Identifying Sick Travelers from West Africa
Narrow focus on Ebola may miss other ailments
The researchers suggest that clinicians should use these data to develop a differential diagnosis and care plan for febrile travelers arriving from the region.
Clinicians looking for Ebola among sick travelers coming from West African countries may miss more common deadly illnesses, especially malaria, which requires quick diagnosis and appropriate treatment, according to a study co-authored by a Boston University School of Public Health researcher.
The study by David Hamer, a BU professor of global health, and colleagues in the GeoSentinel Surveillance Network, cautions that evaluating travelers for malaria and other life-threatening conditions should not be delayed while looking for Ebola.
“The differential diagnosis of illness in travelers arriving from countries with widespread Ebola virus transmission must include not only [Ebola] but also malaria and other more common infections, such as influenza, other respiratory tract infections, and travelers’ diarrhea,” said the study, published in the Annals of Internal Medicine.
“The optimal strategy is preventing infections through comprehensive pre-travel interventions and, for ill travelers, promptly diagnosing and treating illnesses, such as malaria, and initiating empirical treatment if bacteremia, influenza, or meningitis is suspected.”
Patients with Ebola virus typically present with fever, fatigue, myalgia, headache, and gastrointestinal symptoms. These nonspecific symptoms are shared by many other frequently encountered infectious diseases, the research team said.
Researchers reviewed records from 57 travel clinics in 25 countries in the GeoSentinal Network—a clinic-based global surveillance network that tracks infectious diseases and other adverse health outcomes in travelers—to define the spectrum of illness seen in ill travelers returning from Sierra Leone, Liberia, or Guinea, countries where Ebola virus transmission has been widespread. They found that malaria was the most frequent diagnosis among nonimmigrant travelers, affecting about 40 percent of patients. Among immigrants from the same area, latent tuberculosis was one of the most frequently diagnosed illnesses.
The researchers suggest that clinicians should use these data to develop a differential diagnosis and care plan for febrile travelers arriving from the region. “Where adequate laboratory capacity exists, ruling out malaria in febrile travelers from West Africa is critical to limiting morbidity and mortality,” they said in the study. “In situations where laboratory infrastructure is inadequate or a diagnostic result will be delayed, administration of empirical antimalarial therapy and broad-spectrum antibiotic coverage for bacteremia is imperative and potentially life-saving.”
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