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[Differential diagnosis of fever after returning from the tropics]
Abstract:
Fever is the cardinal symptom of many infections in travellers returning from the tropics and is second in place only to infectious diarrhea. Once the obvious causes of fever in an individual patient have been eliminated, it may be very difficult to find the cause of fever. Fevers can be distinguished by their length of duration and divided into acute fevers i.e. up to 3 weeks duration and chronic fevers i.e. more than 3 weeks duration. Whether fever goes along with leucopenia or a normal white blood cell count on the one hand or with leucocytosis on the other hand is of differential diagnostic value. A schedule based on these two parameters will be presented to simplify differential diagnostic considerations. Two rules of thumb will be stressed: (1) Each febrile illness, even febrile diarrhea, jaundice or meningitis, is to be considered a malaria until it is excluded. (2) Patients returning from tropical areas might suffer from banal infections such as pneumonia, urinary tract infections, cholangitis, etc. as well.
Insights
Fever in returned travelers is common, often mimicking other illnesses. Differentiating causes involves considering duration and white blood cell count, with malaria a key concern.
Area of Science:
- Tropical medicine
- Infectious diseases
- Clinical diagnostics
Context:
- Fever is a primary symptom in travelers returning from tropical regions, second only to infectious diarrhea.
- Diagnosing fever of unknown origin in these patients can be challenging after ruling out obvious causes.
Purpose:
- To present a simplified diagnostic approach for fever in returned travelers.
- To highlight key parameters like fever duration and white blood cell count for differential diagnosis.
Summary:
- Fever duration (acute vs. chronic) and white blood cell count (leukopenia/normal vs. leukocytosis) are crucial for differential diagnosis.
- A diagnostic schedule based on these parameters is proposed to aid clinicians.
- Two critical rules emphasize considering malaria in all febrile illnesses and recognizing common infections in returning travelers.
Impact:
- Aims to improve the accuracy and efficiency of diagnosing febrile illnesses in travelers.
- Provides practical guidance for clinicians managing complex cases of fever in a globalized world.