Many travelers return home with fever with or without other accompanying symptoms. Up to 8 percent of travelers to developing countries are ill enough to seek health care while abroad or after returning home [1-3]. Fever in the returned traveler can be a manifestation of a minor, self-limited process or can herald a progressive, life-threatening illness. It may be difficult to distinguish between trivial and serious infections based on initial findings.
The assessment of these patients is often hampered by the clinician's lack of familiarity with the types of infections that the patient may have encountered while traveling. A systematic approach to the evaluation of these patients is vital and should include basic information about the geographic distribution of infections in the locations where the person has lived and traveled (including even brief stays and airport transfers), as well as any activities that were undertaken [1,4,5]. The tempo and intensity of the initial work-up will be influenced by both the clinical findings and by the types of infections that are possible.
The evaluation of such patients should focus on three basic questions:
- What infections are possible given where the patient has lived or traveled and the time when exposures may have occurred?
- Which of these infections is more probable given the patient's clinical findings, pretravel measures, and potential exposures?
- Which of these infections is treatable or transmissible or both?
The epidemiology, etiology, and evaluation of fever in the returning traveler will be reviewed here. Skin lesions acquired during travel are discussed separately. (See "Skin lesions in the returning traveler".)