Fever in a returned traveller: Difference between revisions

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| 1-9 days (tick) or 3-13 days (contact)
 
| 1-9 days (tick) or 3-13 days (contact)
 
| Southern Europe, Middle East, Africa, northwestern China
 
| Southern Europe, Middle East, Africa, northwestern China
| Ixodes ticks or infected humans or animals
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| [[Ixodes]] ticks or infected humans or animals
 
| PCR
 
| PCR
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|-
  +
| [[Yellow fever]]
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| 3-8 days
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| South America and Africa
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| [[Aedes]] mosquitoes
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| PCR or IgM ELISA
  +
|-
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| [[Japanese encephalitis]]
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| 5-15 days
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| Asia and western Pacific
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| [[Culex]] mosquitoes
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| IgM ELISA
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|-
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| [[Rift Valley fever]]
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| 2-6 days
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| Africa and the Arabian peninsula
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| Mosquitoes, or blood from infected animals
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| PCR or IgM ELISA
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|-
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| [[Rabies]]
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| 20 to 60 days (usually 4 weeks)
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| Worldwide
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| Animal bite
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| Saliva PCR; serume/CSF RFFIT; skin biopsy PCR or RFFIT
 
|}
 
|}
   

Revision as of 10:08, 20 November 2019

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

Disease Incubation Distribution Exposures Diagnosis
Viruses
Avian influenza 2-8 days East and Southeast Asia Poultry PCR
MERS-CoV 2-14 days Arabian peninsula Infected humans or camels PCR
Ebola, Lassa fever, or Marburg hemorrhagic fever up to 22 days Africa Infected humans and animals PCR
Crimean-Congo hemorrhagic fever 1-9 days (tick) or 3-13 days (contact) Southern Europe, Middle East, Africa, northwestern China Ixodes ticks or infected humans or animals PCR
Yellow fever 3-8 days South America and Africa Aedes mosquitoes PCR or IgM ELISA
Japanese encephalitis 5-15 days Asia and western Pacific Culex mosquitoes IgM ELISA
Rift Valley fever 2-6 days Africa and the Arabian peninsula Mosquitoes, or blood from infected animals PCR or IgM ELISA
Rabies 20 to 60 days (usually 4 weeks) Worldwide Animal bite Saliva PCR; serume/CSF RFFIT; skin biopsy PCR or RFFIT

Investigations

  • First-line
    • CBC
    • Liver enzymes and function, for viral hepatitides
    • Electrolytes, urea, and creatinine
    • Urinalysis, for proteinuria that would suggest Leptospirosis
    • 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