Diagnoses were recorded at three different time points: (1) the working diagnosis at the emergency room, (2) the discharge diagnosis, and (3) the final diagnosis evaluated at least 1 year after discharge (>1 diagnosis/patient possible on each occasion). Complications and significant underlying diseases were recorded separately. The final clinical or etiological diagnosis of all patients was defined by the same infectious diseases specialist (H. S.), who had access to all

the results. Diagnoses were listed in the order of relevance to the symptoms as judged by the specialist. The diagnoses RG7422 were coded according to the classification used by GeoSentinel3: a standardized list of 588 possible individual diagnoses categorized under 21 broad syndromes was used. Septicemia was defined as a symptomatic condition with a positive blood culture. Unknown bacterial infection was defined as a clinical picture, C-reactive protein (CRP) (CRP median 136, range 50–275 mg/L),

and a timely response RG7420 purchase to systemic antibiotic therapy, all compatible with bacterial infection. Potentially life-threatening illness was defined as a disease potentially leading to death if left without specific or supportive treatment. The countries visited were grouped into five regions: Sub-Saharan Africa, Southeast Asia, Central Asia and Indian Subcontinent, South and Central America and the Caribbean, Other (North Africa, West Asia, Northeast Asia), modified from GeoSentinel.3 ifenprodil Chi-square tests, t-tests, and Mann–Whitney tests served to test for differences between the groups. The binary and

multinomial logistic regression models served to identify explanatory variables to the outcome variables. Variables that were found to have p value less than 0.2 were included in the multivariable models. To identify independent risk factors, forward and backward selection with Akaike information criteria (AIC) was used. One variable (duration of the trip) had 72 missing values of the 462, and to take that into account in the model, we used multiple imputation with an assumption that the missingness process was missing at random (MAR). The analysis was carried out with SPSS 18.0.2 (SPSS, Inc., Chicago, IL, USA). The demographic and travel data are presented in Table 1.