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INTRODUCTION

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Patients returning from travel abroad may present with fever or other symptoms of infection. The evaluation of a potential infectious disease in a returning traveler requires an understanding of the geographical distribution of infections (Table 98-1), risk factors, incubation periods, clinical manifestations, and appropriate laboratory investigations. The Centers for Disease Control and Prevention (CDC) website provides additional health information for travelers based on specific locations around the world: http://wwwnc.cdc.gov/travel/destinations/list/. Some specific disease processes are covered elsewhere in this book: traveler's diarrhea, enteroviral infections, gastroenteritis, giardiasis, salmonellosis, and shigellosis are discussed in Chapters 37 and 96, anthrax and plague are discussed in Chapter 97, and malaria is discussed in Chapter 95. This chapter covers some of the other common infectious diseases that may present in patients returning from travel outside of the United States.

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Table 98-1

Regional Tropical Illnesses

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CLINICAL FEATURES

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The incubation periods for many diseases are commonly longer than an individual traveler's foreign stay, and therefore travelers who are exposed to infectious diseases often develop symptoms of disease after they return from travel. Ask patients about visits to game parks, farms, caves, health facilities, consumption of exotic foods, activities involving fresh or salt water exposure, insect exposure, sexual activities, reported epidemics in the area visited, contact with ill people, and any pre-trip immunizations and prophylactic antibiotics that have been taken. Determine the chronological history of disease progression, including details about the quality, severity, duration, and episodic nature of fever and chills. When completing a complete history and physical examination, note the presence of any abnormal findings such as fever, skin rash, hepatosplenomegaly, lymphadenopathy, and jaundice (Table 98-2).

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Table 98-2

Physical Findings in Selected Tropical Infections

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