title: Fever in returned travellers presenting in the United Kingdom: recommendations for investigation and initial management.
abstract: International travel is increasing. Most physicians and general practitioners will encounter returned travellers with fever and the majority of travel-related infection is associated with travel to the tropics. In those returning from the tropics malaria must always be excluded, and HIV considered, from all settings. Common causes of non-malarial fever include from Africa rickettsial diseases, amoebic liver abscess and Katayama syndrome; from South and South East Asia, enteric fever and arboviral infection; from the Middle East, brucellosis and from the Horn of Africa visceral leishmaniasis. Other rare but important diseases from particular geographical areas include leptospirosis, trypanosomiasis and viral haemorrhagic fever. North and South America, Europe and Australia also have infections which are geographically concentrated. Empirical treatment may have to be started based on epidemiological probability of infection whilst waiting for results to return. The evidence base for much of the management of tropical infections is limited. These recommendations provide a pragmatic approach to the initial diagnosis and management of fever in returned travellers, based on evidence where it is available and on consensus of expert opinion where it is not. With early diagnosis and treatment the majority of patients with a potentially fatal infection related to travel will make a rapid and full recovery.
authors: Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK. victoria.johnston@lshtm.ac.uk
authors: Victoria
authors: V
authors: Johnston
authors: Jane M
authors: JM
authors: Stockley
authors: David
authors: D
authors: Dockrell
authors: David
authors: D
authors: Warrell
authors: Robin
authors: R
authors: Bailey
authors: Geoffrey
authors: G
authors: Pasvol
authors: John
authors: J
authors: Klein
authors: Andrew
authors: A
authors: Ustianowski
authors: Michael
authors: M
authors: Jones
authors: Nicholas J
authors: NJ
authors: Beeching
authors: Michael
authors: M
authors: Brown
authors: Ann L N
authors: AL
authors: Chapman
authors: Frances
authors: F
authors: Sanderson
authors: Christopher J M
authors: CJ
authors: Whitty
mesh_terms: D001102:Arbovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002006:Brucellosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005843:Geography; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007239:Infections / Q000175:diagnosis*; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008101:Liver Abscess, Amebic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012282:Rickettsia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors; D012552:Schistosomiasis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014195:Travel; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006113:United Kingdom / Q000453:epidemiology