Fever in traveler
Background
- If incubation period >1 month: dengue, rickettsia, viral hemorrhagic fever less likely
Clinical Features
- Fever and exposure outside of U.S.
Differential Diagnosis
Fever with CNS Changes
- Malaria,
- Tuberculosis
- Typhoid fever
- Rickettsia
- Poliomyelitis
- Rabies
- Viral (Japanese/ West Nile/ tick borne) encephalitis
- Meningococcal meningitis (associated with Haj to Mecca)
- Eosinophilic meningitis
- Associated with coccidiomycosis or angiostrongyliasis (rat lung worm to brain)
- Trypanosomiasis (African sleeping sickness)
Fever and Respiratory Symptoms
- Pneumonia
- Influenza
- Mycoplasma
- Legionella
- Tuberculosis
- Q fever coxiella burnetti
- Loffler's syndrome
Fever with Sexual/Blood Exposure
- HIV
- Syphilis (Treponema pallidum)
- Cytomegalovirus (CMV)
- Epstein-Barr virus (EBV)
- Hepatitis B
- Hepatitis D co-infection
Evaluation
Workup
Always consider malaria
- Malaria smear (thick and thin)
- CBC with differential
- Chemistry panel
- Liver function tests
- Blood culture
- Urinalysis and urine culture
- Stool culture
- Chest x-ray
- Additional to consider:
- Lumbar puncture
- Hepatitis panel
- STD studies
- Serologies for specific viruses
- Other radiography (CT scan, abdominal ultrasound, MRI brain)
Diagnosis
| GEOGRAPHIC AREA | COMMON TROPICAL DISEASE CAUSING FEVER | OTHER INFECTIONS CAUSING OUTBREAKS OR CLUSTERS IN TRAVELERS |
| Caribbean | Dengue, malaria (Haiti) | Acute histoplasmosis, leptospirosis, chikungunya |
| Central America | Dengue, malaria (primarily Plasmodium vivax) | Leptospirosis, histoplasmosis, coccidioidomycosis |
| South America | Dengue, malaria (primarily P. vivax) | Bartonellosis, leptospirosis, enteric fever, histoplasmosis |
| South-central Asia | Dengue, enteric fever, malaria (primarily non-falciparum) | Chikungunya |
| Southeast Asia | Dengue, malaria (primarily non-falciparum) | Chikungunya, leptospirosis |
| Sub-Saharan Africa | Malaria (primarily P. falciparum), tickborne rickettsiae (main cause of fever in southern Africa), acute schistosomiasis, filariasis | African trypanosomiasis, chikungunya, enteric fever, filariasis |
| DISEASE | USUAL INCUBATION PERIOD (RANGE) | DISTRIBUTION |
| Incubation <14 days | ||
| Chikungunya | 2–4 days (1–14 days) | Tropics, subtropics |
| Dengue | 4–8 days (3–14 days) | Topics, subtropics |
| Encephalitis, arboviral (Japanese encephalitis, tickborne encephalitis, West Nile virus, other) | 3–14 days (1–20 days) | Specific agents vary by region |
| Enteric fever | 7–18 days (3–60 days) | Especially in Indian subcontinent |
| Acute HIV | 10–28 days (10 days to 6 weeks) | Worldwide |
| Influenza | 1–3 days | Worldwide, can also be acquired while traveling |
| Legionellosis | 5–6 days (2–10 days) | Widespread |
| Leptospirosis | 7–12 days (2–26 days) | Widespread, most common in tropical areas |
| Malaria, Plasmodium falciparum | 6–30 days (98% onset within 3 months of travel) | Tropics, subtropics |
| Malaria, P. vivax | 8 days to 12 months (almost half have onset >30 days after completion of travel) | Widespread in tropics and subtropics |
| Spotted-fever rickettsiae | Few days to 2–3 weeks | Causative species vary by region |
| Incubation 14 Days to 6 Weeks | ||
| Encephalitis, arboviral; enteric fever; acute HIV; leptospirosis; malaria | See above incubation periods for relevant diseases | See above distribution for relevant diseases |
| Amebic liver abscess | Weeks to months | Most common in developing countries |
| Hepatitis A | 28–30 days (15–50 days) | Most common in developing countries |
| Hepatitis E | 26–42 days (2–9 weeks) | Widespread |
| Acute schistosomiasis (Katayama syndrome) | 4–8 weeks | Most common in sub-Saharan Africa |
| Incubation >6 weeks | ||
| Amebic liver abscess, hepatitis E, malaria, acute schistosomiasis | See above incubation periods for relevant diseases | See above distribution for relevant diseases |
| Hepatitis B | 90 days (60–150 days) | Widespread |
| Leishmaniasis, visceral | 2–10 months (10 days to years) | Asia, Africa, Latin America, southern Europe, and the Middle East |
| Tuberculosis | Primary, weeks; reactivation, years | Global distribution, rates and levels of resistance vary widely |
Management
Disposition
See Also
- Travel Medicine
External Links
References
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