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
- 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
Evaluation
Workup
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)
Diagnosis
| GEOGRAPHIC AREA | COMMON TROPICAL DISEASE CAUSING FEVER | OTHER INFECTIONS CAUSING OUTBREAKS OR CLUSTERS IN TRAVELERS |
| Caribbean | Dengue, malaria (Haiti) | Acute histoplasmosis, leptospirosis, chikungunya |
| Central America | Dengue, malaria (primarily Plasmodium vivax) | Leptospirosis, histoplasmosis, coccidioidomycosis |
| South America | Dengue, malaria (primarily P. vivax) | Bartonellosis, leptospirosis, enteric fever, histoplasmosis |
| South-central Asia | Dengue, enteric fever, malaria (primarily non-falciparum) | Chikungunya |
| Southeast Asia | Dengue, malaria (primarily non-falciparum) | Chikungunya, leptospirosis |
| Sub-Saharan Africa | Malaria (primarily P. falciparum), tickborne rickettsiae (main cause of fever in southern Africa), acute schistosomiasis, filariasis | African trypanosomiasis, chikungunya, enteric fever, filariasis |
Management
Disposition
See Also
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