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) |
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| Southern Europe, Middle East, Africa, northwestern China |
| Southern Europe, Middle East, Africa, northwestern China |
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− | | Ixodes ticks or infected humans or animals |
+ | | [[Ixodes]] ticks or infected humans or animals |
| PCR |
| PCR |
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+ | |- |
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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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+ | |- |
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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 |
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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
- 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.