Respiratory syndrome and respiratory tract infections in foreign-born and national travelers hospitalized with fever in Italy.

Matteelli, Alberto; Beltrame, Anna; Saleri, Nuccia; Bisoffi, Zeno; Allegri, Roberto; Volonterio, Alberto; Giola, Massimo; Perini, Paolo; Galimberti, Laura; Visonà , Raffaella; Donisi, Alessra; Giani, Gloria; Scalzini, Alfredo; Gaiera, Giovanni; Ravasio, Laura; Anna Carvalho, C C; Gulletta, Maurizio

BACKGROUND We measured frequency and epidemiologic, clinical, and hematochemical variables associated with respiratory tract infections (RTIs) in foreign-born and national patients hospitalized with fever with a history of international travel, and compared the final diagnosis of RTI with the presence of a respiratory syndrome (RS) at presentation. METHODS A prospective, multicenter, observational study was conducted at tertiary care hospitals in Northern Italy from September 1998 to December 2000. RESULTS A final diagnosis of RTI was obtained in 40 cases (7.8%), 27 (67.5%) with lower RTI and 13 (32.5%) with upper RTI. The most common RTIs were pneumonia (35%) and pulmonary tuberculosis (15%). A white blood cell count > or = 10,000 and an erythrocyte sedimentation rate > or = 20 mm/h were independently associated with a final diagnosis of RTI; onset of symptoms at > or = 16 days and > or = 75% neutrophils were independently associated with lower RTI. An RS was identified in 51 (9.9%) of 515 travelers. Sensitivity, specificity, and positive and negative predictive values of a diagnosis of RS for a final diagnosis of RTI were 67.5%, 94.9%, 52.9%, and 97.2%, respectively. CONCLUSIONS Pneumonia and pulmonary tuberculosis were frequent among foreign-born and national travelers with fever admitted to a tertiary care hospital. Half of the pneumonia cases did not present with an RS at first clinical examination.