Fever in the returning traveler, part one: A methodological approach to initial evaluation

The advent of modern commercial air travel ensures that a returning traveler could present to any emergency department or private physician's office in the United States bearing any infection from the farthest corner of the earth. Exotic illnesses in the returned traveler are of concern to the physician because they often strike an otherwise young and healthy segment of the population and may carry significant morbidity and mortality if not recognized early. The infrequency with which these diseases are encountered demands a systematic approach to history, a physical exam, and the construction of a differential diagnosis. Information about the geographic distribution, routes of transmission, and incubation periods of the pathogens allows a clinician to reduce the differential to a manageable number of the likeliest etiologies. This article, to be presented in 2 parts to run over 2 issues of Wilderness & Environmental Medicine, proposes an algorithm for use by the physician faced with a febrile returned traveler. The clinical features of specific diseases and their incubation periods are presented to support the assumptions on which an algorithm-centered approach is based.