COMMENTARY

Evaluation of the Returning Traveler With Fever

Keren Z. Landman, MD

Disclosures

October 25, 2016

In This Article

Practice Advice for Clinicians

  • Febrile patients who have recently traveled to or lived in a malaria-endemic area should always be tested for malaria with a thick and thin blood smear, read immediately.

  • Other important infections to evaluate for include bacterial bloodstream infections, such as typhoid, and arthropod-borne viral infections common in the tropics, such as dengue and chikungunya.

  • Evaluation for other infections should be guided by symptoms (eg, patients with diarrhea should have a stool evaluation).

  • Ask for help from a travel medicine or infectious diseases specialist early in the evaluation.

The CDC's Yellow Book is an excellent resource for clinicians evaluating returning international travelers and can be accessed online at no charge. Other resources include Gideon, which requires a subscription, and HealthMap, which tracks outbreaks using a variety of data sources. Even with these resources, however, it can be daunting to generate a differential diagnosis and a plan.

The ISTM maintains an online clinic directory to assist in locating specialists—and it's there for a reason, says Dr Hamer. "For primary care providers," he says, "it's important that if they feel uncomfortable managing a returning traveler with fever, they should think early about trying to engage with infectious disease specialists or tropical medicine specialists."

Related Resource

Georgia Department of Public Health Travel Clinical Assistant (TCA)

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