Assessment of returned travellers with fever

Medical practitioners need to be wary of patients presenting with fever from infections (other than COVID-19) acquired overseas.

History

In addition to a standard medical history, assess:

Where? Consider diseases in countries the patient has travelled to; check epidemiological profiles.

Timing? Consider onset of symptoms and time since potential exposures, relative to incubation periods.

Risk behaviours and potential exposures:

• Vaccination status and chemoprophylaxis (e.g. for malaria)
• History of sexual activity
• Food and water exposures
• Insect or animal bites or exposures
• Substance use, such as alcohol or drugs
• Use of healthcare services
• Activities and environments e.g. diving, caving, swimming in lakes, mountaineering, etc

Common illnesses to consider

• Malaria
• Infectious gastroenteritis
• Influenza like illnesses (ILIs) and other viral upper respiratory tract infections, including COVID-19
• Enteric fever (Typhoid and paratyphoid)
• Dengue, Chikungunya and other mosquito-borne diseases
• Hepatitis A
• Mpox (previously known as monkeypox)
• Scrub typhus and other rickettsial infections
• Rabies
• Common infectious diseases, such as pneumonia, cellulitis etc

Investigations

Investigations should be tailored to the suspected diseases based on history and examination. The following investigations may be considered, if clinically indicated:

• Full blood examination
• Urea, electrolytes & creatinine, liver function tests
• Blood cultures
• Respiratory multiplex PCR
• Urinalysis +/- MCS +/- chlamydia/gonorrhoea PCR
• Stool for cultures +/- ova/cysts/parasites
• Serology for dengue fever, rickettsia, strongyloides, HIV, Hepatitis A/B/C/E
• Malarial thick and thin films, taken on at least two separate occasions
• CXR

Incubation periods of common conditions

Notification

Many of the infectious diseases diagnosed in returning travellers are notifiable conditions. Where applicable, please ensure a notification to the Victorian Department of Health is completed. For a list of the notifiable conditions and how to notify, see Notifiable infectious diseases, conditions and micro-organisms