Fever in the Returned Traveller

 Today's case involved a 63-year-old man with longstanding, drug-resistant HIV returning from a trip to Asia with persistent fever and atypical pulmonary infiltrates.

Learning points discussed:

-Differential diagnosis of fever in the returned traveler and that the infection that cannot be missed is Malaria

-We discussed some of the clinical features of Pneumocystis jirovecii (formerly carinii) pneumonia

-We discussed opportunistic infections in HIV and their relationship to CD4 counts as well as the fact that tuberculosis infection is on the differential regardless of CD4 count – the guidelines for prophylaxis depending on CD4 count can be found here: https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf

-It was discussed that, anytime a differential diagnosis of pulmonary tuberculosis is considered fungal infection and malignant processes must also be considered

-We discussed some of the endemic fungi including Aspergillus, Blastomycosis, Coccidiomycosis, and Histoplasmosis

Further Reading:

Ryan, E. T., Wilson, M. E., & Kain, K. C. (2002). Illness after international travel. New England Journal of Medicine, 347(7), 505-516.