Fever in the returning traveller

D J Bell
Journal of the Royal College of Physicians of Edinburgh 2012, 42 (1): 43-6; quiz 46
International travel is increasing and a significant number of travellers will develop a febrile illness during or shortly after their return from the tropics. The differential diagnosis is broad and a systematic approach to the management of these patients is required in order to establish the diagnosis and to initiate prompt and effective treatment. Fever may be due to infectious agents found only in tropical countries, or due to infections unrelated to travel and found worldwide. Important infections that should be considered in all returning travellers include malaria, dengue, enteric fever, rickettsial infections, and HIV seroconversion. Other diagnoses will be considered after a detailed history including countries visited with dates, activities undertaken and symptoms. At a minimum, all travellers from countries where there is malaria transmission should be tested repeatedly for malaria as well as having several sets of blood cultures taken. Many tropical infections are diagnosed serologically at specialist reference laboratories. Specialist advice on the investigation and management of returning travellers should be sought from infectious diseases physicians and microbiologists. Patients with malaria or enteric fever may deteriorate rapidly and travellers should be advised to seek prompt medical attention if they become unwell after travel to the tropics. This review will focus on some of the more important imported infections, diagnostic clues from the history, examination and investigations, and important considerations in their management.

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