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...
- Where did you go? (exactly)
- How long were you there?
- What did you do?
- What is the date you left, date you returned home, and date of every stop along the way?
- Exposures: Water, animals (eg mosquito's, tics, farms), sexual?
- 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?
- Dengue fever
- Viral hepatitis (A)
- Typhoid fever
Some good review papers:
- Here is the sentinel article from NEJM (written by local talent) looking at the spectrum of diseases in ill returning travelers.
- Here is a great review on malaria prophylaxis from NEJM.