see [RCH fever in returned traveller](https://www.rch.org.au/clinicalguide/guideline_index/Fever_in_the_recently_returned_traveller/) [NaTHNaC](https://travelhealthpro.org.uk/) [CDC Clinician resources](https://wwwnc.cdc.gov/travel/page/clinician-information-center) [CDC yellow book](https://wwwnc.cdc.gov/travel/page/yellowbook-home) [oxford infectious diseases - multi system diseases](x-devonthink-item://3ACF5B55-EE0D-449A-8040-1D7EE2049BCF?page=758) > - [Australian Prescriber- Fever in returning traveler 2012](x-devonthink-item://EDCC3B8C-9C0E-4F26-A8A3-FDDAA708C523) > - [AFP Fever in returned traveller 2007](x-devonthink-item://1093670C-0870-4214-A919-6DA33755BE96) > - [Neglected Tropical Diseases MJA](x-devonthink-item://F167DB8F-966C-4BF9-BFBF-3A7A7027C920) > - [Graphic Guide to infectious diseases (devonthink)](x-devonthink-item://FAFEB6C5-BAE9-4BCE-8266-C2F9350098C4) #tables ![[Infectious Diseases#Important tropical diseases table]] # History - symptom onset, duration - healthcare while away - travel location - mosquito nets, etc - exposure to risks (animals, bites, drinking water) - immunisation history) **The travel history should include the following:** - The exact *locations*, duration and dates of stay, including any stopovers - The nature of the *accommodation* (e.g. airconditioned hotel or camping), use of bed nets and insect repellents - *Vaccination history* (routine and travel-related) and adherence to preventative medication (such as antimalarial drugs) - Any behaviour that may have led to disease exposure: known insect or tick *bites*, *sick contacts*, animals, *fresh water* (including leisure activities), potentially unsafe food or water and sexual or needle exposures # Regional risks ![[Pasted image 20230726115551.png]] - **SE Asia** - [[Dengue]], non-falciparum [[Malaria]] - south/central Asia - [[Typhoid]] and parathyroid fever - **Africa** - - falciparum malaria - [[Schistosomiasis]] - tickborne rickettsia - Central/**south america** - vivax malaria - [[chikungunya]] - dengue - [[Zika]] ![[Pasted image 20230726115754.png]] # Clinical features specific to infection | **Clinical Features** | **Infection or disease implicated** | | ------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Rashes/skin lesions | [[Dengue]], [[Typhoid]], [[Rickettsia]] infections, [[measles]], leptospirosis, syphilis, gonorrhoea, [[Brucellosis]], [[chikungunya]], [[Zika]] | | Eschar | [[Rickettsia]] infections, borrelia, Crimean-Congo haemorrhagic fever | | Hepatomegaly | [[Malaria]], typhoid, dengue, viral hepatitis, amoebiasis, [[leptospirosis]] | | Splenomegaly | Malaria, typhoid, mononucleosis, [[Trypanosomiasis]], brucellosis, dengue, kala-azar | | Acute abdomen or GI haemorrhage | Typhoid | | Cough, coryza, conjunctivitis | Respiratory viruses, measles | | Jaundice | Viral hepatitis, measles | | Lymphadenopathy | [[Rickettsia]], [[Toxoplasmosis]], brucellosis, HIV, mononucleosis, visceral [[Leishmaniasis]] | | Petechiae | Meningococcal disease, viral haemorrhagic fever, rickettsia | | Haemorrhage | Dengue, meningococcaemia, Lassa fever, Marburg or [[Ebola]], Crimean-Congo virus, [[Yellow Fever]], Rocky