Fever in the Returned Traveler

December 07, 2019

Fever in the Returned Traveler

Today's Pearls:

1. Where did they travel?
2. What did they do there?
3. When did they get sick?

https://www.youtube.com/watch?v=mOYZaiDZ7BM

-----------------------------------------

What a great week of cases! Malaria! Catamenial lung disease! Porphyria! WOW!

------------------------------------------

Dr. Freitas & Dr. Itzhakov presented a case of fever & headache in a returned traveler who was quickly diagnosed with malaria.

In addition to the usual HPI, ROS & exam. We discussed some important considerations in the diagnosis of travel related illness:

1. Where did they travel?

Identifying the countries of travel will help narrow down the likely infection.
The CDC provides a great resource for clinicians to use when counseling departing or returning travelers:

https://wwwnc.cdc.gov/travel

2. What did they do there?

Asking patients what they did, what they ate & where they stayed will further help narrow things down:

https://www.bmj.com/content/360/bmj.j5773

3. When did they get sick?

Evaluating when patients developed symptoms in the context of their potential exposure can help narrow your differential even further.

This is from BMJ. Uptodate has a similar chart that is event more extensive.
https://www.bmj.com/content/360/bmj.j5773

The above graphics were borrowed from BMJ.
They also created a podcast, it's a little dry but has some good parts: check it out here: https://www.bmj.com/content/360/bmj.j5773

Malaria

Illness script: Any age person returning from an endemic area (Africa, Oceania, South America) with cyclic fevers, headache, myalgias & abdominal pain who didn't take or wasn't able to finish their chemoprophylaxis.

Dr. Freitas reminded us of the life cycle of the malarial parasite which include human blood & liver stages + mosquito stages.
It's important to remember the life cycle because this will affect treatment.
If a patient is infected with P. vivax or P. ovale they require specific treatment of the dormant liver phase or the patient may experience relapsing episodes of disease.