Fever in returning travelers can be a dilemma for US trained healthcare providers. In addition to the usual medical problems that we see here daily, there is a wide array of other problems that are rarely seen here. Some can be difficult to diagnose.
Knowing the correct questions to ask can be tough, as each area of the world has its own infectious disease threats and associated health problems. What foods the patient has eaten, what animals they have come into contact with and the health status of persons that they visited might all be important clues in figuring out the diagnosis.
Many travelers make it back home without even knowing that they are ill, and they may not even realize that their problems are related to a recent trip. Years ago, I started my watch timer on the final day of a safari, while standing on the Serengeti Plains. I was back home 28 hours later, well within the incubation period for most tropical diseases.
Malaria, typhoid and viral hepatitis are some of the more common illnesses experienced by travelers. Parasitic infections, HIV infection, bacteremia and insect-borne diseases are also on the list, as well as traumatic injuries. The CDC has a listing of the infectious disease threats for most areas of the world listed on its website at https://wwwnc.cdc.gov/travel (Click the “Destinations” link on the left side).
Persons who have unprotected sex are at risk for HIV and other sexually transmitted diseases, so it is always important to ask whether sex tourism was the point of the trip, especially in those returning from Southeast Asia or Africa. Casual encounters involving businessmen, businesswomen or ordinary tourists also fall into this category. One such patient had a severe facial rash that was unresponsive to the usual antibiotics. When he came to my office, he told me about his encounter with a prostitute a week earlier, during a business trip to Malysia. He had performed oral sex on her prior to their other activities, unwittingly infecting his face and eyes with the virus.
Travel Medicine Case:
A Chinese male in his 30s, with annual travel to SE China, came to the emergency room reporting one week of abdominal pain, fever, chills, diarrhea, vomiting and dizziness. He was hypotensive on arrival. He had multiple studies done in the emergency room to try and figure out a cause for his problems.
He was given IV fluids and antibiotics, and all symptoms quickly resolved.
A CT scan of his abdomen showed a large hepatic abscess. Drainage cultures of the abscess fluid grew Klebsiella pneumoniae organisms.
His blood cultures remained negative over subsequent days, and he was able to go home after a few days in the hospital. Some of his lab tests remained pending at the time of discharge, and will need to be followed up later.
During his China visits, he ate local food, drank local water, had no unprotected sex, and had no travel to rural areas or any animal contact.
An Entamoeba histolytica serology was sent to see if he had a history of exposure to that organism. It came back negative.
He will receive 4 – 8 weeks of oral antibiotics for Klebsiella treatment, with repeat abdominal imaging later.