Fever in Returning Traveller
Head | General Practice | Fever in Returning Traveller (Symptom)
Many travellers return home with fever with or without other accompanying symptoms. Up to 8 percent of travellers to developing countries are ill enough to seek health care while abroad or after returning home. Fever in the returned traveller can be a manifestation of a minor, self-limited process or can herald a progressive, life-threatening illness. It may be difficult to distinguish between trivial and serious infections based on initial findings.
Estimates indicate that 15 to 37 percent of short-term travellers experience a health problem during an international trip, and up to 11 percent of returned travelers has a febrile illness. The majority of travellers with fever have infections that are common in non travellers, such as upper respiratory tract infection, urinary tract infection, or community-acquired pneumonia.
In the majority of cases, the fever is caused by a common illness such as tracheobronchitis, pneumonia, or urinary tract infection. However, fever in returned travelers always should raise suspicion for a severe or potentially life-threatening tropical infection.
Diagnosis and Treatment
In addition to the usual medical history, physicians should obtain a careful travel history, a description of accommodations, information about pretravel immunizations or chemoprophylaxis during travel, a sexual history, and a list of exposures and risk factors. The extent and type of lymphadenopathy are important diagnostic clues. Altered mental status with fever is an alarm symptom and requires urgent evaluation and treatment. Malaria must be considered in patients who traveled even briefly within an endemic area.
Enteric fever is treated with fluoroquinolones, dengue fever with supportive measures only, leptospirosis with penicillin or doxycycline, and rickettsial infections with doxycycline.