Paediatrics: Illness after international travel

Illness after international travel

Approximately 3% of people traveling internationally have fever for a short period. Children will require a full assessment of fever as discussed. When a history of recent travel is known, the additional information needed in your assessment should include:

·  review of travel itinerary;

·  exposure history;

·  duration of fever;

·  likely incubation period;

·  immunization state;

·  use or non-use of antimalarial chemoprophylaxis.

Incubation period

Determining an approximate incubation period is particularly helpful when you are trying to ‘rule-out’ possible causes of fever. It is also useful to con-sider causes according to key features. For example, is the fever:

·  Non-specific?

·  Associated with haemorrhage?

·  Associated with central nervous system involvement?

·  Associated with respiratory symptoms?

·  Associated with exposure to blood?

·  Associated with eosinophila?

The following subsection summarizes the likely causes by incubation period and key features. It can be used to guide your history. For example, if fever began more than 21 days after returning from international travel then dengue, rickettsial infections, and viral haemorrhagic fever (e.g. yel-low fever, Lassa fever) are excluded, irrespective of the history of expo-sure. Once the travel exposure and likely duration of symptoms have been identified, your investigations could include:

·  Peripheral blood film for malaria.

·  FBC and differential WCC.

·  LFTs.

·  Urinalysis.

·  Culture of blood, stool, and urine.

·  CXR.

·  Specific serology based on the likely incubation period.

some of the infections discussed below.

Causes of fever according to incubation period and key features

Fevers with incubation period <14 days

·  Non-specific fever:

malaria (Plasmodium spp.)—tropics, subtropics, and temperate regions;