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.
I have had a bottle of resublimed iodine crystals for years -> I use them for water purification as described in this 1975 Western Journal of Medicine item (see the two attached pages).
I take the small one ounce bottle with a few crystals in it in my pocket on trips – it can be used over and over again.
I use my bandana to filter out large particles when filling my 1 quart water bottle with contaminated water. I simply cover the bottle opening with the bandana and place the bottle in the river or under a running water source to fill it. Supersaturated iodine solution from the little bottle gets added to the water in the 1 quart bottle, with 40 minute wait until it is ready to drink.
I always loosen the cap on the one quart bottle and invert it after adding the iodine. The treated water gets into the threads of the cap that way, preventing illness from retained unpurified water retained there.
Larger amounts of water can be prepared / treated in the same manner as the 1 quart bottle. Just increase the number of milliliters of supersaturated iodine solution accordingly for however many quarts of water you have in your storage container. The forty minute wait period still applies, and the water stays clean so long as it remains in the closed container.
Many water purification systems purchased by campers or international travelers are bulky, expensive, prone to failure or require batteries. This method has no such disadvantages and is light / easy to carry. My bottle at home has a lifetime supply of crystals, too. Even though my bandana is not a 2 micrometer filter (usually required to stop all bacteria), iodine takes care of any bacteria passing through. Salmonella, Shigella, Campylobacter, Yersinia, Vibrios, protozoa, viruses and Cryptosporidia are all killed by the halogen.
Airport screening for Ebola-infected individuals goes into effect today.
In light of cries to do something from the terrified public, many governments are instituting such measures, ineffective though they may be.
The incubation period of 2-21 days for Ebola and other viral hemorrhagic fevers makes it difficult to detect them early. Infected individuals may be long past the screeners when they become ill.
Contact with sick individuals will also not be reported, in some cases.
Our best protection is to be alert when dealing with sick persons; asking them appropriate questions about where they have been and what they have been doing prior to their illness. Gowns, gloves, mask and eye shields should be donned for any patient from an endemic area who has bleeding, diarrhea or vomiting.
Influenza vaccination of the public and health care workers should be encouraged beginning immediately. Since hemorrhagic fever patients have a flu-like illness, our ability to detect them will be enhanced if fewer influenza patients are around.