Fever in the returned traveller

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 and possible contact with infectious diseases. Associated symptoms, especially diarrhoea, abdominal pain, rash and other skin lesions. Past history, prophylaxis (incl.immunisation) and drug history (incl. antimalarial therapy).

Key examination

• General features

• Vital signs

• Neck for neck stiffness

• Skin and lymph node sites

• Respiratory and cardiovascular examination

• Abdominal examination, 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 and amoebic liver abscess.

• Be vigilant for meningitis and encephalitis.