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Key Features

  • Most infections are common and self-limited

  • Identify patients with transmissible diseases that require isolation

  • The incubation period may be helpful in diagnosis

  • Less than 3 weeks following exposure may suggest dengue, leptospirosis and yellow fever; > 3 weeks suggest typhoid fever, malaria, and tuberculosis

  • Travel history should include directed questions regarding

    • Geography (rural versus urban, specific country visited)

    • Time of year

    • Animal or arthropod contact

    • Unprotected sexual intercourse

    • Ingestion of untreated water or raw foods

    • Historical or pretravel immunizations

    • Adherence to malaria prophylaxis

Clinical Findings & Differential Diagnosis

  • Fever and rash may indicate

    • Dengue

    • Chikungunya

    • Zika virus

    • Viral hemorrhagic fever

    • Leptospirosis

    • Meningococcemia

    • Yellow fever

    • Typhus

    • Salmonella typhi

    • Acute HIV infection

  • Pulmonary infiltrates may be caused by

    • Tuberculosis

    • Ascaris

    • Paragonimus

    • Strongyloides

  • Meningoencephalitis may be caused by

    • N meningitides

    • Leptospirosis

    • Arboviruses

    • Rabies

    • Cerebral malaria

  • Jaundice may be indicative of

    • Hepatitis A

    • Yellow fever

    • Hemorrhagic fever

    • Leptospirosis

    • Malaria

  • Fever without localizing symptoms or signs may be caused by

    • Malaria

    • Typhoid fever

    • Acute HIV infection

    • Rickettsial illness

    • Visceral leishmaniasis

    • Trypanosomiasis

    • Dengue

  • Traveler's diarrhea (see Diarrhea, Traveler's)

Diagnosis

  • Laboratory tests and imaging studies are based on clinical suspicion and may include

    • Complete blood count with differential, electrolytes; blood cultures, serologic tests

    • Thick/thin smears of peripheral blood

    • Urinalysis

    • Liver biochemical tests

    • Chest radiograph

    • Placement of a PPD (purified protein derivative)

    • Examination of sputum for acid-fast bacilli and possibly for ova and parasites

    • Lumbar puncture

    • Nape biopsy (if rabies is suspected)

    • Bone marrow biopsy

  • See also Diarrhea, Traveler's

Treatment

  • See individual infection for Treatment recommendations

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