3% were immigrant VFRs In addition, the study was performed from

3% were immigrant VFRs. In addition, the study was performed from November 2002 to May 2003, a period marked by the emergence of the severe acute respiratory syndrome (SARS). This fact could explain why 62.1% of our febrile travelers returned from Africa, regarding that WHO recommended avoiding Asian destinations at that time.20 As a result, only 11.8% of our patients traveled to Southeast Asia. The choice of destinations could explain some of our results regarding febrile diseases

other than malaria as previously Selleckchem GPCR Compound Library discussed.21 We evaluated the predictive factors of imported malaria in febrile travelers whatever was the visited country within a continent. However, the risk of malaria varies across continent and moreover, across countries, not every country being at similar risk for malaria. This point is a source of heterogenity in this study. Nonetheless, the aim of our study was to provide practitioners not fully aware of the geographic distribution of malaria with easy to determine predictive factors of malaria. Malaria

cases were not divided into subspecies, which is of importance selleck chemicals when evaluating predictive factors. Indeed, we were unable to establish predictive factor of malaria regarding plasmodium species because of the small number of cases in most groups. However, it is noteworthy that most of our malaria cases (67%) due to P falciparum, and occurred in VFRs (55%) and in travelers returning from Africa. This is concordant with national records of imported malaria in France. Of 8,056 imported malaria cases seen in France in 2000, 83% were attributed to P falciparum and 63% occurred in VFRs from African origin.22 In our study, none of the 54 malaria cases were observed in travelers returning from India which is concordant with recent data showing that the incidence of malaria in travelers to India decreased from 93/100

to 19 cases/100 travelers between 1992 in 2005.23 In this study, we compare cases versus non cases. Our controls (non cases) were febrile returning travelers with fever due to illness other than malaria. We previously compared the characteristics of our travelers with those presenting in our unit for pretravel advice. Our ill travelers were representative of our “pretravel population”(data not shown). Our patients were indifferently examined by the two investigators. Recording of data was performed before the final SPTBN5 diagnosis was made. We only assessed variables easy to collect in any febrile patient. In the Swiss study, some clinical factors were difficult to use routinely such as splenomegaly, which is not easily reproducible by physicians.16 Similarly we recorded biological criteria available only routinely. This is the reason why we did not look at hypercholesterolemia, a factor strongly associated with malaria (OR = 75.22) in a previous study.24 Surprisingly, we found an association between inadequate chemoprophylaxis and medical advice taken before travel.

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