values of CRP can be a useful laboratory finding for travelers returning from the tropics/subtropics, as these findings are typically caused mainly by certain imported bacterial IDs, but also by viral and protozoan IDs.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany. herbinger@lrz.uni-muenchen.de.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Herbinger
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hanus
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Schunk
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Beissner
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: von Sonnenburg
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Löscher
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Bretzel
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany. German Centre for Infection Research (DZIF), Partner Site Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Hans Dieter
authors.initials: HD
authors.lastname: Nothdurft
authors.affiliation: Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
authors.forename: Kristina Lydia
authors.initials: KL
authors.lastname: Huber
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D001424:Bacterial Infections / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D002169:Campylobacter Infections / Q000378:metabolism; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003586:Cytomegalovirus Infections / Q000378:metabolism; D004405:Dysentery, Bacillary / Q000378:metabolism; D004749:Entamoebiasis / Q000378:metabolism; D004751:Enteritis / Q000378:metabolism; D020031:Epstein-Barr Virus Infections / Q000378:metabolism; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000378:metabolism; D007843:Latin America; D008288:Malaria / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010272:Parasitic Diseases / Q000378:metabolism*; D010284:Paratyphoid Fever / Q000378:metabolism; D012282:Rickettsia Infections / Q000378:metabolism; D012480:Salmonella Infections / Q000378:metabolism; D012737:Sex Factors; D014195:Travel; D014435:Typhoid Fever / Q000378:metabolism; D014777:Virus Diseases / Q000378:metabolism*; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein