Surprise Souvenirs: Why Clinicians Should Always Ask About Foreign Travel

Americans take 60 million international trips each year, and as many as half of those travelers bring back unwanted souvenirs in the form of gastrointestinal illnesses, fevers, skin disorders and other ills.

That's why physicians should routinely ask patients if they've recently been out of the country, says Dr. Stefan Hagmann, assistant professor of pediatrics at Einstein. 

Dr. Stefan HagmannDr. Hagmann and his team analyzed data from the GeoSentinel Surveillance Network, consisting of travel and tropical medicine clinics in 24 countries on six continents that compile clinical information on sick travelers. Patients in the study had crossed an international border within the last 10 years and had sought medical care from a GeoSentinel clinician for a presumed travel-associated condition.

Charting the Conditions
Gastrointestinal illness was the leading diagnostic category (58 percent). Topping the list of GI conditions were giardiasis (caused by accidentally ingesting the protozoan Giardia) and intestinal strongyloidiasis (a tropical or subtropical ailment caused by a parasitic worm that penetrates the skin). The next most common category was systemic febrile illness (18 percent), with malaria and dengue as the most common identified diagnoses. A close third were dermatologic disorders (17 percent), most often related to insect bites. Together, those three categories accounted for more than 90 percent of the illnesses afflicting travelers seen at GeoSentinel clinics. Vaccine-preventable infections affected 2 percent of travelers who sought medical care.

The researchers also looked at correlations between types of travelers and diseases they brought back. For example, malaria predominated among travelers visiting friends and relatives, while rickettsial infections (tick-borne spotted fever and the like) disproportionately affected tourists.

Always Ask
"Questions about recent travel should be a routine part of medical history-taking," says Dr. Hagmann, a pediatric infectious disease specialist at Bronx-Lebanon Hospital who is also on the pediatrics staff at Montefiore. "They would allow for quicker diagnosis and earlier treatment of travel-related conditions. Consider a patient who arrives in the doctor's office with a fever and mentions a recent trip to a malaria endemic area. That information warrants malaria smears and, if available, a rapid malaria test."

The study appeared in the December 2014 issue of Family Practice.  

Posted on: Thursday, January 29, 2015