Fever and other symptoms of infection are the most common complaints for returning travelers (see Table 98-1). The evaluation of infectious disease in the returning traveler requires an understanding of the geographical distribution of infections (see Table 98-2), risk factors, incubation periods, clinical manifestations, and appropriate laboratory investigations. See Centers for Disease Control and Prevention (CDC) website for further information: http://wwwnc.cdc.gov/travel/destinations/list.aspx. Traveler's diarrhea, enteroviral infections, gastroenteritis, giardiasis, salmonellosis, shigellosis are discussed in Chapter 96 “Foodborne and Waterborne Diseases” and in Chapter 37 “Diseases Presenting Primarily with Diarrhea”; malaria is discussed in Chapter 95 “Malaria”; upper respiratory infection and pertussis are discussed in Chapter 30 “Pneumonia, Bronchitis, and Upper Respiratory Infections”; STDs are discussed in Chapter 87 “Sexually Transmitted Diseases”; hepatitis A and B are discussed in Chapter 48 “Hepatic Disorders, and Hepatic Failure”; HIV (human immunodeficiency virus). Infections and acquired immune deficiency syndrome are discussed in Chapter 92; anthrax and plague are discussed in Chapter 97 “Zoonotic Diseases.” This chapter covers the most common infectious disease presentations in returning travelers; the reader is referred to the source material, cited at the end of the chapter, for further information, and discussion of less common diseases.
Table 98-1 Traveler Risk of Exposure to Infectious Agents |Favorite Table|Download (.pdf)
Table 98-1 Traveler Risk of Exposure to Infectious Agents
|Risk (Frequency)||Diseases/Syndromes (# references to other manual chapters)|
|High risk (1 in 10)||Traveler's diarrhea (96), upper respiratory illness (30)|
|Moderate risk (1 in 200)||Chikungunya, dengue fever, enteroviral infection (96), gastroenteritis (96), giardiasis, hepatitis A (48), malaria (95), salmonellosis (96), sexually transmitted diseases (87), shigellosis.|
|Low risk (1 in 1000)||Amebiasis, ascariasis (roundworm), enterobiasis (pinworm), hepatitis B (48), scabies (155), tuberculosis (31), typhoid/paratyphoid|
|Very low risk (1 in > 1000)||Anthrax (97), brucellosis, Chagas disease, cysticercosis, hemorrhagic fevers (including yellow fever), Human immunodeficiency virus (92), hookworm, leishmaniasis, leptospirosis, pertussis (30), plague (97), schistosomiasis/Katayama syndrome, typhus/rickettsial disease, trypanosomiasis|
Table 98-2 Common Regional Tropical Illness |Favorite Table|Download (.pdf)
Table 98-2 Common Regional Tropical Illness
|Africa||Malaria, human immunodeficiency virus, TB, hookworm, tapeworm, roundworm, brucellosis, yellow fever (and other hemorrhagic fevers), relapsing fever, schistosomiasis, tick typhus|
|Central and South America||Malaria, relapsing fever, dengue fever, filariasis, TB, schistosomiasis, Chagas disease, louse-borne typhus|
|Mexico, Caribbean||Dengue fever, hookworm, malaria, cysticercosis, amebiasis, louse-borne typhus|
|Middle East||Malaria, hookworm, anthrax, brucellosis|
|China and East Asia||Dengue fever, hookworm, malaria, strongyloidiasis, hemorrhagic fever, scrub typhus|
The incubation period for disease is most commonly longer than a traveler's foreign stay, and therefore travelers commonly become febrile/symptomatic upon return. Travel history should include query concerning visits to game parks, farms, caves, health facilities, consumption of exotic foods, activities involving fresh or salt water exposure, insect exposure, sexual activities, epidemics in the area visited, contact with ill people, as well as pretrip immunizations and prophylactic antibiotics taken. A history ...