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Management of Travelers with Fever and Exanthema, Notably Dengue and Chikungunya Infections

Febrile exanthema frequently presents as an acute condition in travelers. Sixty-two travelers who presented with febrile exanthema were prospectively included over a 20-month period. Diagnostic tests were performed according to clinical presentation and risk exposures. Symptoms occurred after return in 56% of these travelers, and the median interval between return and symptom onset was 2 days. The 3 main travel destinations were the Indian Ocean (35%), Africa (21%), and Asia (18%). The 3 main etiologies were chikungunya (35%), dengue (26%), and African tick bite fever (ATBF) (10%). Travel to the Indian Ocean and South Africa was significantly associated with respectively chikungunya and ATBF. Arthralgias were significantly more frequent in chikungunya than in dengue, whereas leucopenia, neutropenia, and thrombopenia were significantly more frequent in dengue. Travelers presenting with febrile exanthema should therefore be screened for arboviral infections according to the area visited.

Received October 12, 2007. Accepted for publication February 11, 2008.

^* Address correspondence to Patrick Hochedez, Department of Infectious and Tropical Disease, Hôpital Pitié-Salpêtrière, Paris. E-mail: p.hochedez{at}free.fr

Authors’ addresses: Patrick Hochedez, Ana Canestri, Amélie Guihot, François Bricaire, and Eric Caumes, Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, 47–83 boulevard de l’Hôpital, 75013 Paris, France, Tel: 33-1-42-16-01-14, Fax: 33-1-42-16-01-65, E-mails: patrick.hochedez{at}free.fr, ana.canestris{at}psl.aphp.fr, amelie.guihot{at}psl.aphp.fr, francois.bricaire{at}psl.aphp.fr, and eric.caumes{at}psl.aphp.fr. Ségolène Brichler, Service de Virologie Hôpital Avicenne, Bobigny, France, Tel: 33-1-48-95-75-96, Fax: 33-1-48-95-59-11, E-mail: segolene.brichler{at}avc.aphp.fr.

Reprint requests: Eric Caumes, Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, 47–83 boulevard de l’Hôpital, 75013 Paris, France, Tel: 33-1-42-16-01-14, Fax: 33-1-42-16-01-65, E-mail: eric.caumes{at}psl.aphp.fr.