Illness in a traveller - Quick Reference

This is a Quick Reference article. See also the main article Fever in a returning traveller .

Causes

• Primary disease activated or worsened while on travel
• New illness started while on travel, independent of destination
• A disease that is rare in the home country but typical for the destination, usually an infection

Patient history

• Travel history (travel destinations and times)
• Symptoms and their onset dates in chronological order
• Exposure to infections (sexual contacts, dubious food, injections, insect stings, animal contacts, contact with freshwater)
• Possible abuse of alcohol or drugs
• Medication and possible treatment received during the travel
• Vaccinations
• Antimalarial medication and its regularity
• Symptoms in travel companions

Investigations

• Respiratory tract, consciousness, cutaneous symptoms, diarrhoea, urinary tract symptoms
• Malaria specimen always when the possibility of malaria cannot be reliably excluded (destination, reliably conducted prophylactic medication, another obvious diagnosis explaining the symptoms – malaria still possible)
• Basic investigations: basic blood count, CRP, ALT, urine sample
• At discretion: plasma Na, K, creatinine, faecal bacteria and parasites, chest x-ray, possible antibody tests

Fever in a traveller

• The possibility of malaria must always be kept in mind, even if the patient appears to be in good condition when examined.
• Further care must immediately be arranged for a seriously ill patient.
  • Septicaemia , meningitis , pneumonia , pyelonephritis , malaria
• Fever without local symptoms
  • Malaria, dengue , typhoid fever , primary HIV infection
• Fever and pulmonary symptoms
  • Pneumonia, legionellosis
• Fever and cerebral symptoms
  • Encephalitides (herpes, Japanese encephalitis, tick-borne encephalitis)
  • Septicaemia
  • Mefloquine use while on travel
  • Alcohol or drug abuse while on travel
  • Dehydration, ”sunstroke”
• Fever and diarrhoea
  • Fever and melaena: salmonella, shigella, EHEC
  • Other severe diarrhoea: campylobacter, ETEC, viruses
• Fever and jaundice
  • Viral hepatitis , malaria, typhoid fever
  • Alcoholic hepatitis, pancreatitis
• Fever and skin rash
  • Primary HIV infection
  • Various bacterial and viral infections
  • Allergic conditions (foods, drugs)
  • Stings and bites
  • Sunburns