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Author Notes:

Corresponding author. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-28, Atlanta, GA 30329, USA. kangelo@cdc.gov (K.M. Angelo).

Kristina M. Angelo: Primary writer, primary contributor to data interpretation.

Kira Barbre: Secondary writer, contributor to data interpretation.

Wun-Ju Shieh: Supplied case study information, provided pathologic explanations for the images and manuscript, technical editing, contributor to data interpretation.

Phyllis E. Kozarsky: Critical manuscript revision and writing, technical editing, contributor to data interpretation.

Dianna M. Blau: Critical manuscript revision and writing, technical editing, contributor to data interpretation.

Mark J, Sotir: Conception and design, critical manuscript revision and writing, contributor to data interpretation.

Sherif R. Zaki: Conception and design, technical editing, contributor to data interpretation.

We would like to thank the domestic health departments and international ministries of health that assisted with sending specimens to CDC for testing and the clinicians that provided clinical information on the travelers.

This project was designated nonresearch by a CDC human subjects advisor. None of the authors reported any conflicts of interest.


Research Funding:

No funding received by the authors.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Infectious Diseases
  • Pathology
  • Autopsy
  • International
  • Travel
  • Biopsy

International travelers with infectious diseases determined by pathology results, Centers for Disease Control and Prevention - United States, 1995-2015


Journal Title:

Travel Medicine and Infectious Disease


Volume 19


, Pages 8-15

Type of Work:

Article | Post-print: After Peer Review


Background The failure to consider travel-related diagnoses, the lack of diagnostic capacity for specialized laboratory testing, and the declining number of autopsies may affect the diagnosis and management of travel-related infections. Pre- and post-mortem pathology can help determine causes of illness and death in international travelers. Methods We conducted a retrospective review of biopsy and autopsy specimens sent to the Infectious Diseases Pathology Branch laboratory (IDPBL) at the Centers for Disease Control and Prevention (CDC) for diagnostic testing from 1995 through 2015. Cases were included if the specimen submitted for diagnosis was from a traveler with prior international travel during the disease incubation period and the cause of illness or death was unknown at the time of specimen submission. Results Twenty-one travelers, six (29%) with biopsy specimens and 15 (71%) with autopsy specimens, met the inclusion criteria. Among the 15 travelers who underwent autopsies, the most common diagnoses were protozoal infections (7 travelers; 47%), including five malaria cases, followed by viral infections (6 travelers; 40%). Conclusions Biopsy or autopsy specimens can assist in diagnosing infectious diseases in travelers, especially from pathogens not endemic in the U.S. CDC's IDPBL provides a useful resource for clinicians considering infectious diseases in returned travelers.

Copyright information:

© 2017

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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