Fever in the returned traveller Flashcards
Probability diagnosis
Malaria
Viral respiratory illness (e.g. influenza)
Bacterial pneumonia
Hepatitis (may be subclinical)
Gastroenteritis/diarrhoeal illness
Dengue
Serious disorders not to be missed
- Malaria
- Tuberculosis
- Typhoid
- Viral haemorrhagic diseases (e.g. Ebola, Lassa)
- Encephalitis
- Meningococcal meningitis
- Melioidosis
- Amoebiasis (liver abscess)
- HIV seroconversion illness
Pitfalls (often missed)
- Ascending cholangitis
- Infective endocarditis
- Cytomegalovirus
- Epstein–Barr virus (glandular fever)
- Dengue fever
- Lyme disease
- Bronchopneumonia
- Ross River fever
- Rarities:
- chikungunya
- Legionnaire disease
- schistosomiasis
- African trypanosomiasis
- typhus
- Rift Valley fever
- spotted fever
- yellow fever
- other haemorrhagic fevers
Masquerades checklist
Drugs (reaction to antimalarials)
Urinary tract infection
Key history
Ask about itinerary;
- length of stay
- exposure to mosquitoes
- possible contact with infectious diseases.
Associated symptoms, especially diarrhoea, abdominal pain, rash and other skin lesions.
Past history, prophylaxis (incl.immunisation)
Drug history (incl. antimalarial therapy).
Key examination
General features / Vital signs
Neck for neck stiffness
Skin and lymph node sites
Respiratory and cardiovascular examination
Abd exam, especially liver and spleen
Key investigations
- FBE (?eosinophils)
- ESR
- Blood culture
- Urine MC
- Stool MC
- LFTs
- Thick and thin blood films
- New malaria test
- Dengue serology
- CXR
Tubercular skin test and interferon gamma release assay (for suspected TB)
Specific tests for suspected diseases, e.g. Ebola, influenza
Diagnostic tips
All fever in a returned traveller is malaria until proved otherwise.
Three causes of a dry cough (in the absence of chest signs) are;
- malaria
- typhoid
- amoebic liver abscess.
Be vigilant for meningitis and encephalitis.
