Fever After International Travel
Infectious Disease:
• Endemic in either the destination or home region
Viral Syndromes:
Arboviral infections, a common cause of febrile illnesses associated with international travel
• Dengue virus
• Chikungunya virus
• Zika virus
• Dengue fever:
Nonspecific febrile illness with headache, body aches, leukopenia, thrombocytopenia, and elevated aspartate aminotransferase and alanine aminotransferase levels; dengue shock syndrome may lead to capillary leak syndrome with hemoconcentration.
Other viruses:
• Lassa fever
• Yellow fever
• Crimean-Congo hemorrhagic fever
• Filovirus infections, such as Ebola virus disease or Marburg virus disease
Bacterial Infections:
• Leptospirosis - Nonspecific febrile illness, elevations in hepatic aminotransferase and bilirubin levels, thrombocytopenia, and renal dysfunction. No hemolytic anemia.
• Rickettsial infections - Including African tick typhus (caused by Rickettsia africae): nonspecific febrile illness
• Typhoid fever - Another cause of a nonspecific febrile illness in international travelers. Salmonella typhi
Parasitic Diseases:
• East African trypanosomiasis
• Babesiosis
• Plasmodium falciparum:
Most cases of malaria diagnosed in the United States occur during the U.S. summer months among patients who have traveled to sub-Saharan Africa
Nonspecific febrile illness with headache, chills, and myalgias, symptoms that usually develop within 4 to 12 weeks after the infectious mosquito bite
Diarrhea can also occur
Cough or shortness of breath
Life-Threatening Causes of Fever:
• Falciparum malaria
• Enteric fever
• Melioidosis
• Dengue
Initial Investigations:
• CBC
• Biochemical studies, including tests of liver and renal function
• Blood culture; rapid diagnostic tests for malaria and dengue; polymerase-chain-reaction (PCR) testing of a saliva sample (e.g., for rickettsia); serologic tests; a chest film; blood-smear examination; and urine tests, including a dipstick test, microscopic examination, culture, and possibly PCR testing (e.g., for Zika virus or leptospira)
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