Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Evaluation of fever in the returning traveler

INTRODUCTION

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?

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: Aug 21, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006; 354:119.
  2. Steffen R, Rickenbach M, Wilhelm U, et al. Health problems after travel to developing countries. J Infect Dis 1987; 156:84.
  3. Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med 2000; 7:259.
  4. Wilson ME, Weld LH, Boggild A, et al. Fever in returned travelers: results from the GeoSentinel Surveillance Network. Clin Infect Dis 2007; 44:1560.
  5. Ryan ET, Wilson ME, Kain KC. Illness after international travel. N Engl J Med 2002; 347:505.
  6. Steffen R, deBernardis C, Baños A. Travel epidemiology--a global perspective. Int J Antimicrob Agents 2003; 21:89.
  7. O'Brien D, Tobin S, Brown GV, Torresi J. Fever in returned travelers: review of hospital admissions for a 3-year period. Clin Infect Dis 2001; 33:603.
  8. Bottieau E, Clerinx J, Schrooten W, et al. Etiology and outcome of fever after a stay in the tropics. Arch Intern Med 2006; 166:1642.
  9. Bottieau E, Clerinx J, Van den Enden E, et al. Infectious mononucleosis-like syndromes in febrile travelers returning from the tropics. J Travel Med 2006; 13:191.
  10. MacLean, J, Lalonde, R, Ward, B. Fever from the tropics. Travel Medicine Advisor 1994; (sec 5:27:1-27.14).
  11. Emond RT, Smith H, Welsby PD. Assessment of patients with suspected viral haemorrhagic fever. Br Med J 1978; 1:966.
  12. Schwartz E, Mendelson E, Sidi Y. Dengue fever among travelers. Am J Med 1996; 101:516.
  13. Jensenius M, Fournier PE, Vene S, et al. African tick bite fever in travelers to rural sub-Equatorial Africa. Clin Infect Dis 2003; 36:1411.
  14. Raoult D, Fournier PE, Fenollar F, et al. Rickettsia africae, a tick-borne pathogen in travelers to sub-Saharan Africa. N Engl J Med 2001; 344:1504.
  15. Moser MR, Bender TR, Margolis HS, et al. An outbreak of influenza aboard a commercial airliner. Am J Epidemiol 1979; 110:1.
  16. Driver CR, Valway SE, Morgan WM, et al. Transmission of Mycobacterium tuberculosis associated with air travel. JAMA 1994; 272:1031.
  17. Jernigan DB, Hofmann J, Cetron MS, et al. Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa. Lancet 1996; 347:494.
  18. Olsen SJ, Chang HL, Cheung TY, et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med 2003; 349:2416.
  19. World Health Organization. International Travel and Health: Vaccination Requirements and Health Advice, Geneva: World Health Organization (Updated and published annually).
  20. Wilson, ME. A world guide to infections: Diseases, distribution, diagnosis, Oxford University Press, New York 1991.
  21. CDC. Yellow Book Homepage. http://wwwnc.cdc.gov/travel/page/yellowbook-home-2014 (Accessed on August 21, 2013).
  22. Phillips-Howard PA, Radalowicz A, Mitchell J, Bradley DJ. Risk of malaria in British residents returning from malarious areas. BMJ 1990; 300:499.
  23. Lipner EM, Law MA, Barnett E, et al. Filariasis in travelers presenting to the GeoSentinel Surveillance Network. PLoS Negl Trop Dis 2007; 1:e88.
  24. Shah S, Filler S, Causer LM, et al. Malaria surveillance--United States, 2002. MMWR Surveill Summ 2004; 53:21.
  25. Mali, S, Steele, S, Slutsker, L, Arguin, PM. Malaria Surveillance --- United States, 2007. MMWR Surveill Summ 2009; 58(SS-02):1-16.
  26. Meltzer E, Artom G, Marva E, et al. Schistosomiasis among travelers: new aspects of an old disease. Emerg Infect Dis 2006; 12:1696.
  27. Visser LG, Polderman AM, Stuiver PC. Outbreak of schistosomiasis among travelers returning from Mali, West Africa. Clin Infect Dis 1995; 20:280.
  28. Ross AG, Vickers D, Olds GR, et al. Katayama syndrome. Lancet Infect Dis 2007; 7:218.
  29. Levine MM, Ferreccio C, Cryz S, Ortiz E. Comparison of enteric-coated capsules and liquid formulation of Ty21a typhoid vaccine in randomised controlled field trial. Lancet 1990; 336:891.
  30. Chen LH, Wilson ME, Schlagenhauf P. Controversies and misconceptions in malaria chemoprophylaxis for travelers. JAMA 2007; 297:2251.
  31. Reyburn H, Behrens RH, Warhurst D, Bradley D. The effect of chemoprophylaxis on the timing of onset of falciparum malaria. Trop Med Int Health 1998; 3:281.
  32. Mulhall BP. Sexually transmissible diseases and travel. Br Med Bull 1993; 49:394.
  33. Matteelli A, Carosi G. Sexually transmitted diseases in travelers. Clin Infect Dis 2001; 32:1063.