Mountain Spotted Fever | | Altered conscious state, lethargy, <br>Meningism | Cerebral malaria, [[Meningitis]], African trypanosomiasis | | Fever persisting >2 weeks | Malaria, enteric fever, EBV, CMV, toxoplasmosis, acute [[HIV]], acute schistosomiasis, [[Brucellosis]], [[Tuberculosis]], Q fever | | Fever with onset >6 weeks after travel | _Plasmodium vivax_ or _P ovale_, acute hepatitis (B, C or E), TB, amoebic liver abscess | | neuro symptoms | malaria, TB, typhoid, rickettsia, polio, [[Rabies]], viral (japanese / west nile / tick) encephalitis, meningococcal meningitis, coccidiomycosis, [[Trypanosomiasis]] | | resp symptoms | pneumonia, influenza/ covid, mycoplasma, legionella, TB, Q fever (coxiella burnetti) | | a/w sexual or blood exposure | [[HIV]], [[Syphilis]], CMV, EBV, [[Hepatitis\|Hep B]] | # other table over overseas diseases | Disease | Aetiology | Transmission | Presentation | Investigations | Treatment | Where? | | ---- | ---- | ---- | ---- | ---- | ---- | ---- | | **Amoebiasis** | Entamoeba histolytica | Bad water, F-O transmission of cysts | Asymptomatic, abdo discomfort, diarrhoea, tender of caecum and colon, tender hepatomegaly, dehydration. | Stool micro, ↑ WBC, ↓Hb, sigmoidoscopy. | Rehydration, Metronidazole, then diloxanide furoate to eliminate cysts. | Asia, Middle East, Americas, Africa | | **Cholera** | Vibrio cholerae | FO via contaminated water | Profuse watery diarrhoea, signs of dehydration, ↑ temp | Stool samples – micro, culture, sensitivity | Rehydration therapy; aspirin + chlorpromazine, tetracycline | India, Pakistan, Bangladesh, Afghanistan, SE Asia, Middle East, Africa | | **Dengue** | Flavivirus, 4 distinct serotypes | Aedes mozzie, monkeys are the reservoir | Asymptomatic, fever, myalgia, arthralgia, anorexia, sore throat, eye pain, abdo pain, petechiae, ↑ temp, lymphadenopathy, hepatomegaly | FBC (↓ platelets), serology | Supportive – plasma, antipyretics | SE Asia, Pacific, Africa, Caribbean, Americas | | **Diphtheria** | Corynebacterium diphtheriae | Droplets or direct contact | Fever, nasal discharge, hoarseness, cough, tonsillitis, cervical lymphadenopathy | Swabs/blood cultures – micro and culture, test for toxin production | Antitoxin, penicillin G or erythromycin | Most developing countries | | **Giardiasis** | Giardia Lamblia | F-O route | Watery diarrhoea, steatorrhoea, abdo cramps, flatulence, weight loss, distended abdomen | Stools micro and ELISA for antigens. | Rehydration, symptomatic relief, metronidazole | Worldwide – causes 3% of travel diarrhoea | | **Haemorrhagic fevers** | Crimean-Congo, Ebola, Marburg, Lassa, Rift Valley | Mozzies, ticks, rodents, direct contact | Fever, malaise, headache, myalgia, pharyngitis, vomiting, diarrhoea, skin rash, haemorrhagic manifestations | Serology | Supportive | Tropical and subtropical regions, sub-sahara Africa. | | **Hepatitis A** | Hep A virus RNA enterovirus | FO via contaminated food and water | Fever, myalgia, abdo discomfort, anorexia, vomiting, dark urine, pale faeces, jaundice, arthralgia, rash, hepatosplenomegaly | Serology, LFTs | Supportive | Worldwide | | **Hepatitis B** | Hep B virus, DNA. | Blood