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 in traveler

Fever with CNS Changes

Fever and Respiratory Symptoms

Fever with Sexual/Blood Exposure

  • HIV
  • Syphilis (Treponema pallidum)
  • Cytomegalovirus (CMV)
  • Epstein-Barr Virus (EBV)
  • Hepatitis B

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

External Links

References

Authors:

Ross Donaldson