1921
Volume 95, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

The present controlled cross-sectional study aimed to assess elevated values of C-reactive protein (CRP), a positive acute-phase protein, induced by imported infectious diseases (IDs) seen in patients consulting the University of Munich (1999–2015) after being in the tropics/subtropics. The analysis investigated data sets from 11,079 diseased German travelers (cases) returning from Latin America (1,986), Africa (3,387), and Asia (5,706), and from 714 healthy Germans who had not recently traveled (controls). The proportions of elevated values of CRP (> 0.5 mg/dL) were significantly larger among cases (44.3%) than among controls (20.7%). Among cases, this proportion was largest among males (49.2%) in comparison to females (39.9%), among travelers with short travel duration of 1–14 days (49.6%) in comparison to travelers with a travel duration of > 180 days (30.8%), and with travel destination in Africa (47.0%) in comparison to Asia (44.2%) and Latin America (39.9%), among all-inclusive travelers (47.4%) in comparison to business travelers (46.7%) and backpackers (44.1%), and among patients presenting with fever (70.9%) and arthralgia (54.3%). The study identified various imported IDs with significantly larger proportions of elevated values of CRP including viral (cytomegalovirus infection [94.7%], influenza [88.9%], infectious mononucleosis [71.8%]), bacterial (typhoid fever [100%], paratyphoid fever [92.9%], shigellosis [76.8%], rickettsiosis [74.2%], enteritis [71.3%], infection [68.7%]), and protozoan (vivax malaria [100%], ovale malaria [100%], falciparum malaria [95.4%], noninvasive infection [65.9%]) IDs. This study demonstrates that elevated values of CRP can be a useful laboratory finding for travelers returning from the tropics/subtropics, as these findings are typically caused mainly by certain imported bacterial IDs, but also by viral and protozoan IDs.