or body fluids | Fever, anorexia, upper abdo discomfort, nausea, vomiting, distaste for cigarettes?, dark urine, pale stools, jaundice. | Serology, LFTs | Supportive, lamivudine, tenofovir | Worldwide | | **Hepatitis C** | Hep C ss RNA virus | Blood products, sex | Fever, anorexia, upper abdo discomfort, nausea, vomiting, dark urine, pale stools, jaundice, hepatosplenomegaly. | Serology, LFT | Supportive, ribavirin + IFN | Worldwide | | **Hepatitis E** | Hep E calcivirus | FO via contaminated water | Fever, myalgia, abdo discomfort, anorexia, vomiting, dark urine, pale faeces, jaundice, arthralgia, rash | Serology, LEFT | Supportive | Outbreaks mainly in developing countries | | **HIV/AIDS** | HIV retrovirus | Blood and body fluids | Weight loss, fever, peripheral neuropathy, cognitive disorders, herpes, folliculitis, tinea, kaposis sarcome, pruritis, dermatitis, candidiasis, recurrent infections – every symptom that you can think of | Serology, FBC, viral load for monitoring purposes | 2 nucleoside RT inhibitors + protease inhibitor. Also treat secondary problems | Worldwide, especially in developing countries. | | **Influenza virus** | Types A, B and C with H and N subtypes | Secretion and large droplets | Fever, chills, headache, myalgia, dry cough, rhinitis, stuffiness, sore throat. May have chest signs | FBC - ↑ WBC | Oral oseltamir, inhaled zanamavir, amantadine, ribavirin | Worldwide | | **Japanese Encephalitis** | Flavivirus | Via Culex tritaeniorhynchus | Mostly asymptomatic | CSF – ELISA for IgM | Supportive, may need anticonvulsant | Asia | | **Leptospirosis (weil’s disease)** | Leptospira genus | Between skin and rat urine (ewww) | Fever, headache, myalgia, chills, conjunctival suffusion, skin rash | Swab – micro and culture | A weeks worth of doxycycline or IV benzylpenicillin | Tropical countries | | **Leprosy** | Mycobacterium leprae | Droplets, broken skin | Skin lesions, sensory skin disturbances, muscle wasting | Skin smear – micro | Rifampicin + dapsone | Endemic in Africa, also in India and SE Asia | | **Lyme Disease** | Borrelia burgdorferi | Tick bite | Expanding annular lesions, fever, flu-like symptoms, stiff neck, headache, chest pain | Blood/CSF/Skin – culture, PCR, serology | Tetracycline, if there is neuro involvement treat with benzylpenicillin | Worldwide | # important viral haemorrhagic fevers | virus | area | vector | | ---- | ---- | ---- | | lassavirus | west africa | Rats | | Hantaviruses | S and north america, S asia, Europe, | rodents | | Crimean–Congo haemorrhagic fever virus, | Africa | ticks | | Ebola | central africa | bats | | Marbug virus | equatorial africa | bats | # Related Questions ## abscess - [ ] 1Q: [Cellulitis](x-devonthink-item://8A1FC024-FD4E-4202-A93D-77C4E8234DC5?page=2) -- [Answer](x-devonthink-item://7EEBE66F-C2B1-4EF7-B29C-FB52D469C8CD?page=0) ## ebola - [x] 5Q: [Fever in Returned Traveller](x-devonthink-item://09CFA1A7-00F1-4151-979E-8F3984924D54?page=53) -- [Answer](x-devonthink-item://CF5E9C2B-42F9-4F9C-AC29-877E20134927?page=34) ## fever in returned traveller - [ ] 9Q: [Fever in returned