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Table 33.1

Focused Assessment of the Patient with a Febrile Illness after Travel Abroad

History
  • Which countries traveled to and through? Travel in urban or rural areas or both? Precise localities and dates essential
  • Immunizations before travel
  • Malaria prophylaxis taken as prescribed? Insect bite avoidance measures taken?
  • When did symptoms first appear (Table 33.2)?
  • Treatments taken?
  • Known or possible occupational or recreational exposure to infection (including sexually transmitted diseases)?
ExposurePotential infection or disease
Raw or undercooked foodsEnteric infections, hepatitis A and E, trichinosis
Drinking untreated water; milk, cheeseGastroenteritis, enteric fever, hepatitis A and E, brucellosis, tularaemia
Fresh water swimmingSchistosomiasis, leptospirosis
Sexual contactHIV, syphilis, hepatitis B, gonococcaemia
Insect bitesMalaria, chikungunya, dengue and Zika (mosquitoes); tick typhus, Crimean-Congo haemorrhagic fever, borreliosis, tularaemia (ticks); scrub typhus (mites); Chagas' disease (triatomine bugs); African trypanosomiasis (tse tse flies)
Animal exposure or bitesRabies, Q fever, tularaemia, borreliosis, viral haemorrhagic fevers, plague, MERS CoV
Exposure to infected personsInfluenza, measles, viral hepatitis, viral haemorrhagic fevers, meningococcemia
Examination SignPotential infection or disease
RashChikungunya, dengue and Zika virus, typhoid, tick-borne, endemic or scrub typhus, syphilis, gonorrhoea, measles, viral haemorrhagic fever
JaundiceHepatitis A, B and E (patients usually afebrile when jaundice appears), malaria, yellow fever, leptospirosis, relapsing fever, cytomegalovirus and Epstein-Barr virus infection
LymphadenopathyRickettsial infections, brucellosis, dengue fever, HIV, tuberculosis, visceral leishmaniasis, toxoplasmosis, EBV infection
HepatomegalyAmoebiasis, malaria, typhoid, hepatitis, leptospirosis, most arboviruses
SplenomegalyMalaria, relapsing fever, trypanosomiasis, typhoid, brucellosis, kala-azar, typhus, chikungunya, dengue and Zika
Eschar (crustedTyphus (tick-borne or scrub), borreliosis, Crimean-Congo haemorrhagic
ulcer with black centre and erythematous margin)fever, cutaneous anthrax (relatively painless oedema as well)
HaemorrhageSevere dengue; meninococcaemia; epidemic louse borne typhus; Rocky Mountain spotted fever, viral haemorrhagic fevers