Fever in traveler

Background

• If incubation period >1 month: dengue, rickettsia, viral hemorrhagic fever less likely

Clinical Features

• Fever and exposure outside of U.S.

Differential Diagnosis

Fever in traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid fever
• Typhus
• Viral hemorrhagic fevers
  • Ebola virus disease
  • Marburg virus disease
  • Lassa fever
  • Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever
• Q fever
• Amebiasis
• Zika virus

Fever with CNS Changes

• Malaria,
• Tuberculosis
• Typhoid fever
• Rickettsia
• Poliomyelitis
• Rabies
• Viral (Japanese/ West Nile/ tick borne) encephalitis
• Meningococcal meningitis (associated with Haj to Mecca)
• Eosinophilic meningitis
  • Associated with coccidiomycosis or angiostrongyliasis (rat lung worm to brain)
• Trypanosomiasis (African sleeping sickness)

Fever and Respiratory Symptoms

• Pneumonia
• Influenza
• Mycoplasma
• Legionella
• Tuberculosis
• Q fever coxiella burnetti
• Loffler's syndrome

Fever with Sexual/Blood Exposure

• HIV
• Syphilis (Treponema pallidum)
• Cytomegalovirus (CMV)
• Epstein-Barr Virus (EBV)
• Hepatitis B

Evaluation

Always consider malaria

• Malaria smear (thick and thin)
• CBC with differential
• Chemistry panel
• Liver function tests
• Blood culture
• Urinalysis and urine culture
• Stool culture
• Chest x-ray
• Additional to consider:
  • Lumbar puncture
  • Hepatitis panel
  • STD studies
  • Serologies for specific viruses
  • Other radiography (CT scan, abdominal ultrasound, MRI brain)

See Also

• Travel Medicine

External Links

• https://wwwnc.cdc.gov/travel/yellowbook/2016/post-travel-evaluation/fever-in-returned-travelers
• https://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=167&seg_id=3279