Fever in traveler
General
- If incubation period >1 month: dengue, rickettsia, viral hemorrhagic fever less likely
- CBC with differential; thick smear; liver function tests; urinalysis; blood & stool cultures; chest x-ray; serologies for specific viruses
Differential Diagnosis
Fever + 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 by tsetse fly = Africal sleeping sickness = red chancre at site of fly bite, fever, headache, myalgias proceding to meningoencephalitis. May see trypansosomes in smear in acute phase
Fever + Respiratory Symptoms
- streptococcal pneumonia, influenza, mycoplasma, legionella, tuberculosis
- Q fever: coxiella burnetti: fever, pneumonia, hepatitis after animal exposure
- Loffler's syndrome: pulmonary infiltrates, eosinophilia from transient migration of larval helminthes through lungs
- cough also seen in malaria, typhoid fever, scrub typhus, dengue
Sexually Transmitted / Blood Exposure and Fever
- can have fever without genital findings: HIV, syphilis (Treponema pallidum) cytomegalovirus (CMV), Epstein-Barr Virus (EBV), hepatitis B
- also from tattoos, piercings, share razor, blood transfusion