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

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

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
CaribbeanDengue, malaria (Haiti)Acute histoplasmosis, leptospirosis, chikungunya
Central AmericaDengue, malaria (primarily Plasmodium vivax)Leptospirosis, histoplasmosis, coccidioidomycosis
South AmericaDengue, malaria (primarily P. vivax)Bartonellosis, leptospirosis, enteric fever, histoplasmosis
South-central AsiaDengue, enteric fever, malaria (primarily non-falciparum)Chikungunya
Southeast AsiaDengue, malaria (primarily non-falciparum)Chikungunya, leptospirosis
Sub-Saharan AfricaMalaria (primarily P. falciparum), tickborne rickettsiae (main cause of fever in southern Africa), acute schistosomiasis, filariasisAfrican trypanosomiasis, chikungunya, enteric fever, filariasis
DISEASE USUAL INCUBATION PERIOD (RANGE) DISTRIBUTION
Incubation <14 days
Chikungunya2–4 days (1–14 days)Tropics, subtropics
Dengue4–8 days (3–14 days)Topics, subtropics
Encephalitis, arboviral (Japanese encephalitis, tickborne encephalitis, West Nile virus, other)3–14 days (1–20 days)Specific agents vary by region
Enteric fever7–18 days (3–60 days)Especially in Indian subcontinent
Acute HIV10–28 days (10 days to 6 weeks)Worldwide
Influenza1–3 daysWorldwide, can also be acquired while traveling
Legionellosis5–6 days (2–10 days)Widespread
Leptospirosis7–12 days (2–26 days)Widespread, most common in tropical areas
Malaria, Plasmodium falciparum6–30 days (98% onset within 3 months of travel)Tropics, subtropics
Malaria, P. vivax8 days to 12 months (almost half have onset >30 days after completion of travel)Widespread in tropics and subtropics
Spotted-fever rickettsiaeFew days to 2–3 weeksCausative species vary by region
Incubation 14 Days to 6 Weeks
Encephalitis, arboviral; enteric fever; acute HIV; leptospirosis; malariaSee above incubation periods for relevant diseasesSee above distribution for relevant diseases
Amebic liver abscessWeeks to monthsMost common in developing countries
Hepatitis A28–30 days (15–50 days)Most common in developing countries
Hepatitis E26–42 days (2–9 weeks)Widespread
Acute schistosomiasis (Katayama syndrome)4–8 weeksMost common in sub-Saharan Africa
Incubation >6 weeks
Amebic liver abscess, hepatitis E, malaria, acute schistosomiasisSee above incubation periods for relevant diseasesSee above distribution for relevant diseases
Hepatitis B90 days (60–150 days)Widespread
Leishmaniasis, visceral2–10 months (10 days to years)Asia, Africa, Latin America, southern Europe, and the Middle East
TuberculosisPrimary, weeks; reactivation, yearsGlobal distribution, rates and levels of resistance vary widely

See Also

References

    This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.