Nine (2%) needed treatment in high dependency or intensive care units (four with P. falciparum malaria, two septicemia, two pneumonia, one leptospirosis). Significant complications developed in 19 patients (4%). One patient died of P. aeruginosa septicemia. In the multivariate model, potentially life-threatening illness was associated with older age (≥40 years, OR 2.3, 95% CI 1.4–3.8), having a baseline CRP value ≥100 (OR 3.6, 95% CI 2.0–6.4), platelet count ≤140 (OR

3.8, 95% CI 2.0–7.2), and a white blood cell count ≥8 (OR 2.0, 95% CI 1.2–3.5). Patients with gastrointestinal symptoms were less likely to be diagnosed with a life-threatening illness (OR 0.4, 95% CI 0.2–0.6). There was no independent association between life-threatening illness and region of birth, duration of travel, muscle or joint www.selleckchem.com/products/jq1.html symptoms, or urinary tract symptoms. Risk factors for malaria and septicaemia as compared to other final diagnoses are presented in Table 3. The present data, while confirming several findings of previous studies, provide additional information useful in the diagnostic approach to returning travelers with fever. To retrospectively identify returned travelers with fever,

requests for malaria smear were considered an accurate approach: Selleck Afatinib doctors on duty are aware of the national recommendation to request a malaria smear from all febrile travelers who have returned from malaria-endemic

areas. The first 10 patients each month were included to ensure even distribution throughout the year. Although the most common destination of Finnish tourists is Thailand, patients in the aminophylline present study most commonly had visited Sub-Saharan Africa. The classification of potentially life-threatening illnesses was created by the study group as a tool to evaluate if the selection of patients referred to tertiary care was accurate. The classification is naturally ambiguous but a rather strict definition was preferred. Those included were not representative of all febrile travelers, but patients referred to a tertiary hospital. Accordingly, the proportion of those with a potentially life-threatening illness was high. High dependency or intensive care treatment was needed for 2%, consistent with the findings of Bottieau and colleagues.9 Hospitalization proved more common (54%) than in other reports (26%–27%),5,9 which may partly be explained by the national guidelines advising to observe febrile travelers with strong suspicion of malaria until a sufficient number of malaria smears has been collected. The median length of hospitalization (5 days) in our study was similar to that in other reports (4–5 d).8,9 The final diagnosis differed from the working diagnosis in 55%, and from the discharge diagnosis in 25%.