Fever in Traveller

 

• Background

  The differential diagnosis for fever in a returning traveller can seem daunting, but here's a few key points:

  • Always rule out malaria. It has non-specific symptoms, is common, and can be fatal, unlike many other imported fevers.
  • Typhoid and paratyphoid fever (aka enteric fever) are the 2nd commonest serious imported infection in the UK.
  • Exotic travel does not necessarily mean an exotic infection: influenza, HIV, viral hepatitis, and many other infections are common to tropical and non-tropical countries.

• DDx: fever in returning traveller by incubation period

  Short incubation (<10 days):

  • Influenza
  • Arboviral: yellow fever, dengue, chikungunya.
  • Rickettsial infection.
  • Relapsing fever.
  • Leptospirosis

  Intermediate incubation (10-21 days):

  • Malaria
  • Enteric fever: typhoid and paratyphoid.
  • Chagas
  • Viral haemorrhagic fever.
  • Leptospirosis

  Long incubation (>3 weeks):

  • Malaria
  • Acute schistosomiasis.
  • Viral: hepatitis A-E, HIV seroconversion.
  • Protozoal: african trypanosomiasis, amoebic liver abscess, visceral leishmaniasis.
  • TB
  • Rabies

• DDx: fever in returning traveller by geography

  Caribbean and Latin America

  • Arboviruses: chikungunya, dengue, Zika, yellow fever.
  • Malaria in certain areas.
  • Bacterial: leptospirosis, bartonellosis (South America).
  • Fungal: histoplasmosis, coccidioidomycosis (Central America).

  South Asia

  • Arboviruses: dengue, chikungunya.
  • Bacterial: enteric fever (South-Central), leptospirosis (South-East).
  • Malaria (usually non-falciparum).

  Sub-Saharan Africa

  • Malaria (usually P. falciparum).
  • Bacterial: Rickettsial infection, enteric fever.
  • Arboviruses: dengue, chikungunya, yellow fever.
  • Helminths: acute schistosomiasis, filariasis.
  • African trypanosomiasis.
  • Viral haemorrhagic fever: Lassa, Ebola, Marburg.