Preliminary data of this study have been presented during the 8th Congress of the International Society of Travel Medicine (ISTM) in New York, USA, May 2003 (FC 03.01).
Infectious Mononucleosis–Like Syndromes in Febrile Travelers Returning From the Tropics
Article first published online: 14 JUL 2006
Journal of Travel Medicine
Volume 13, Issue 4, pages 191–197, July/August 2006
How to Cite
Bottieau, E., Clerinx, J., Van den Enden, E., Van Esbroeck, M., Colebunders, R., Van Gompel, A. and Van den Ende, J. (2006), Infectious Mononucleosis–Like Syndromes in Febrile Travelers Returning From the Tropics. Journal of Travel Medicine, 13: 191–197. doi: 10.1111/j.1708-8305.2006.00049.x
- Issue published online: 14 JUL 2006
- Article first published online: 14 JUL 2006
Background Infectious mononucleosis (IM), resulting from Epstein–Barr virus (EBV) infection, and IM-like syndromes, mainly due to cytomegalovirus (CMV), Toxoplasma gondii, or human immunodeficiency virus (HIV), have been occasionally reported in travelers returning from the tropics. Our objective was to investigate the prevalence, outcome, and diagnostic predictors of these syndromes in febrile travelers.
Methods Between April 2000 and March 2005, all febrile travelers and migrants presenting at our referral centers within 12 months after a tropical stay were prospectively included. We identified all patients serologically diagnosed with IM or IM-like syndrome and compared them with the rest of the cohort.
Results During the 5-year period, 72/1,842 patients (4%) were diagnosed with an IM-like syndrome, including 36 CMV, 16 T gondii, 15 EBV, and 5 HIV primary infections. All patients were western travelers or expatriates. Mean delay before consultation was 2 weeks. Most patients had consulted other practitioners and/or received presumptive treatment. A minority of patients presented with IM clinical features. Lymphocytosis ≥40% of the white blood cells (WBC) and reactive/atypical lymphocyte morphology were observed in 60 and 30% of the patients. The four diseases were indistinguishable. Protracted fever and asthenia were common but complications rarely occurred. IM-like syndromes were independently associated with fever >7 days, lymphadenopathy, elevated liver enzymes, and lymphocytosis ≥40% of WBC. Diagnostic probability increased to >20% if at least three of these predictors were present.
Conclusions Diagnosis of IM and IM-like syndrome is not uncommon in febrile travelers, with a higher proportion of primary CMV, T gondii, and HIV infections than in nonimported series. Consequently, classic IM clinical and laboratory features are often lacking. All four pathogens should be systematically considered because early diagnosis should avoid unnecessary investigations and treatment and allow early intervention in case of primary HIV infection.