Patient returns from foreign travel with fever. How should this change your fever evaluation?

Common things being common, the usual sources of fever, recent travel or not, are still the usual sources. Proceed with a fever evaluation as normal but also consider sending off LFTs and a blood smear to screen for the following 6 common causes of fever after international travel.

1. Malaria - transmitted by mosquito, causes flu like illness, parasites on Giemsa-stained thick and thin smears, specific antibiotic treatment dependent on species of protozoa and sensitivity patterns
   
2. Dengue Fever - transmitted by mosquito, severe flu like illness - ie breakbone fever - +/- rash, leukopenia-thrombocytopenia-moderate elevations of LFTs, treatment is supportive
   
3. Typhoid Fever - transmitted by fecally contaminated food and water, flu like illness +/- rash, relative bradycardia (given fever), LFTs usually 2 - 3x normal, treat with fluoroquinolone
   
4. Rickettsial Infection - transmitted by arthropod vector, flu like illness +/- rash +/- eschar at inoculation site, leukopenia-thrombocytopenia-elevated LFTs, treat with doxycycline
   
5. Leptospirosis - transmitted by urine contaminated food and water, flu like illness, , most cases resolve spontaneously but can consider treatment with doxycycline, consider sending microagglutination test if confirmation of diagnosis needed
6. Hepatitis A
   

Source

Cavagnaro, C. et al., "Fever After International Travel" Clinical Pediatric Emergency Medicine. 2008.

House, H. and Ehlers, J. "Travel-Related Infections" Emergency Medicine Clinics of North America. 2008.