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fever in a returning traveler
History:
- travel history, fever onset, possible exposures [1]
Physical examination:
- altered mental status
- meningial signs
- abdominal tenderness
- pulmonary consolidation
- rash, cellulitis
- jaundice
- eye signs
- genital lesions
Laboratory:
- complete blood count
- chemistry 14 panel
- C-reactive protein in serum
- urinalysis with microscopy & reflex culture
- blood cultures
- blood smears for malarial parasites
- save lavender top for molecular diagnostic tests
- save red top for later studies
- other specific testing as indicated
Radiology:
- chest X-ray
Management:
- assess qSOFA score
- altered mental status
- tachypnea
- hypotension
- assess for signs of severe disease
- cyanosis
- meningeal signs
- peritoneal signs
- digital gangrene
- isolate if possibile highly contagious infection
- consider empiric antibiotics [1]
Related
travel medicine (traveler's health)
General
fever
References
- Thwaites GE, Day NP
Approach to Fever in the Returning Traveler.
N Engl J Med 2017; 376:548-560. February 9, 2017
PMID: 28177860
http://www.nejm.org/doi/full/10.1056/NEJMra1508435