  34. Rogstad KE. Sex, sun, sea, and STIs: sexually transmitted infections acquired on holiday. BMJ 2004; 329:214.
  35. Hawkes S, Hart GJ, Johnson AM, et al. Risk behaviour and HIV prevalence in international travellers. AIDS 1994; 8:247.
  36. Moore J, Beeker C, Harrison JS, et al. HIV risk behavior among Peace Corps Volunteers. AIDS 1995; 9:795.
  37. Correia JD, Shafer RT, Patel V, et al. Blood and body fluid exposure as a health risk for international travelers. J Travel Med 2001; 8:263.
  38. Centers for Disease Control and Prevention (CDC). Update: management of patients with suspected viral hemorrhagic fever--United States. MMWR Morb Mortal Wkly Rep 1995; 44:475.
  39. Monsuez JJ, Kidouche R, Le Gueno B, Postic D. Leptospirosis presenting as haemorrhagic fever in visitor to Africa. Lancet 1997; 349:254.
  40. Winters RA, Murray HW. Malaria--the mime revisited: fifteen more years of experience at a New York City teaching hospital. Am J Med 1992; 93:243.
  41. Svenson JE, MacLean JD, Gyorkos TW, Keystone J. Imported malaria. Clinical presentation and examination of symptomatic travelers. Arch Intern Med 1995; 155:861.
  42. Mutsch M, Tavernini M, Marx A, et al. Influenza virus infection in travelers to tropical and subtropical countries. Clin Infect Dis 2005; 40:1282.
  43. Connor, EA, Schwartz, E. Typhoid and paratyphoid fevers in travelers. Lancet Infect Dis 2005; 6:623.
  44. Leder K, Torresi J, Libman MD, et al. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med 2013; 158:456.
  45. Dorsey G, Gandhi M, Oyugi JH, Rosenthal PJ. Difficulties in the prevention, diagnosis, and treatment of imported malaria. Arch Intern Med 2000; 160:2505.
  46. Newman RD, Parise ME, Barber AM, Steketee RW. Malaria-related deaths among U.S. travelers, 1963-2001. Ann Intern Med 2004; 141:547.
  47. Christen D, Steffen R, Schlagenhauf P. Deaths caused by malaria in Switzerland 1988-2002. Am J Trop Med Hyg 2006; 75:1188.
  48. Wichmann O, Gascon J, Schunk M, et al. Severe dengue virus infection in travelers: risk factors and laboratory indicators. J Infect Dis 2007; 195:1089.
  49. Mohammed HP, Ramos MM, Rivera A, et al. Travel-associated dengue infections in the United States, 1996 to 2005. J Travel Med 2010; 17:8.
  50. Piper-Jenks N, Horowitz HW, Schwartz E. Risk of hepatitis E infection to travelers. J Travel Med 2000; 7:194.
  51. Chretien JP, Smoak BL. African Trypanosomiasis: Changing Epidemiology and Consequences. Curr Infect Dis Rep 2005; 7:54.
  52. Sinha A, Grace C, Alston WK, et al. African trypanosomiasis in two travelers from the United States. Clin Infect Dis 1999; 29:840.
  53. Jelinek T, Bisoffi Z, Bonazzi L, et al. Cluster of African trypanosomiasis in travelers to Tanzanian national parks.
  54. Hughes MA, Petri WA Jr. Amebic liver abscess. Infect Dis Clin North Am 2000; 14:565.
  55. Wilks D, Jacobson SK, Lever AM, Farrington M. Fatal melioidosis in a tourist returning from Thailand. J Infect 1994; 29:87.
  56. Dance DA, Smith MD, Aucken HM, Pitt TL. Imported melioidosis in England and Wales. Lancet 1999; 353:208.
  57. Schwartz E, Hatz C, Blum J. New world cutaneous leishmaniasis in travellers. Lancet Infect Dis 2006; 6:342.
  58. Borgherini G, Poubeau P, Staikowsky F, et al. Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis 2007; 44:1401.
  59. Lakshmi V, Neeraja M, Subbalaxmi MV, et al. Clinical features and molecular diagnosis of Chikungunya fever from South India. Clin Infect Dis 2008; 46:1436.
  60. Centers for Disease Control and Prevention (CDC). Malaria--Great Exuma, Bahamas, May-June 2006. MMWR Morb Mortal Wkly Rep 2006; 55:1013.
  61. Hochedez P, Canestri A, Guihot A, et al. Management of travelers with fever and exanthema, notably dengue and chikungunya infections. Am J Trop Med Hyg 2008; 78:710.
  62. van Crevel R, Speelman P, Gravekamp C, Terpstra WJ. Leptospirosis in travelers. Clin Infect Dis 1994; 19:132.
  63. Centers for Disease Control and Prevention (CDC). Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. MMWR Morb Mortal Wkly Rep 2001; 50:21.
  64. Panackal AA, Hajjeh RA, Cetron MS, Warnock DW. Fungal infections among returning travelers. Clin Infect Dis 2002; 35:1088.
  65. Cairns L, Blythe D, Kao A, et al. Outbreak of coccidioidomycosis in Washington state residents returning from Mexico. Clin Infect Dis 2000; 30:61.
  66. Salomon J, Flament Saillour M, De Truchis P, et al. An outbreak of acute pulmonary histoplasmosis in members of a trekking trip in Martinique, French West Indies. J Travel Med 2003; 10:87.