Fever in the Returned Traveller.
|Intended Audience||SAS doctors|
Fever commonly accompanies serious illness in returned travellers. The initial focus in evaluating a febrile returned traveller should be on identifying infections that are rapidly progressive, treatable or transmissible. In some instances, public health officials must be alerted if the traveller may have been contagious en route or infected with a pathogen of public health importance (such as viral haemorrhagic fevers) at the origin or destination. Details about activities (such as freshwater exposure on schistosomiasis-endemic areas, animal bites, sexual activity, or local medical care with injections) and accommodation in areas with malaria (bed nets, window screens, air conditioning during travel) may provide useful clues.
Preparation before travel (such ash epatitis A vaccine or yellow fever vaccine) will markedly reduce the likelihood of some infections, so this is a relevant part of the history. As recommended by the CDC, findings that should prompt urgent attention include haemorrhage, neurological impairment and acute respiratory distress.
Fever in returned travellers is often caused by common, cosmopolitan infections, such as pneumonia and pyelonephritis, which should not be overlooked in the search for more exotic diagnoses. However, different geographic areas are associated with specific causes for fever in the returned traveller and this will be discussed further in the presentation.
Malaria is the most common cause of acute undifferentiated fever after travel to sub-Saharan Africa and to some other tropical areas. Dengue is the most common cause of febrile illness among people who seek medical care after travel to Latni America or Asia.
Bacterial infections, such as leptospirosis, meningococcaemia and rickettsial infections can also cause fever and haemorrhage and should always be considered because of the need to institute prompt, specific treatment.
Viral haemorrhagic fevers are important to identify. The algorithm for management of suspected cases of Viral Haemorrhagic Fever will be discussed. It is important in such a case to involve the Infectious Diseases and Virology departments of each hospital early and they will liaise with Public Health authorities as per protocol.
Fever in the returned traveller is a common scenario encountered in a primary care and general medical setting. It is important that doctors have the ability to take a good travel history, including questions on: a detailed itinerary; type of accommodation; exposure-specific activities such as freshwater contact; healthcare work; vermin; sexual history; vaccination and chemoprophylaxis adherence; illnesses whilst travelling.
Initial symptoms of life-threatening and self-limiting infections can be identical. Fever in returned travellers is often caused by common, cosmopolitan infections such as pneumonia and pyelonephritis, which should not be overlooked in the search for more exotic diagnoses.
Malaria is a common cause of fever in those returning from the tropics. Dengue is the most common cause of febrile illness among people who seek medical care after travel to Latin America or Asia. Viral haemorrhagic fevers are important to identify.
Consider infection control, public health implications and requirements for reportable diseases.