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| Fever | | *[[Fever in traveler]] |
| | | *[[Eosinophilic fever]] |
| - get incubation period- if > 1mo, dengue, rickettsia, viral hem fvr less likely
| | *[[Traveler's diarrhea]] |
| | | *[[Travel skin conditions]] |
| - cbc c diff, thick smear, lft, ua, blood/ stool cx, cxr, serologies for specific viruses
| | *[[Parasitic diseases]] |
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| Malaria
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| - most imp cause of fvr
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| - plasmodium falciparum can be rapidly fatal and needs to be ruled out soon
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| - p falciparum from sub Saharan Africa, 90% of pt have sx within 1 mo of return
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| - p vivax- Asia and Latin, 50% pt have sx within 1 mo- 2% up to 1 yr out
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| - chemoprophylaxsis does not guarantee protection
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| - usually have fvr, but 10- 40% may not
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| - fvr q 48- 72 hr pathognomic of vivax, ovale, malariae infc
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| - can also have ha, cough, gi sx
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| - check thick smear initially and if neg, repeat in 12- 24 hrs
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| - thrombocytopenia and splenomegaly common
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| - p falciparum unpredictable- admit and monitor for hypoglycemia
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| - iv meds if renal, resp failure, ams, sx, shock, anemia, p falcip rbc load >4% in nonimmune pt
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| Dengue
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| - aedes mosquito in urban area
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| - incubate for 4- 7d, influenza like prodrome, fvr, ha, myalgia, LN, rash
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| - dengue shock syndrome and hem fvr rare in travelers- usually in pt c prev infc
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| - leukopenia, thrombocytopenia
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| - dx by 4x increase in acute/ conv titres
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| Rickettsia/ Typhus
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| - fvr, ha, myalgia
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| - xmitted by arthropods/ ticks
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| - painless eschar at inoculation site imp clue
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| - camping, hiking in grassy/ scrub area
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| - regional LN, rash, leukopenia, thrombocytopenia
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| - dx clinically
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| - tx c tetracycline
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| - confirm serologically
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| Leptospirosis
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| - fvr, myalgia, ha, rash
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| - conjuntival suffusion characteristic but not common
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| - exp to fresh water while rafting, kayaking
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| - biphasic illness with meningitis, uveitis, transminitis, proteinuria, hematuria
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| - tx c pcn or tetra
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| - confirm by serology
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| Typhoid Fever
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| - fvr, ha
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| - visiting friends in India, Phillipines Latin
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| - abd pain, constipation, -diarrhea rare
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| - leukopenia, thrombocytopenia, dry cough, LN
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| - insidious onset unlike dengue or rickettsia
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| - dx by blood cx for salmonella enterica serotype typhi
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| - serology unreliable
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| - tx empirically with flouroquinolone or 3rd gen cephal
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| - vaccine partially effecive and breakthrough infc possible
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| Hemorrhagic Fever
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| - meningococcemia, malaria, leptospirosis, rickettsia- all treatable with abx
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| - also untreatable viruses- dengue, yellow fvr- but hem forms rarely seen in travelers
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| - also consider Ebola and Lassa fever- public health hazard
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| - h/o visit to rural area or contact with ill people in endemic area
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| - usually 3 wk after exposure
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| CNS Changes and Fever
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| - malaria, tb, typhoid fvr, rickettsia, poliomyelitis, rabies, viral (Japanese/ West Nile/ tick borne) encephalitis
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| - meningococcal meningitis assoc with Haj to Mecca
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| - eosinophilic meningitis assoc c coccidiomycosis or angiostrongyliasis- rat lung worm to brain
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| - trypanosomiasis by tsetse fly- Africal sleeping sickness- red chancre at site of fly bite, fvr, ha, myalgia going to meningoencephalitis. May see trypansosomes in smear in acute phase
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| Resp Sx and Fever
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| - consider strep pneumonia, influenza, mycoplasma, legionella, tb
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| - Q Fever- coxiella burnetti- fvr, pna, hepatitis and animal exposure
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| - Lofflers syn- pulm infiltrates, eosinophilia from transient migration of larval helminthes through lungs
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| - Cough also seen in malaria, typhoid fvr, scrub typhus, dengue
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| Sex/ Blood Exposure and Fever
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| - can have fvr without genital findings- hiv, syphilis (treponema pallidum) cmv, ebv, hep B
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| - also from tattoo, piercing, share razor, blood xfsn
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| Eosinophilic Fever
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| - >400 per cubic mm
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| - due to blood CA or allergy or helminthic infc
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| - hookworm, ascariasis, strongyloides, schistosomiasis, filariasis, visceral larva migrans, trichinosis, cocci
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| - eval with stool for O&P
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| - serology
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| - blood smear
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| - skin snips for microfilariae
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| Diarrhea
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| - most respond to antibiotics or antimotility agents
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| - as duration of diarrhea increases, higher chance of parasitic cause
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| - giardia, cryptosporidiosis, entamoeba, cyclospora
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| - dysentery if stool bloody, fvr or wbc in stool- invasive inflamm enteropathy
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| - has abrupt onset, metastatic lesions, reactive arthopathies, or campylobacter assoc guillain barre- maybe flouroquinolone resis esp in SE Asia
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| - amoebic dysentery insidious and can get amoebic liver abscess
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| - if do not find infc cause of dysentery, eval pt for IBD or CA
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| - prolonged diarrhea and malabsorption- giardia or tropical sprue- does not respond to removal of gluten from diet- tx with tetra and folate
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| - also consider postinfectious disaccharidase deficiency or irritable bowel dz
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| - if diarrhea starts >1 mo after travel- not caused by travel
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| - tx regular travelers diarrhea with fluids, antimotility agents, abx- fluoro or macrolide
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| - tx invasive enteropathy- bloody/ fvr- same but no antimotility agents
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| - if bloody stool but no fvr, consider enterhemorrhagic E coli- do not give abx since will get hemolytic uremic syndrome in kids
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| - examine stool if diarrhea invasive, persistent, unresponsive to standard tx or immune compromised
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| - if persistent diarrhea, give empiric flouro or macrolide or consid metronidazole for giardia- most common parasite
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| - try lactose free diet
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| - chronic diarrhea usually self limited within 1 yr
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| Skin Conditions
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| Papules
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| - insect bites- cluster or linear distribution
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| - scabies- if sex active or backpacker
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| - seabathers eruption- confined to skin covered by swim suit- jellyfish larvae trapped under cloth
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| - cercarial dermatitis- skin exposed to freshwater schistosomes or coastal water clam diggers itch
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| Sub Q Swelling and Nodules
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| - myasis- skin invaded by fly larvae- like boil but with central opening in which larvae may hide
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| - tungiasis
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| - loa loa
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| - trypanosomiasis
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| Ulcers
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| - pyoderma/ ecthyma- secondary staph cellulitits post bite
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| - leishmaniasis
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| - mycobacterium marinum
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| Linear and Migratory Lesions
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| - cutaneous larvae migrans- by soil contact with dog/ cat feces
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| - photodermatitis
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| Mistry
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| | '''External Links''' |
| | * [https://wwwnc.cdc.gov/travel Center for Disease Control and Prevention - Travelers' Health] |
| | * [https://wwwnc.cdc.gov/travel/notices Center for Disease Control and Prevention - Travel Health Notices] |
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| [[Category:ID]] | | [[Category:ID]] |
| | [[Category:Tropical Medicine]] |
