Fever in returned travelers

Case report:

A 22 year old patient comes into practice and reports of existing for more than 14 days of fever with chills, night sweats, headaches and back pain. From history it can be seen that the patient had taken a trip to Ecuador and Peru four months ago with numerous activities in rural areas and in the jungle. Before leaving he had received vaccinations against hepatitis B and yellow fever and taken doxycycline (VIBRAMYCIN among others) to prevent malaria daily.

Diagnosis:

The physical examination of the patients was largely unremarkable, a skin exanthema or enlarged lymph nodes could not be found; there was no neck stiffness, physical findings of lungs, heart, abdomen and extremities were normal. The body temperature was 36.8 � C, which Urinalysis was positive for protein, bilirubin and urobilirubin. The laboratory tests showed a slight anemia and moderate elevation of transaminases. Likewise, the ECG showed a sinus rhythm in a frequency of 93 per minute with low, nonspecific ST and T changes. A blood smear in the form of a "thick drop" revealed parasites in red blood cells enlarged and confirmed the suspected malaria infection. Further analysis showed vivax infection by Plasmodium.
Special features of diagnostics: In the medical history of patients with symptoms after a tropical travel, special emphasis should be placed on the exact dates, the contents of the travel (business, tourism, adventure travel), type of accommodation, carried out activities (swimming, camping, jungle trekking, sexual activities etc.), eating and drinking habits (Low not boiled water, supply of inadequately cooked or fried food), contact with wild animals, insect bites, taking medications and vaccination history. With regard to the incubation of tropical diseases there are major differences, as can be seen from the table.

Therapy:

Incubation of selected tropical infections:

< 10 days
• Lassa fever
• Leptospirosis - 7 Up to 12 days
• dengue fever
• Typhus abdominalis- 7 to 14 days
• Relapsing fever (Borrelia recurrent)
• yellow fever
• Pest (Yersinia pestis)
• Meningococcal infection (Neisseria meningitidis)
• Rocky Mountain spotted fever

10-30 days
• Amoebiasis (Entamoeba histolytica)
• Hepatitis A - 2 to 4 weeks
• trypanosomiasis
• malaria
• Lassa fever
• epidemic hemorrhagic
• Fever (Hantavirus)
• brucellosis
• schistosomiasis
• typhoid fever
• babesiosis

> 3 months
• Liver abscess (Entamoeba histolytica)
• malaria
• Bartonella bacilliformis
• trypanosomiasis
• tuberculosis
• hepatitis C
• babesiosis
• hepatitis B
• Visceral larva migrans (Toxocara)
• Acute HIV infection -> 6 weeks