Beta-hemolytic Streptococcus sp. MG-132 chemical structure was cultured from four pharyngeal swabs in eight patients with tonsillitis. Of the three patients presenting with acute lobar pneumonia, none were formally diagnosed with Streptococcus pneumoniae or L. pneumophila

infections. However, all were cured with amoxicillin, as the presentation suggested pneumococcal infection (Table 4). One patient presented with mixed infection with rhinovirus. Among the 68 patients with ILI who were microbiologically evaluated, influenza viruses accounted for 30% (21/68) and other viruses accounted for 37% (25/68), including rhinovirus which accounted for 22% (15/68). Univariate analysis PD0332991 nmr was unable to detect risk factors predictive

of influenza (H1N1) 2009 (data not shown). Rhinorrhea was associated with viruses other than influenza (p = 0.04). This study provides a prospective and solid evaluation of etiological causes of RTI in a population of returning travelers with RTI regardless of intensity. The unusual situation surrounding the H1N1 pandemic allowed us to access a general population, accustomed to mild RTI symptoms for which they do not usually consult. This was illustrated in a study of 779 American travelers visiting developing countries where 75 patients (10%) presented symptoms of RTI after return but only 22 (3%) sought medical consultation for RTI.14 In France, at the beginning of the flu pandemic, travelers with any sign of RTI were advised to promptly consult a clinician.9 Therefore, we were able to test most, if not all, our patients with RTI, providing an accurate evaluation of the spectrum of respiratory pathogens that may target travelers. The age distribution in our study (>60% of our cases are more than 30 y old) is consistent with that found in a Japanese study

during the same outbreak. Indeed the median age of confirmed cases of influenza A(H1N1) 2009 in Japanese travelers (ie, 25 y old) filipin was older than the median age of influenza confirmed cases who did not travel (ie, 15 y old).15 Older adults tend to travel more often than younger and therefore are perhaps more at risk of contracting respiratory disease. The clinical spectrum of RTI in travelers is broad. In the Geosentinel study in which RTI was diagnosed in 1719 returning travelers (7.8% of all returning travelers), the main clinical presentations of RTI were “nonspecified” upper RTI (diagnosed in 47% of the patients), bronchitis (20%), pneumonia (13%), pharyngitis (13%), and ILI (5%).16 In an Italian series of 540 hospitalized patients with a history of travel and fever, RTI was diagnosed in 40 patients (7% of the febrile patients) and the most common RTIs were pneumonia (35%) and tuberculosis (15%), whereas ILI was found in 2.5% of the patients.