Fever in the Returned Traveler

36F w/ fever for 6 days after the day of returning from Manzini, Eswatini. Stayed there 15 days, visited rural fields. Also, weakness, myalgia, night sweats, sore throat

What is your approach?

Many approaches possible.

Check out this amazing tweetorial by @BoggildLab
https://twitter.com/BoggildLab/status/1226586319901659137?s=20

  1. Common things being common: In addition to RTI, gastroenteritis, SSTI, UTI/STI, DO NOT want to miss: MDRT (malaria, dengue, rickettsial infections, typhoid fever)

Or this great video tutorial by @EvelynSongMD and @CPSolvers

https://clinicalproblemsolving.com/%20dx-schema-fever-in-a-returning-traveler/

2. Beware of transmissible infections➡️infection prevention: Ebola, Marburg, Lassa, TB, MERS, SARS, Influenza

Here, we wanted to review “ABCDE” mnemonic by @WuidQ

  • Adventure
  • Body
  • Chronology
  • Defend
  • Exposure

#Adventure
Where did the patient travel?
https://wwwnc.cdc.gov/travel/destinations/list

  • Central America
  • Caribbean
  • South America
  • Subsaharan Africa
  • Southeast Asia
  • South Central Asia

Great approach by regions here:

https://www.nejm.org/doi/full/10.1056/NEJMoa051331

#Body for syndrome
1. Undifferentiated fever illness
2. Respiratory
3. Gastrointestinal: Diarrheal vs. Non-diarrheal.
4. Skin
5. Genitourinary
6. Other

https://bit.ly/2XQ1sJX

https://www.nejm.org/doi/full/10.1056/NEJMoa051331

#Chronology

Time between travel/exposures to onset of symptoms (Period of incubation)

What do you think of this table? Any feedback?

#Defense

What vaccination/prophylaxis/medications did the patient receive?

Important information when thinking on preventable infections and resistant organisms.

#Exposure history.
Good mnemonic “I MD SOAPS” by @WuidQ

Special emphasis on:
Animals exposures/bites, vector bites
Food/water consumption
Water exposure
Activities (e.g. safari, caving, swimming, etc.)

In summary,

  1. Common things being common: Think MDRT: Malaria, Dengue, Rickettsial infections, Typhoid fever
  2. Beware of transmissible infections -> Infection Prevention
  3. #ABCDE approach

#ABCDE mnemonic summarized in this infographic

Originally tweeted by Infectious Diseases Fellows Network (@ID_fellows) on 11 August, 2020.

Leave a Reply