A. History: Acute (<7 days)
B. Further History: Recent Travel
| Next Pivotal Assessment | Findings |
|---|---|
| Region Visited |
| Region | Possible Diseases |
|---|---|
| Sub-Saharan Africa | Malaria, Ebola, typhoid, yellow fever |
| South Asia | Typhoid, dengue, chikungunya, leptospirosis |
| Southeast Asia | Dengue, malaria, melioidosis, Japanese encephalitis |
| South America | Dengue, malaria, yellow fever, leishmaniasis |
| Middle East | MERS, brucellosis, leishmaniasis |
| Caribbean | Dengue, chikungunya, Zika |
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To determine the cause of a fever in a patient who recently traveled outside the United States, a structured and thorough approach is essential. Here’s a step-by-step guide:
Locations Visited: Countries, cities, rural vs. urban settings.
Dates of Travel: Timing of travel in relation to onset of symptoms (helps assess incubation periods).
Activities: Swimming in freshwater, insect bites, animal contact, hiking, sexual activity, healthcare exposure, food/water sources.
Vaccinations/Prophylaxis: Yellow fever vaccine, malaria prophylaxis, typhoid vaccine, etc.
Travel Companions: Did others get sick?
Acute (<10 days) vs. Subacute (10–21 days) vs. Chronic (>21 days).
Look for:
Rash
Diarrhea
Respiratory symptoms
Jaundice
Neurologic changes
Lymphadenopathy
Eosinophilia
| Region | Possible Diseases |
|---|---|
| Sub-Saharan Africa | Malaria, Ebola, typhoid, yellow fever |
| South Asia | Typhoid, dengue, chikungunya, leptospirosis |
| Southeast Asia | Dengue, malaria, melioidosis, Japanese encephalitis |
| South America | Dengue, malaria, yellow fever, leishmaniasis |
| Middle East | MERS, brucellosis, leishmaniasis |
| Caribbean | Dengue, chikungunya, Zika |
Basic labs: CBC with differential, LFTs, renal panel
Malaria smears × 3 or rapid antigen tests
Blood cultures (for typhoid/brucellosis)
Urinalysis and culture
Stool O&P (ova and parasites) and culture if diarrhea
Dengue serology/NS1 antigen
Hepatitis panel
HIV testing if appropriate
Chest X-ray if respiratory symptoms
Liver/spleen imaging if hepatosplenomegaly
If suspecting highly infectious disease (e.g., viral hemorrhagic fevers, MERS, or COVID-19), notify infection control and isolate the patient as needed.
Report to public health authorities if applicable.
Especially if the diagnosis is unclear or the patient is deteriorating.
Especially in patients returning from Sub-Saharan Africa or other malaria-endemic areas.
Malaria is the most common and potentially fatal imported cause of fever in travelers.
Would you like a diagnostic algorithm or summary table for travel-related fever causes by region or symptom complex?