Infectious Diseases in the Returning Traveler

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 suggests typhoid fever, malaria, and tuberculosis

Travel history should include directed questions regarding

• Geography (rural versus urban, specific country and region 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

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

• COVID-19 (SARS-CoV-2)

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

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

Next-generation sequencing (NGS) of plasma or body fluids such as cerebrospinal fluid is used increasingly as an adjunctive diagnostic modality when traditional methods have not yielded a diagnosis

See also Diarrhea, Traveler's

See individual infection for Treatment recommendations