Fever in the Returning Traveler

Abstract

Fever in ill travelers returning home from developing nations is common. Most travelers present with undifferentiated febrile syndromes. Regional proportionate morbidity rates and patients' travel histories are essential in narrowing the differential diagnosis. Most patients in whom a diagnosis is confirmed have malaria, dengue fever, enteric fever, or rickettsial disease. Empiric treatment based on the clinical presentation is required in many cases, because acquisition of confirmatory laboratory data is often delayed. The focus of this article is travel-related illness that falls within the spectrum of the acute febrile syndrome.

Management of infections in critically ill returning travellers in the intensive care unit—I: considerations on infection control and transmission of resistance

“…Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. 17 The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and more recently Ebola haemorrhagic fever, has highlighted the risks. However, other well-known communicable pathogens such as MRSA 18 and CPE 19,20 have been described previously.…”

Operation United Assistance: Infectious Disease Threats to Deployed Military Personnel

“…Given its frequency and lethality, it remains important to promptly test for P. falciparum malaria using a malaria rapid diagnostic test and serial microscopy of malaria smears concurrent with initial Ebola assessment.231 For those who had intermittently or regularly taken malaria chemopro phylaxis, the clinician must consider that malaria can present with an atypical pattern, and the lower parasitemia/antigen burden may make the diagnosis of malaria more difficult. 232 There is concern that the malaria rapid diagnostic test avail able for U.S. personnel might not adequately detect P. ovale, necessitating thick and thin smears or molecular approaches for definitive diagnosis.233'234 Diagnostic tests should be lim ited to rapid antigen tests and malaria smears until Ebola is excluded, and may require empiric antimicrobial manage ment based on the clinical syndrome at presentation. If an alternate diagnosis to Ebola is found, risk and surveillance returns to premorbid Ebola epidemiologic risk until the day 21 incubating period.…”

A “Syndromic” Approach for Diagnosing and Managing Travel-Related Infectious Diseases in Children

“…For instance, dengue has a short incubation period and generally presents during or upon initial return from travel, while Plasmodium falciparum infection typically presents within the first 30 days after departing an endemic region, and hypnozoites of Plasmodium vivax or Plasmodium ovale may result in infections up to a year later. 8,16 It is important to try to determine the most accurate estimate of symptom onset from the time of exposure. Seasonality is also an important consideration, as risk for many diseases may vary significantly due to climate factors.…”

“…(Continued ) Arranged in descending order from most to least likely within each syndrome category 8,12,14,[16][17][18][19][20][21][22]. **Average incubation periods (full ranges not shown).…”