{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:17:17Z","timestamp":1790741837520,"version":"4.1.0"},"reference-count":65,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>10\u2009064 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\u201314, 3\u201311 and 5\u20137 times more likely in malaria than non-malaria patients. High variability of results between studies reflects heterogeneity in study design, regions visited, participants\u2019 characteristics, setting, laboratory investigations performed and diseases included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jtm\/taaa207","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T08:09:44Z","timestamp":1603958984000},"source":"Crossref","is-referenced-by-count":53,"title":["Aetiology of fever in returning travellers and migrants: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"27","author":[{"given":"Imogen","family":"Buss","sequence":"first","affiliation":[{"name":"Centre for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaise","family":"Genton","sequence":"additional","affiliation":[{"name":"Centre for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"},{"name":"Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"D\u2019Acremont","sequence":"additional","affiliation":[{"name":"Centre for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"},{"name":"Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,4]]},"reference":[{"key":"2020123008201146400_ref1","doi-asserted-by":"crossref","DOI":"10.1142\/p1063","volume-title":"Globalisation, migration and health: challenges and opportunities","author":"Renzaho","year":"2016"},{"key":"2020123008201146400_ref2","volume-title":"International Tourism Highlights","author":"World Tourism Organization (UNWTO)","year":"2019","edition":"2019 Edition"},{"key":"2020123008201146400_ref3","volume-title":"The International Migration Report 2017 (Highlights) | Multimedia Library"},{"key":"2020123008201146400_ref4","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1016\/S0140-6736(07)61779-6","article-title":"Infection with chikungunya virus in Italy: an outbreak in a temperate region","volume":"370","author":"Rezza","year":"2007","journal-title":"Lancet Lond Engl"},{"key":"2020123008201146400_ref5","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/S1473-3099(15)70091-5","article-title":"Effect of climate change on vector-borne disease risk in the UK","volume":"15","author":"Medlock","year":"2015","journal-title":"Lancet Infect Dis"},{"key":"2020123008201146400_ref6","doi-asserted-by":"crossref","first-page":"e0007213","DOI":"10.1371\/journal.pntd.0007213","article-title":"Global expansion and redistribution of Aedes-borne virus transmission risk with climate change","volume":"13","author":"Ryan","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2020123008201146400_ref7","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1136\/annrheumdis-2013-203848","article-title":"The emerging problem of biological treatment in migrant and travelling populations: it is time to extend guidelines for the screening of infectious diseases","volume":"73","author":"Bartalesi","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"2020123008201146400_ref8","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1038\/embor.2008.144","article-title":"Tropical travel medicine. 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