Fever in the Returning Traveler

Area of Science:

• Travel Medicine
• Infectious Diseases
• Epidemiology

Background:

• Global tourism is projected to reach two billion international trips annually by 2030.
• Illness rates among travelers returning from developing nations range from 43-79%.
• Prompt diagnosis of fever in travelers is critical due to the potential for life-threatening tropical diseases.

Purpose of the Study:

• To review the epidemiology, diagnosis, and treatment of febrile illnesses in travelers returning from endemic areas.
• To highlight common and dangerous tropical diseases encountered by international travelers.
• To provide guidance on diagnostic approaches for febrile travelers.

Main Methods:

• A selective literature search of PubMed publications from 2001-2022.
• Focus on studies concerning traveler's fever, tropical diseases, and their management.
• Inclusion of epidemiological data, diagnostic strategies, and treatment considerations.

Main Results:

• Common post-travel illnesses include diarrhea, fever, and skin conditions.
• Malaria (Plasmodium falciparum) is a leading cause of fever in travelers from sub-Saharan Africa (approx. 50/1000).
• Dengue fever is prevalent in Southeast Asia (50-160/1000), with other risks including chikungunya, Zika, typhoid, and rarely, viral hemorrhagic fevers. COVID-19 and influenza are key differentials.

Conclusions:

• Precise travel history, including routes and risk factors, is essential for diagnosis.
• Knowledge of disease geographic distribution and incubation periods aids in differential diagnosis.
• Clinical algorithms assist in focusing diagnostic work-ups and selecting appropriate tests for febrile travelers.