Notably, in our study, every 10th patient had more than one diagnosis, similar to a previous report9 which stresses the importance of thoroughness in diagnosing travelers with fever. The present data were collected before the onset of the influenza A (H1N1) pandemic in 2009. Nasal swabs for influenza A and B antigen were taken only in 18% of cases that met the criteria of influenza-like illness. These data are consistent with previous studies, 17-AAG molecular weight suggesting influenza to be under-diagnosed in travelers.17 The pandemic increased the use of rapid diagnostic tests, hopefully not only temporarily. HIV infection was diagnosed in 3% of those tested, 1%

of all patients. Similar proportions of HIV cases have been found in another study on febrile returning travelers.9 Despite the widely recognized possibility of negative test at the early course of acute HIV infection, the test was repeated later only in 17 cases. There are studies on testing HIV in selected groups of returning travelers,18–20 but this group has not

been systematically tested. In populations where the prevalence of HIV is >0.1%, Centers for Disease Control and Prevention, USA (CDC) recommend offering routine HIV testing for everyone in contact with health care.21 Our results suggest that travelers are a high-risk group for HIV infection; therefore, routine HIV testing should be recommended for all travelers with fever. When examining returning traveler with fever, the most important task is to recognize

potentially life-threatening infections. In other studies, malaria has been reported as the most common reason for fever without localized Akt inhibitor symptoms in returning travelers1–3,5,7–9; in most investigations septicemia has not been reported.1–3,5,8 In the study of Antinori 2004,7 blood culture was taken from 56% of febrile returning travelers and found positive in 10% of them. In Bottieau’s report (2006),9 the diagnosis was made by blood culture in 2% of all patients. In our study, blood cultures were taken from 93%, of which septicemia Galactosylceramidase was detected in 5%. The high proportion of septicemia may reflect the selection of our patients, most of whom had been referred to the tertiary hospital after initial contact within primary or secondary care. In our study mortality was 0.2% (1/462) which corresponds to other reports (0.2%–1.2%).4,5,9 In other studies malaria has been the main cause of death5,9; in our study there were no malaria-related deaths. Risk factors for tropical diseases have been examined by Bottieau and colleagues22; we focused on risk factors for malaria and septicaemia, and found differences between them. Several independent risk factors were listed for malaria patients: they were more likely to have traveled and/or to be born in Africa, had CRP levels >100 mg/L and platelet counts <140×109/L. These findings are in line with other studies.