许多出版物聚焦于返程旅客的发烧,但是没有考虑所有疾病的系统评价,或所有引起发烧的热带疾病。为了制定适当的实践准则,这种审查是必要的。
本综述的主要目标是(i)确定从(亚)热带国家返回的旅行者/移民发烧的病因以及具有特定诊断的患者比例,和(ii)评估特定热带疾病的预测因素。
Embase,搜索了MEDLINE和Cochrane图书馆,其中包含了发烧和旅行/移民的术语。包括所有针对返回旅行者发烧原因和/或热带病的临床和实验室预测因素的研究。对病因诊断的频率进行了荟萃分析。
确定了10064项研究;541项进行了全文审查;30项符合数据提取标准。热带感染占发烧诊断的33%,疟疾导致22%,登革热5%和肠道热2%。非热带感染占发热病例的36%,急性胃肠炎导致14%和呼吸道感染13%。正似然比表明脾肿大,疟疾患者的血小板减少症和高胆红素血症分别比非疟疾患者高5-14、3-11和5-7倍。研究之间结果的高度可变性反映了研究设计的异质性,访问过的地区,参与者的特征,设置,进行实验室调查并包括疾病。
疟疾占发热病例的五分之一,强调快速疟疾检测对高热返回旅客的重要性,其次是其他常见热带病的快速检测。研究之间的高度差异突出了协调研究设计和促进多中心研究调查疾病预测因素的必要性。包括较低的发病率,这可能有助于制定循证指南。卫生工作者使用包含临床预测因子的临床决策支持算法,可以帮助标准化研究,并提高建议的质量。
Numerous publications focus on fever in returning travellers, but there is no known systematic
review considering all diseases, or all tropical diseases causing fever. Such a
review is necessary in order to develop appropriate practice guidelines.
Primary objectives of this
review were (i) to determine the aetiology of fever in travellers/migrants returning from (sub) tropical countries as well as the proportion of patients with specific diagnoses, and (ii) to assess the predictors for specific tropical diseases.
Embase, MEDLINE and Cochrane Library were searched with terms combining fever and travel/migrants. All studies focusing on causes of fever in returning travellers and/or clinical and laboratory predictors of tropical diseases were included. Meta-analyses were performed on frequencies of etiological diagnoses.
10 064 studies were identified; 541 underwent full-text
review; 30 met criteria for data extraction. Tropical infections accounted for 33% of fever diagnoses, with malaria causing 22%, dengue 5% and enteric fever 2%. Non-tropical infections accounted for 36% of febrile cases, with acute gastroenteritis causing 14% and respiratory tract infections 13%. Positive likelihood ratios demonstrated that splenomegaly, thrombocytopenia and hyperbilirubinemia were respectively 5-14, 3-11 and 5-7 times more likely in malaria than non-malaria patients. High variability of results between studies reflects heterogeneity in study design, regions visited, participants\' characteristics, setting, laboratory investigations performed and diseases included.
Malaria accounted for one-fifth of febrile cases, highlighting the importance of rapid malaria testing in febrile returning travellers, followed by other rapid tests for common tropical diseases. High variability between studies highlights the need to harmonize study designs and to promote multi-centre studies investigating predictors of diseases, including of lower incidence, which may help to develop evidence-based guidelines. The use of clinical decision support algorithms by health workers which incorporate clinical predictors, could help standardize studies as well as improve quality of recommendations.