traveller](x-devonthink-item://8AAAF35C-CCF4-4157-9551-5B05727AA0CD?page=7) -- [Answer](x-devonthink-item://FDFBA3A1-6207-4204-AB6D-7483D80C5B5C?page=7) - [x] DUPLICATE Q: [Malaria](x-devonthink-item://8AAAF35C-CCF4-4157-9551-5B05727AA0CD?page=7) -- [Answer](x-devonthink-item://FDFBA3A1-6207-4204-AB6D-7483D80C5B5C?page=7) - [ ] 10Q: [Typhoid](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=32) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=10) - [ ] 11Q: [Fever in returned traveller](x-devonthink-item://EF003416-CCE0-4A7D-AE59-F054D2880322?page=16) -- [Answer](x-devonthink-item://30A6ADA2-CC99-445A-B901-7117A6AEB2CC?page=18) - [ ] 12Q: [Fever in Returned Traveller](x-devonthink-item://93BBB26D-55F3-43AF-A3B9-F829BE210561?page=11) -- [Answer](x-devonthink-item://E3D816B5-653D-4DC6-A389-8C69022A6062?page=9) - [ ] 13Q: [Fever in Returned Traveller](x-devonthink-item://87BC05C2-0A6B-436D-B51A-75E14AA5EA7E?page=13) -- [Answer](x-devonthink-item://98D17FA0-225B-4E94-B21C-4E36D5C76A7C?page=67) - [x] DUPLICATE Q: [Fever in Returned Traveller](x-devonthink-item://09CFA1A7-00F1-4151-979E-8F3984924D54?page=53) -- [Answer](x-devonthink-item://CF5E9C2B-42F9-4F9C-AC29-877E20134927?page=34) - [x] 14Q: [Fever in Returned Traveller](x-devonthink-item://7061D1B4-0AB9-4963-B3B0-23BDD975B2CD?page=14) -- [Answer](x-devonthink-item://3F30C77E-E23E-4200-89FE-48A41618E0C2?page=10) ## hepatitis - [x] 17Q: [Hepatitis](x-devonthink-item://4AD9F692-A113-4718-94B0-7292F2273B1F?page=17) -- [Answer](x-devonthink-item://A10DE51E-92FA-42D1-8AA0-7AE68C2FA743?page=27) -- [prop](x-devonthink-item://B864660E-6598-4555-ACA9-B87F41ED4C3A?page=16) ## hiv - [ ] 18Q: [AIDS](x-devonthink-item://A8F2D7A0-9A26-4012-AF42-19D640D674B4?page=6) -- [Answer](x-devonthink-item://A10DE51E-92FA-42D1-8AA0-7AE68C2FA743?page=2) ## lymphadenopathy - [x] 19Q: [Question](x-devonthink-item://1EA9311E-0B9E-49F7-8D6E-4C4187A838C4?page=55) -- [Answer](x-devonthink-item://B1CB2E8F-5D04-49EE-8274-043871389D28?page=35) ## malaria - [x] DUPLICATE Q: [Fever in returned traveller](x-devonthink-item://8AAAF35C-CCF4-4157-9551-5B05727AA0CD?page=7) -- [Answer](x-devonthink-item://FDFBA3A1-6207-4204-AB6D-7483D80C5B5C?page=7) - [x] DUPLICATE Q: [Malaria](x-devonthink-item://8AAAF35C-CCF4-4157-9551-5B05727AA0CD?page=7) -- [Answer](x-devonthink-item://FDFBA3A1-6207-4204-AB6D-7483D80C5B5C?page=7) - [x] DUPLICATE Q: [Fever in Returned Traveller](x-devonthink-item://87BC05C2-0A6B-436D-B51A-75E14AA5EA7E?page=13) -- [Answer](x-devonthink-item://98D17FA0-225B-4E94-B21C-4E36D5C76A7C?page=67) ## measles - [x] 22Q: [Measles](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=52) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=33) -- [prop](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=66) - [x] 23Q: [Unwell Child with Rash](x-devonthink-item://73409C77-B2FA-4E0A-AEB3-5EB284457F0C?page=55) -- [Answer](x-devonthink-item://5A848952-80E3-4184-B553-368412A69917?page=36) -- [prop](x-devonthink-item://2A1F4A99-92AE-4C8E-B325-AE448BD46AC6?page=13) ## meningitis - [ ] 24Q: [Possible meningitis](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=34) -- [Answer](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=36) - [ ] 