Fever in the Retuned Traveller

This was technically yesterday's case -- but since we only had one case today I thought this would be a better topic for the blog.

Two excellent reviews of the spectum of illnesses causing fever in the returned traveller are available from CID here and the NEJM here.

Keys in history:

• What pre-travel preparation (vaccines, prophylaxis) was received? Was it taken? How many doses were missed?
• Where did they go (as exact as possible)? What were the exact dates and places?
• When did they return?
• When did they get sick?
• What exposures did they potentially have?
  
  • Food
  • Water (drinking/swimming)
  • Animals (including humans -- i.e. sexual contacts, blood exposure, sick contacts)
  • Vectors (mosquitos, ticks, other)
• What, if any, localizing features do they have on history or physical exam?

Then, after excluding malaria (from malaria regions) you put the history in context with the duration of illness, and where they went to arrive at a likely diagnosis.

A recent publication using the same database suggests that of the diarrheal illnesses, parasitic infections are most common, followed by campylobacter, shigella and salmonella.