Fever in traveler: Difference between revisions
ClaireLewis (talk | contribs) (→Workup) |
|||
(7 intermediate revisions by 3 users not shown) | |||
Line 33: | Line 33: | ||
*[[HIV]] | *[[HIV]] | ||
*[[Syphilis]] (''Treponema pallidum'') | *[[Syphilis]] (''Treponema pallidum'') | ||
*Cytomegalovirus (CMV) | *[[Cytomegalovirus]] (CMV) | ||
*Epstein-Barr | *[[Epstein-Barr virus]] (EBV) | ||
*Hepatitis B | *[[Hepatitis B]] | ||
**[[Hepatitis D]] co-infection | |||
==Evaluation== | ==Evaluation== | ||
Line 45: | Line 46: | ||
*Liver function tests | *Liver function tests | ||
*Blood culture | *Blood culture | ||
*Urinalysis and urine culture | *[[Urinalysis]] and urine culture | ||
*Stool culture | *Stool culture | ||
*Chest x-ray | *Chest x-ray | ||
*Additional to consider: | *Additional to consider: | ||
**[[Lumbar puncture]] | **[[Lumbar puncture]] | ||
**Hepatitis panel | **[[Viral hepatitis|Hepatitis]] panel | ||
**[[STD]] studies | **[[STD]] studies | ||
**Serologies for specific viruses | **Serologies for specific viruses | ||
Line 71: | Line 72: | ||
| Southeast Asia||[[Dengue]], [[malaria]] (primarily non-falciparum)||[[Chikungunya]], [[leptospirosis]] | | Southeast Asia||[[Dengue]], [[malaria]] (primarily non-falciparum)||[[Chikungunya]], [[leptospirosis]] | ||
|- | |- | ||
| Sub-Saharan Africa||[[Malaria]] (primarily P. falciparum), [[ | | 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]] | ||
|} | |} | ||
Line 78: | Line 79: | ||
| align="center" style="background:#f0f0f0;"|'''USUAL INCUBATION PERIOD (RANGE)''' | | align="center" style="background:#f0f0f0;"|'''USUAL INCUBATION PERIOD (RANGE)''' | ||
| align="center" style="background:#f0f0f0;"|'''DISTRIBUTION''' | | align="center" style="background:#f0f0f0;"|'''DISTRIBUTION''' | ||
|- | |- | ||
| '''Incubation <14 days'''|||| | | '''Incubation <14 days'''|||| | ||
|- | |- | ||
| Chikungunya||2–4 days (1–14 days)||Tropics, subtropics | | [[Chikungunya]]||2–4 days (1–14 days)||Tropics, subtropics | ||
|- | |- | ||
| Dengue||4–8 days (3–14 days)||Topics, 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 | | 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 | | [[Enteric fever]]||7–18 days (3–60 days)||Especially in Indian subcontinent | ||
|- | |- | ||
| Acute HIV||10–28 days (10 days to 6 weeks)||Worldwide | | [[Acute HIV]]||10–28 days (10 days to 6 weeks)||Worldwide | ||
|- | |- | ||
| Influenza||1–3 days||Worldwide, can also be acquired while traveling | | [[Influenza]]||1–3 days||Worldwide, can also be acquired while traveling | ||
|- | |- | ||
| Legionellosis||5–6 days (2–10 days)||Widespread | | [[Legionellosis]]||5–6 days (2–10 days)||Widespread | ||
|- | |- | ||
| Leptospirosis||7–12 days (2–26 days)||Widespread, most common in tropical areas | | [[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]], 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 | | [[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 | | [[Spotted-fever rickettsiae]]||Few days to 2–3 weeks||Causative species vary by region | ||
|- | |- | ||
| '''Incubation 14 Days to 6 Weeks'''|||| | | '''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 | | [[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 | | [[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 A]]||28–30 days (15–50 days)||Most common in developing countries | ||
|- | |- | ||
| Hepatitis E||26–42 days (2–9 weeks)||Widespread | | [[Hepatitis E]]||26–42 days (2–9 weeks)||Widespread | ||
|- | |- | ||
| Acute schistosomiasis (Katayama syndrome)||4–8 weeks||Most common in sub-Saharan Africa | | Acute [[schistosomiasis]] (Katayama syndrome)||4–8 weeks||Most common in sub-Saharan Africa | ||
|- | |- | ||
| '''Incubation >6 weeks'''|||| | | '''Incubation >6 weeks'''|||| | ||
|- | |- | ||
| Amebic liver abscess, hepatitis E, malaria, acute schistosomiasis||See above incubation periods for relevant diseases||See above distribution for relevant diseases | | [[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 | | [[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 | | [[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 | | [[Tuberculosis]]||Primary, weeks; reactivation, years||Global distribution, rates and levels of resistance vary widely | ||
|} | |} | ||
Line 141: | Line 139: | ||
==References== | ==References== | ||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Tropical Medicine]] | [[Category:Tropical Medicine]] |
Latest revision as of 14:53, 18 August 2019
Background
- If incubation period >1 month: dengue, rickettsia, viral hemorrhagic fever less likely
Clinical Features
- Fever and exposure outside of U.S.
Differential Diagnosis
Fever in traveler
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
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
- Hepatitis panel
- STD studies
- Serologies for specific viruses
- Other radiography (CT scan, abdominal ultrasound, MRI brain)
Diagnosis
GEOGRAPHIC AREA | COMMON TROPICAL DISEASE CAUSING FEVER | 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 |
DISEASE | USUAL INCUBATION PERIOD (RANGE) | 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
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