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CDHB

Causes of Fever in the Returning Traveller

These include malaria as well as typhoid and paratyphoid fevers, dengue fever, typhus, Legionnaires' disease, tuberculosis, amoebic liver abscess, hepatitis (viral), respiratory viruses including influenza and viral haemorrhagic fever.

Investigations

• Blood cultures - 3 sets.
• Urine culture.
• Stool culture.
• CBC + diff, blood film and eosinophil count.
• Coagulation profile for DIC.
• Na, K, creatinine, AST, ALT, GGT, ALP, bili.
• Hepatitis markers.
• Specific serology and where possible, specific PCR testing.
• CXR.
• ECG.
• Abdominal ultrasound if diagnosis is unclear after the above tests have been done.

Blood cultures may be reported as positive for Gram negative bacilli. If typhoid fever is a possible diagnosis begin ceftriaxone 2 g IV q24h unless patient has known severe adverse effects from ceftriaxone. In that case, use ciprofloxacin 400 mg q12h IV, or 500 mg BD PO, until sensitivities are known. Aminoglycosides are ineffective.

Topic Code: 2729