Fever in a returned traveller
From IDWiki
History
- Pretravel
- Vaccinations
- Prophylaxis, e.g. malaria
- Vector protection, including bed nets and mosquito spray
- Travel
- Make explicit timeline of locations visited, for how long
- Assess activities and exposures in each location
- Food and water
- Recreational water
- Animals
- Vectors
- Sex
- Combine timeline of exposures with incubation periods to rule out diseases
- Dengue: 3-5 days
- Malaria: 7-21 days
- Hepatitis A: 6 days to 6 weeks
- Hepatitis B: 1-6 months
- Typhoid: 7-21 days
- Non-typhoidal Salmonella: 3-7 days
Differential Diagnosis
Investigations
- First-line
- CBC
- Liver enzymes and function, for viral hepatitides
- Electrolytes, urea, and creatinine
- Urinalysis
- Blood cultures x2, for enteric/typhoid fever
- Thick and thin smears x3 over 3 days, for malaria
- Based on history and lab results
- Urine culture
- Stool culture and O&P
- Hepatitis serologies
- Serology for zika, chikungunya, and dengue viruses, with repeat in 14 days if negative
- C. difficile toxin
- NP swab
Further Reading
- Freedman DO, et al. Spectrum of Disease and Relation to Place of Exposure among Ill Returned Travelers. N Engl J Med 2006; 354:119-130.