25Q: [Meningitis](x-devonthink-item://C1DDA3AB-2DA2-4922-A8A6-F597AB7E2558?page=14) -- [Answer](x-devonthink-item://A10DE51E-92FA-42D1-8AA0-7AE68C2FA743?page=17) -- [prop](x-devonthink-item://B864660E-6598-4555-ACA9-B87F41ED4C3A?page=11) - [ ] 26Q: [Meningitis](x-devonthink-item://09CFA1A7-00F1-4151-979E-8F3984924D54?page=28) -- [Answer](x-devonthink-item://CF5E9C2B-42F9-4F9C-AC29-877E20134927?page=18) ## meningococcaemia - [ ] 27Q: [Unwell Child with Rash](x-devonthink-item://0C18BB01-C981-4C61-B0E9-93B507919817?page=2) -- [Answer](x-devonthink-item://75D8E35B-EE77-4D1B-A665-438451C976AE?page=1) -- [prop](x-devonthink-item://E34679F3-102F-4E16-AF81-9D679412EDAC?page=2) ## rash - [ ] 28Q: [18 month old with rash](x-devonthink-item://09493372-578D-4C97-972A-EEC617B38B53?page=10) -- [Answer](x-devonthink-item://A0D348CE-FCD4-4ECD-BE21-6CA73F6DE8CD?page=4) - [ ] 29Q: [Painful rash](x-devonthink-item://80040649-2DDB-4266-9A7C-4DE4E6DD4AE6?page=9) -- [Answer](x-devonthink-item://C96EDD2F-137A-43E5-80EE-5F42C5971D55?page=13) -- [prop](x-devonthink-item://51B63B5B-D684-4BF3-8B62-95FCA5EF7503?page=11) - [x] DUPLICATE Q: [Measles](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=52) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=33) - [ ] 30Q: [Rash](x-devonthink-item://F0498813-9350-484C-AD5B-6FF7C3AE9015?page=12) -- [Answer](x-devonthink-item://A491A3F6-FD6D-492F-BCBE-7F7BAE101EDF?page=9) - [ ] 31Q: [Rash](x-devonthink-item://5DC0999B-D537-4002-86AF-FD7B54B45E2E?page=23) -- [Answer](x-devonthink-item://406AF611-5CD4-4B3B-9795-327E8F4E3626?page=8) - [ ] 32Q: [Child with Rash](x-devonthink-item://7FCD3940-4BB4-45FE-86A6-E5707E82D5B5?page=25) -- [Answer](x-devonthink-item://3263A68A-96A6-43EC-985B-43260C3509BF?page=8) - [ ] 33Q: [Kawasaki Disease](x-devonthink-item://84CE632D-3DD4-4F41-A900-23F41BE57287?page=1) -- [Answer](x-devonthink-item://D25C2F83-6C30-4F45-8B5B-6E7E57BD24A3?page=19) - [ ] 34Q: [Erythema Multiforme](x-devonthink-item://EE0B8625-5F19-46CF-8208-56D79DC48BC5?page=18) -- [Answer](x-devonthink-item://6F751245-A36C-447A-8AE7-599AD5871C71?page=17) -- [prop](x-devonthink-item://308BBEF4-A83E-4972-8F63-9249898FC8E8?page=12) - [x] 35Q: [Child with Rash](x-devonthink-item://D6654B01-83AA-4553-94F0-791FD96A636D?page=15) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=8) -- [prop](x-devonthink-item://AB9BDA6D-9CA8-4E73-9D15-B6105225A1B4?page=4) - [x] DUPLICATE Q: [Unwell Child with Rash](x-devonthink-item://73409C77-B2FA-4E0A-AEB3-5EB284457F0C?page=55) -- [Answer](x-devonthink-item://5A848952-80E3-4184-B553-368412A69917?page=36) - [ ] 36Q: [Unwell Infant with Rash](x-devonthink-item://8993893C-07A9-47B0-A68B-F8ED4C37C83D?page=16) -- [Answer](x-devonthink-item://C6A8980F-CAE5-458C-AC1E-FEBE553FDDE2?page=12) -- [prop](x-devonthink-item://3124817F-4CDF-46FB-993B-1501587D1E75?page=5) ## ttp - [x] DUPLICATE Q: [Thrombocytopenia](x-devonthink-item://1A14F7A1-E434-47A6-BC68-AF2DD1A7C090?page=1) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=25) ## typhoid - [x] DUPLICATE Q: [Typhoid](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=32) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=10)