[Return from the tropics: relevant diagnosis and rational therapy]

Area of Science:

• Tropical medicine
• Infectious diseases
• Traveler's health

Background:

• Gastrointestinal disorders, especially diarrhea, are common reasons for seeking medical care after tropical travel.
• Infectious agents are often the cause, but specific pathogens are frequently not identified.
• Most acute diarrheal episodes resolve without specific medical intervention.

Purpose of the Study:

• To evaluate the necessity and economic viability of routine bacteriological and parasitological investigations for travelers' diarrhea.
• To emphasize the importance of excluding life-threatening infections, such as falciparum malaria, in febrile travelers returning from the tropics.
• To question the value of extensive check-ups for asymptomatic travelers seeking exclusion of "exotic" infections.

Main Methods:

• Review of clinical guidelines and literature regarding the diagnosis and management of common tropical illnesses.
• Analysis of the diagnostic yield and cost-effectiveness of various laboratory investigations.
• Clinical reasoning for prioritizing urgent and potentially dangerous conditions.

Main Results:

• Specific pathogens are often not identified in cases of travelers' diarrhea.
• Empirical treatment or watchful waiting is often sufficient for acute diarrhea.
• Fever in returning travelers necessitates prompt exclusion of serious infections like malaria.
• Routine screening for asymptomatic infections in travelers is generally not indicated.

Conclusions:

• Bacteriological and parasitological investigations for acute diarrhea should be used judiciously and economically.
• The primary focus for febrile travelers should be the exclusion of severe, treatable infections.
• Unnecessary investigations for asymptomatic travelers returning from the tropics should be avoided.