View source for Fever in traveler

==Background==
*If incubation period >1 month: dengue, rickettsia, viral hemorrhagic fever less likely

==Clinical Features==
*[[Fever]] and exposure outside of U.S.

==Differential Diagnosis==
{{Template:Fever in Traveler DDX}}

===Fever with CNS Changes===
*[[Malaria]],
*[[Tuberculosis]]
*[[Typhoid fever]]
*[[Rickettsia]]
*[[Poliomyelitis]]
*[[Rabies]]
*Viral (Japanese/ West Nile/ tick borne) encephalitis
*Meningococcal meningitis (associated with Haj to Mecca)
*Eosinophilic meningitis 
**Associated with coccidiomycosis or angiostrongyliasis (rat lung worm to brain)
*[[Trypanosomiasis]] (African sleeping sickness)

===Fever and Respiratory Symptoms===
*[[Pneumonia]]
*[[Influenza]]
*[[Mycoplasma]]
*[[Legionella]]
*[[Tuberculosis]]
*[[Q fever]] ''coxiella burnetti''
*[[Loffler's syndrome]]

===Fever with Sexual/Blood Exposure===
*[[HIV]]
*[[Syphilis]] (''Treponema pallidum'') 
*[[Cytomegalovirus]] (CMV)
*[[Epstein-Barr virus]] (EBV)
*[[Hepatitis B]] 
**[[Hepatitis D]] co-infection

==Evaluation==
===Workup===
'''Always consider malaria'''
*Malaria smear (thick and thin)
*CBC with differential
*Chemistry panel
*Liver function tests
*Blood culture
*[[Urinalysis]] and urine culture
*Stool culture
*Chest x-ray
*Additional to consider:
**[[Lumbar puncture]]
**[[Viral hepatitis|Hepatitis]] panel
**[[STD]] studies
**Serologies for specific viruses
**Other radiography (CT scan, abdominal ultrasound, MRI brain)

===Diagnosis===
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''GEOGRAPHIC AREA'''
| align="center" style="background:#f0f0f0;"|'''COMMON TROPICAL DISEASE CAUSING FEVER'''
| align="center" style="background:#f0f0f0;"|'''OTHER INFECTIONS CAUSING OUTBREAKS OR CLUSTERS IN TRAVELERS'''
|-
| Caribbean||[[Dengue]], [[malaria]] (Haiti)||Acute [[histoplasmosis]], [[leptospirosis]], [[chikungunya]]
|-
| Central America||[[Dengue]], [[malaria]] (primarily Plasmodium vivax)||[[Leptospirosis]], [[histoplasmosis]], [[coccidioidomycosis]]
|-
| South America||[[Dengue]], [[malaria]] (primarily P. vivax)||[[Bartonellosis]], [[leptospirosis]], [[enteric fever]], [[histoplasmosis]]
|-
| South-central Asia||[[Dengue]], [[enteric fever]], [[malaria]] (primarily non-falciparum)||[[Chikungunya]]
|-
| Southeast Asia||[[Dengue]], [[malaria]] (primarily non-falciparum)||[[Chikungunya]], [[leptospirosis]]
|-
| Sub-Saharan Africa||[[Malaria]] (primarily P. falciparum), tickborne [[rickettsiae]] (main cause of fever in southern Africa), acute [[schistosomiasis]], [[filariasis]]||[[African trypanosomiasis]], [[chikungunya]], [[enteric fever]], [[filariasis]]
|}

{| {{table}}
| align="center" style="background:#f0f0f0;"|'''DISEASE'''
| align="center" style="background:#f0f0f0;"|'''USUAL INCUBATION PERIOD (RANGE)'''
| align="center" style="background:#f0f0f0;"|'''DISTRIBUTION'''
|-
| '''Incubation <14 days'''||||
|-
| [[Chikungunya]]||2–4 days (1–14 days)||Tropics, subtropics
|-
| [[Dengue]]||4–8 days (3–14 days)||Topics, subtropics
|-
| Encephalitis, arboviral ([[Japanese encephalitis]], [[tickborne encephalitis]], [[West Nile virus]], other)||3–14 days (1–20 days)||Specific agents vary by region
|-
| [[Enteric fever]]||7–18 days (3–60 days)||Especially in Indian subcontinent
|-
| [[Acute HIV]]||10–28 days (10 days to 6 weeks)||Worldwide
|-
| [[Influenza]]||1–3 days||Worldwide, can also be acquired while traveling
|-
| [[Legionellosis]]||5–6 days (2–10 days)||Widespread
|-
| [[Leptospirosis]]||7–12 days (2–26 days)||Widespread, most common in tropical areas
|-
| [[Malaria]], Plasmodium falciparum||6–30 days (98% onset within 3 months of travel)||Tropics, subtropics
|-
| [[Malaria]], P. vivax||8 days to 12 months (almost half have onset >30 days after completion of travel)||Widespread in tropics and subtropics
|-
| [[Spotted-fever rickettsiae]]||Few days to 2–3 weeks||Causative species vary by region
|-
| '''Incubation 14 Days to 6 Weeks'''||||
|-
| [[Encephalitis]], [[arboviral]]; [[enteric fever]]; acute [[HIV]]; [[leptospirosis]]; [[malaria]]||See above incubation periods for relevant diseases||See above distribution for relevant diseases
|-
| [[Amebic liver abscess]]||Weeks to months||Most common in developing countries
|-
| [[Hepatitis A]]||28–30 days (15–50 days)||Most common in developing countries
|-
| [[Hepatitis E]]||26–42 days (2–9 weeks)||Widespread
|-
| Acute [[schistosomiasis]] (Katayama syndrome)||4–8 weeks||Most common in sub-Saharan Africa
|-
| '''Incubation >6 weeks'''||||
|-
| [[Amebic liver abscess]], hepatitis E, malaria, acute schistosomiasis||See above incubation periods for relevant diseases||See above distribution for relevant diseases
|-
| [[Hepatitis B]]||90 days (60–150 days)||Widespread
|-
| [[Leishmaniasis]], visceral||2–10 months (10 days to years)||Asia, Africa, Latin America, southern Europe, and the Middle East
|-
| [[Tuberculosis]]||Primary, weeks; reactivation, years||Global distribution, rates and levels of resistance vary widely
|}

==Management==

==Disposition==

==See Also==
*[[Travel Medicine]]

==External Links==
*https://wwwnc.cdc.gov/travel/yellowbook/2016/post-travel-evaluation/fever-in-returned-travelers
*https://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=167&seg_id=3279

==References==
<references/>
[[Category:ID]]
[[Category:Tropical Medicine]]