Author(s): Nick Beeching and Mike Beadsworth
The management of the patient with a febrile illness within two months of travel abroad is summarized in Figure 33.1. See Box 33.1 for sources of advice on the diagnosis and management of infectious diseases acquired abroad.
This will depend on the clinical syndrome and likely pathogens.
Consider pulmonary tuberculosis, SARS and MERS CoV, and Legionnaires' disease, in addition to the common causes of community-acquired pneumonia (Chapter 62).
The presence of eosinophilia in association with fever in returned travellers usually indicates an invasive helminth infection, but exclude other causes, especially atopy and drug reactions. Causes include filariasis (clues nocturnal or diurnal fever pattern); early phase of strongyloides and hookworm infections (abdominal pain, diarrhoea); hookworm and roundworm pneumonitis (cough, wheeze); early schistosomiasis (freshwater exposure especially in Africa/Middle East, urticarial rash, wheeze, altered semen); and loiasis (travel to Africa, transient peripheral skin swellings). Seek expert advice on special investigations needed.
Beeching NJ, Fletcher TE, Wijaya L (2013). Health problems in returned travellers. In Principles and Practice of Travel Medicine, 2nd edn. Ed. Jane N.Zuckerman .Blackwell Publishing Ltd. pp 260286.
Centers for Disease Control and Prevention: Traveler's Healths. https://www.cdc.gov/
Checkley AM, Chiodini PL, Dockrell DH, et al, for British Infection Society and Hospital for Tropical Diseases. Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management (2010). Journal of Infection , 60, 120.
Johnston V, Stockley JM, Dockrell D, et al, for British Infection Society and the Hospital for Tropical Diseases Fever in returned travellers presenting in the United Kingdom: recommendations for investigation and initial management (2009). Journal of Infection , 59, 118.
Kularatne SAM (2015). Dengue fever. BMJ 351, h4661. DOI: 10.1136/bmj.h4661.
Lalloo DG, Shingadia D, Bell DJ, Beeching NJ, Whitty CJM, Chiodini PL, for the PHE Advisory Committee on Malaria Prevention in UK Travellers (2016). UK malaria treatment guidelines. Journal of Infection 72, 635649.
Thwaites GE, Day NP (2017). Approach to fever in the returning traveler. New England Journal of Medicine , 376, 548560.