Wednesday, March 18, 2009

Fever in the Returning Traveler

Fever in the Returning Traveler....a very common situation.

There are some very pertinent questions that must be asked: above and beyond your medical history and physical exam, it is important to ask the following questions...
  1. Where did you go? (exactly)

  2. How long were you there?

  3. What did you do?

  4. What is the date you left, date you returned home, and date of every stop along the way?

  5. Exposures: Water, animals (eg mosquito's, tics, farms), sexual?

  6. Did you get pre-travel advice? What was the advice? Did you take the advice?

An approach: Think about what causes fever...

  • Infection related to where patient was traveling.

  • Infection not-related to travel.

  • Non-infectious causes of fever.

What are the 4 "biggies" for infection in the returning traveler?

  • Malaria

  • Dengue fever

  • Viral hepatitis (A)

  • Typhoid fever

Some good review papers:

  1. Here is the sentinel article from NEJM (written by local talent) looking at the spectrum of diseases in ill returning travelers.
  2. Here is a great review on malaria prophylaxis from NEJM.

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