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References

  1. Tillett WS, Francis T, , 1930. Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med 52: 169177. [Google Scholar]
  2. Gewurz H, Mold C, Siegel J, Fiedel B, , 1982. C-reactive protein and acute phase response. Adv Intern Med 27: 345372. [Google Scholar]
  3. Lau DC, Dhillon B, Yan H, Szmitko PE, Verma S, , 2005. Adipokines: molecular links between obesity and atherosclerosis. Am J Physiol Heart Circ Physiol 288: H2031H2041.[Crossref] [Google Scholar]
  4. Pepys MB, Baltz ML, , 1983. Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid A protein. Adv Immunol 34: 141212.[Crossref] [Google Scholar]
  5. Weinhold B, Rüther U, , 1997. Interleukin-6-dependent and -independent regulation of the human C-reactive protein gene. Biochem J 327: 425429.[Crossref] [Google Scholar]
  6. Thompson D, Pepys MB, Wood SP, , 1999. The physiological structure of human C-reactive protein and its complex with phosphocholine. Structure 7: 169177.[Crossref] [Google Scholar]
  7. Wu TL, Tsao KC, Chang CP, Li CN, Sun CF, Wu JT, , 2002. Development of ELISA on microplate for serum C-reactive protein and establishment of age-dependent normal reference range. Clin Chim Acta 322: 163168.[Crossref] [Google Scholar]
  8. Ansar W, Ghosh S, , 2013. C-reactive protein and the biology of disease. Immunol Res 56: 131142.[Crossref] [Google Scholar]
  9. Allin KH, Nordestgaard BG, , 2011. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci 48: 155170.[Crossref] [Google Scholar]
  10. Sasaki K, Fujita I, Hamasaki Y, Miyazaki S, , 2002. Differentiating between bacterial and viral infection by measuring both C-reactive protein and 2′-5′-oligoadenylate synthetase as inflammatory markers. J Infect Chemother 8: 7680.[Crossref] [Google Scholar]
  11. Nakayama T, Sonoda S, Urano T, Yamada T, Okada M, , 1993. Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious diseases. Clin Chem 39: 293297. [Google Scholar]
  12. Hurt N, Smith T, Tanner M, Mwankusye S, Bordmann G, Weiss NA, Teuscher T, , 1994. Evaluation of C-reactive protein and haptoglobin as malaria episode markers in an area of high transmission in Africa. Trans R Soc Trop Med Hyg 88: 182186.[Crossref] [Google Scholar]
  13. McGuire W, D'Alessandro U, Olaleye BO, Thomson MC, Langerock P, Greenwood BM, Kwiatkowski D, , 1996. C-reactive protein and haptoglobin in the evaluation of a community-based malaria control programme. Trans R Soc Trop Med Hyg 90: 1014.[Crossref] [Google Scholar]
  14. Paul R, Sinha PK, Bhattacharya R, Banerjee AK, Raychaudhuri P, Mondal J, , 2012. Study of C reactive protein as a prognostic marker in malaria from eastern India. Adv Biomed Res 1: 41.[Crossref] [Google Scholar]
  15. Ansar W, Bandyopadhyay SM, Chowdhury S, Habib SH, Mandal C, , 2006. Role of C-reactive protein in complement-mediated hemolysis in malaria. Glycoconj J 23: 233240.[Crossref] [Google Scholar]
  16. Mattecka S, Bock C, Vogt B, Yapici G, Schrödl W, Janko C, Schindler R, Sheriff A, , 2013. CRP and SAP from different species have different membrane ligand specificities. Autoimmunity 46: 347350.[Crossref] [Google Scholar]
  17. Culley FJ, Harris RA, Kaye PM, McAdam KP, Raynes JG, , 1996. C-reactive protein binds to a novel ligand on Leishmania donovani and increases uptake into human macrophages. J Immunol 156: 46914696. [Google Scholar]
  18. Herbinger KH, Alberer M, Berens-Riha N, Schunk M, Bretzel G, von Sonnenburg F, Nothdurft HD, Löscher T, Beissner M, , 2016. Spectrum of imported infectious diseases: a comparative prevalence study of 16,817 German travelers and 977 immigrants from the tropics and subtropics. Am J Trop Med Hyg 94: 757766.[Crossref] [Google Scholar]
  19. United Nations World Tourism Organization (UNWTO), 2016. UNWTO World Tourism Barometer and Statistical Annex, March, 2016. Available at: http://www.e-unwto.org/doi/abs/10.18111/wtobarometereng.2016.14.2.1. Accessed July 28, 2016. [Google Scholar]
  20. Statistisches Bundesamt (Federal Statistical Office of Germany), 2016. Available at: https://www.destatis.de/DE/PresseService/Presse/Pressemitteilungen/2016/03/PD16_085_464.html. Accessed July 28, 2016.
  21. Paschke C, Apelt N, Fleischmann E, Perona P, Walentiny C, Löscher T, Herbinger KH, , 2011. Controlled study on enteropathogens in travelers returning from the tropics with and without diarrhea. Clin Microbiol Infect 17: 11941200.[Crossref] [Google Scholar]
  22. Herbinger KH, Fleischmann E, Weber C, Perona P, Loescher T, Bretzel G, , 2011. Epidemiological, clinical, and diagnostic data on intestinal infections with Entamoeba histolytica and Entamoeba dispar among returning travelers. Infection 39: 527535.[Crossref] [Google Scholar]
  23. Herbinger KH, Siess C, Nothdurft HD, von Sonnenburg F, Loescher T, , 2011. Skin disorders among travelers returning from tropical and non-tropical countries consulting a travel medicine clinic. Trop Med Int Health 16: 14571464.[Crossref] [Google Scholar]
  24. Herbinger KH, Schunk M, Nothdurft HD, von Sonnenburg F, Löscher T, Bretzel G, , 2012. Comparative study on infection-induced thrombocytopenia among returned travelers. Infection 40: 373379.[Crossref] [Google Scholar]
  25. Herbinger KH, Drerup L, Alberer M, Nothdurft HD, von Sonnenburg F, Löscher T, , 2012. Spectrum of imported infectious diseases among children and adolescents returning from the tropics and subtropics. J Travel Med 19: 150157.[Crossref] [Google Scholar]
  26. Herbinger KH, Metzner M, Beissner M, Bretzel G, Nothdurft HD, von Sonnenburg F, Löscher T, , 2013. Infection-induced anaemia: a cross-sectional study of 14,636 German travelers aged 20–49 years. Infection 41: 10791087.[Crossref] [Google Scholar]
  27. Berens-Riha N, Kroidl I, Schunk M, Alberer M, Beissner M, Pritsch M, Kroidl A, Fröschl G, Hanus I, Bretzel G, von Sonnenburg F, Nothdurft HD, Löscher T, Herbinger KH, , 2014. Evidence for significant influence of host immunity on changes in differential blood count during malaria. Malar J 13: 155.[Crossref] [Google Scholar]
  28. Herbinger KH, Hanus I, Beissner M, Berens-Riha N, Kroidl I, von Sonnenburg F, Löscher T, Hoelscher M, Nothdurft HD, Schunk M, , 2016. Lymphocytosis and lymphopenia induced by imported infectious diseases: a controlled cross-sectional study of 17,229 diseased German travelers returning from the tropics and subtropics. Am J Trop Med Hyg 94: 13851391.[Crossref] [Google Scholar]
  29. Herbinger KH, Hanus I, Felbinger TW, Weber C, Beissner M, von Sonnenburg F, Löscher T, Bretzel G, Nothdurft HD, Hoelscher M, Alberer M, , 2016. Elevated values of clinically relevant transferases induced by imported infectious diseases: a controlled cross-sectional study of 14,559 diseased German travelers returning from the tropics and subtropics. Am J Trop Med Hyg 95: 481487.[Crossref] [Google Scholar]
  30. Becker O, , 2014. Labor Informationen (laboratory manual), 8th edition. Munich, Germany, 108. [Google Scholar]
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Supplementary PDF

  • Received : 15 May 2016
  • Accepted : 21 Jun 2016
  • Published online : 05 Oct 2016

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