What is the approach to a patient with fever recent travel history?

Fever is an important and relatively common presentation of infections in returning travellers. The most common infections diagnosed in febrile returning travellers are malaria, dengue, mononucleosis, rickettsial infections and typhoid and paratyphoid, but many remain undiagnosed.

Leggat, Peter Assessment of febrile illness in the returned traveller. Australian family physician 2007 vol:36 iss:5 pg:328 -332

A history of travel is the most important question. An accurate history will assist in developing an appropriate differential diagnosis and help guide initial investigations.

Ask about:
• specific presenting symptoms
• medical history (including medication/drug history)
• possible exposure to infectious diseases, and
• details of travel history.

Physical findings in returning travellers can be nonspecific and can mimic nontravel related diseases. Certain findings can be helpful. For example, a cyclic fever may indicate malaria; a maculopapular rash may be seen in several diseases such as dengue, rickettsial infections, leptospirosis, or human immunodeficiency syndrome; and an eschar, a painless ulcer with a blackened center, may indicate a rickettsial disease such as scrub typhus

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