TAILIEUCHUNG - Chapter 117. Health Advice for International Travel (Part 9)

Fever Fever in a traveler who has returned from a malarious area should be considered a medical emergency because death from P. falciparum malaria can follow an illness of only several days' duration. Although "fever from the tropics" does not always have a tropical cause, malaria should be the first diagnosis considered. The risk of P. falciparum malaria is highest among travelers returning from Africa or Oceania and among those who become symptomatic within the first 2 months after return. Other important causes of fever after travel include viral hepatitis (hepatitis A and E), typhoid fever, bacterial enteritis, arboviral. | Chapter 117. Health Advice for International Travel Part 9 Fever Fever in a traveler who has returned from a malarious area should be considered a medical emergency because death from P. falciparum malaria can follow an illness of only several days duration. Although fever from the tropics does not always have a tropical cause malaria should be the first diagnosis considered. The risk of P. falciparum malaria is highest among travelers returning from Africa or Oceania and among those who become symptomatic within the first 2 months after return. Other important causes of fever after travel include viral hepatitis hepatitis A and E typhoid fever bacterial enteritis arboviral infections . dengue fever rickettsial infections including tick and scrub typhus and Q fever and in rare instances leptospirosis acute HIV infection and amebic liver abscess. A cooperative study by GeoSentinel an emerging infectious disease surveillance group established by the CDC and the International Society of Travel Medicine showed that among 3907 febrile returned travelers malaria was acquired most often from Africa dengue from Southeast Asia and the Caribbean typhoid fever from southern Asia and rickettsial infections tick typhus from southern Africa Table 117-3 . In at least 25 of cases no etiology can be found and the illness resolves spontaneously. Clinicians should keep in mind that no present-day antimalarial agent guarantees protection from malaria and that some immunizations notably that against typhoid fever are only partially protective. Table 117-3 Etiology and Geographic Distribution Percent of Systemic Febrile Illness in Returned Travelers N 3907 Etiology Car ib CA m SA m SS A S CA SE A Malaria 1 13 13 62 14 13 Dengue 23 12 14 1 14 32 Mononucle osis 7 7 8 1 2 3 Rickettsia 0 0 0 6 1 2 Salmonella 2 3 2 1 14 3 Note Carib Caribbean CAm Central America SAm South America SSA Sub-Saharan Africa SCA South Central Asia SEA Southeast Asia. Bold type is for emphasis only. Source .

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