fever in a returned traveller

Question 1

how will travel related illness generally manifest?

Answer 1

• GI symptoms
• jaundice
• respiratory symptoms
• rash

Question 2

what things should be established in the history?

Answer 2

• geographic region of travel within last 12 months
• dates of travel and duration of stay
• time on onset of symptoms
• type of accommodate (rural vs urban)
• recreation activities and exposures
• type of food and water consumed
• sexual history and exposure
• PMH

Question 3

what tropical illnesses have an incubation period of 0-10 days from exposure?

Answer 3

Dengue, rickettsia, viral (including infectious mononucleosis), gastrointestinal (bacteria / amoeba)

Question 4

what tropical illnesses have an incubation period of 10-21 days from exposure?

Answer 4

Malaria, typhoid, primary HIV infection

Question 5

what tropical illnesses have an incubation period of >21 days from exposure?

Answer 5

Malaria, chronic bacterial infections (e.g. brucella, coxiella, endocarditis, bone and joint infections); TB; parasitic infections (helminths/protozoa)

Question 6

what pre travel immunisations can be given?

Answer 6

Vaccination against hepatitis A, hepatitis B, typhoid, tetanus + yellow fever and rabies when appropriate

can consider malarial chemoprophylaxis if area is high risk

(NB: when they present check their vaccination history e.g for MMR)

Question 7

what illnesses can cause a maculopapular rash?

Answer 7

dengue fever,
leptospirosis,
rickettsia, 
infectious 
mononucleosis (EBV, CMV), 
childhood viruses (rubella, parvovirus B19), 
primary HIV infection

Question 8

what illnesses can cause splenomegaly?

Answer 8

mononucleosis, malaria, visceral leishmaniasis, typhoid fever, brucellosis

Question 9

what can a fever and altered mental status in the returned traveller indicate?

Answer 9

may represent meningo-encephalitis and is a medical emergency. E.g. cerebral malaria, Japanese encephalitis and West Nile Virus encephalitis.

Do not forget common infective causes (N. meningitis, Strep. Pneumonia, Herpes simplex virus (HSV)).

Question 10

what investigations should be done?

Answer 10

• Complete blood count with differential
• LFTs
• U+E, electrolytes
• Malaria smears ± antigen detection dipstick: at least 3 times over 24-48 hours
• Blood cultures x2 (must have biohazard labels/travel documented)
• Urinalysis (± urine culture)
• Stool culture +/- stool for ova, cysts and parasites (OCP)
• Chest x-ray
• HIV, Hep B, Hep C and Syphillis (treponema) serology (white top)
• Acute serology tube to be saved in lab (white top)