Post-Travel Fever by Dr. Paul Assad

Post travel fever

Important consideration:

Causes:

Final diagnosis found in cases of fever in returning travelers by order of decreasing frequency:

History: Questions to ask

Itinerary : endemic diseases in the zones and countries visited.
Travel dates
Date of return home
Length of time since disease exposure
Incubation period are fairly characteristic and can help in the differential diagnosis. By knowing the amount of time since the endemic disease zone exposure and the incubation period, many disease can be quickly ruled out.
Duration of fever

Vaccination history: Vaccines prior to departure and efficiency of each vaccine : Hepatitis A = 100% , Typhoid = 80% protective
Visit to tropical areas
Rural vs. urban visits
Measures to prevent bites
History of bites
Adhere to malaria prophylaxis?
Adhere to food – drink – guidelines?
Contact with sick people overseas
Illness and symptoms while overseas
Treatment by medical personnel – treatment- injections – medications- transfusion.
Exposure to unsafe food-drink—raw foods-ice-street vendors-
Bites; mosquito-flies- ticks-flees – dog- animal
Walking barefoot on beach- moist soil
Fresh water swimming- wading
Recreational drugs- piercing-tattooing
Unprotected sex with new partner

incubation Periods
	Acute	Sub acute	Chronic
Infectious Agent	6-14 days	2 weeks to 6 months	> 6 months

Protozoa	Malaria	Malaria	Malaria
	Trypanosomiasis	Leishmaniasis	Leishmaniasis
		Trypanosomiasis	Amebic Abscess

Bacterial	Typhoid	Brucellosis	Brucellosis
	Leptospirosis	TB	TB
	Meningitis
	Legionellosis
	Bacterial Enteritis

Rickettsial	Boutonneuse fever
	RockY Mountain Spotted F.

Viral	Dengue	Hep. A,B,C	Rabies
	Other Arboviruses	HIV
	Viral Hemorrhagic Fever	CMV
		E.B. virus


Helminthes	Schistosomiasis	Schistosomiasis	Filiariasis
		Filiariasis



Physical Exam
Rash	Dengue-Typhoid-Typhus-Syphillis - HIV- Cutaneous Leishmaniasis- Brucellosis- Lyme Disease
	Drug reaction- bites-

Jaundice	Malaria-Yellow fever-Hepatitis- Leptospirosis- Relapsing fever

Lymphadenopathy:	Dengue-Brucellosis-Visceral Leishmaniasis - HIV - Rikettsial Infection- Mono-
	CMV – EBV- (inguinal) STD	Filariasis	Trypanosomiasis

Hepatomegaly	Malaria- Typhoid - Hepatitis- Leptospirosis- Amebiasis

Splenomegaly	Malaria-Brucellosis- Typhoid- Relapsing fever- Visceral Leishmaniasis-Typhus-
	Dengue- Trypanosomiasis
Bleeding	Ebola-Congo Crimean HF. Viral Hemorrhagic fevers	(Lassa- Marburg)
Eschar	Rickettsial Infections- Tick and scrub typhus - cutaneous anthrax -

Lab test:

CBC ( anemia – eosinophilia – elevated WBC – Low platelets)

Thin Tick blood smear x 3 ( 12 hours apart)

Stool examination for leukocytes and culture ( Bacterial causes)

Liver function tests – Hepatitis serology

Blood cultures

Serology when available ( Dengue – arboviruses – Brucellosis – Typhus )

Chest XRAY

TB skin test

Urinalysis – urine culture

Dr Paul Assad

Travel Advisor: Dick MacLean – Richard Lalonde - Brian Ward