Sick after Travelling - Monday April 16, 2012

Thank you to Dr. D. Frost for hosting morning report and for team 6 for brining the case.

We discussed a case of a previously healthy person returning from travels to the Caribbean who presented with fever at home, abdominal pain, nausea/vomiting, headache, pleuritic chest pain, and general unwell.  She also had an elevated WBC of 25.  She had recent antibiotics exposure (amoxicillin) prior to her travel for a URTI that resolved.

We discussed that it is important to consider both travel-related and un-related causes of fever.  For travel-unrelated causes, the differential diagnosis includes infectious (UTI, pyelonephritis [our patient had R CVA tenderness], gastroenteritis, C. diff [our patient had recent antibiotics exposure], pneumonia, meningitis, etc…], inflammatory, malignancy (primary hematologic or non-hematologic), drugs.

For travel-related causes, it is important to think of infection, but also thromboembolic disease.  We discussed the important points on history that should be asked.  This starts from pre-travel advice and immunization, to prophylaxis taken and patient adherence to them during (and after) the trip.  A detailed itinerary of travel including dates and location, as well as activities under taken.  Ask especially about insect bites, sexual encounters, exposure to animals, and exposure to food and water.  It is also important to know the health of the patient and treatment taken while away.  It is important to clarify the date of return and onset of symptoms as incubation periods sometimes give a clue to the diagnosis.

It is extremely important to consider malaria as a possible diagnosis, and appropriate tests need to be undertaken to rule out this possibility.  Some (among many other) possibilities include dengue fever, typhoid fever, and viral illnesses (HIV, hepatitis, HTLV [given region of travel]).  In our patient, we suspect she may have had leptospirosis.

We have discussed a number of resources.  The CDC Travel website has a list of destination-based synopsis as well as the “Yellow Book”.  You can also find disease specific information on this website.  The site can be accessed here.  The GIDEON (Global Infectious Diseases and Epidemiology Network) web site can be accessed here.  The GeoSentinel Surveillance Network also published in 2007 a review of etiologies of febrile illness broken down by region of travel.  The article can be accessed here.