HISTORY
 Travel location and season, duration of stay
 Exposure history: planned activities, accommodations
and transportation, food, water, swimming, etc
 Incubation period: when did fever or symptoms start?
 Pre-travel vaccinations and malaria meds
 General health and immune system status
PHYSICAL
 Vital signs
 Skin findings including bite marks
 Joint, respiratory, GI, Neuro symptoms
LABS
 Eosinophilia
 Leukopenia, Thrombocytopenia
 LFTs
 Stool studies
Incubation periods <21 days
 Malaria, Dengue
 Yellow fever, Japanese encephalitis
 Meningococcemia
 Leptospirosis
 Typhoid fever
 East African trypanosomiasis
Incubation periods <21 days
 Malaria (esp. after ineffective prophylaxis)
 Acute HIV
 Acute systemic Schistosomiasis (Katayama fever)
 Viral hepatitis (A, B, C, D, E)
 Tuberculosis
 Leishmaniasis
 West African trypanosomiasis
CASE 1: 21 y/o male nursing student returns from 3 week stay
with relatives in rural India
 No mosquito bites and took malaria prophylaxis daily
 Had Hepatitis A vaccine prior to leaving
 HR 60, BP 90/60, appears very ill
 N,V,D
CASE 2::26 y/o. anthropology TA returns from 10 day dig in
Bolivia with multiple insect bites
 Rural areas, stayed in local housing
 Sudden onset fever, H/A, myalgias
 Anemia and thrombocytopenia
 Bites are not infected, no purpura, no cough
CASE 3: 22 y/o woman is seen in December after return from
Botswana for 3 months July - September
 Hiking, had to cross small stream early in her trip
 Fever, headache, myalgias, sore throat, joint aches,
fatigue and swollen cervical nodes
 VS Temp 100.7, RR 20, Pulse 80, BP 100/72
 Appear slightly ill
 Skin warm, dry, no rash or obvious bites
 +cervical nodes, injected pharynx
 Heart, lungs, abdomen, joints normal
Illness related to EXPOSURE
• Food and water
• hepatitis A*, toxoplasmosis,trichinella, enteric fever (typhoid, paratyphoid) *, bacterial gastroenteritis, amoebiasis
• Unpasteurized Dairy
• Brucella (dogs, goats, cattle, horses),enteric fever *, Salmonella gastroenteritis, tuberculosis (bovis)
• Mosquitoes
• Malaria, dengue, filariasis, loa loa, yellow fever *, Japanese encephalitis*, Chikungunya
• Ticks
• tick typhus, Rocky Mountain spotted fever, Crimean-Congo hemorrhagic fever, lyme disease, relapsing fever (Borrelia spp.),
tularemia, babesiosis
• Sand flies
– Leishmaniasis, sandfly fever, bartonellosis (Oroya fever)
• Black flies
– onchocerciasis (river blindness)
• Tsetse flies
– African trypanosomiasis (African sleeping dz)
• Reduvid bugs
– American trypanosomiasis (Chagas’ disease)
• Chiggers
– scrub typhus
• Caves
– rabies (bat bite, or bat guano inhalation) *, histoplasmosis
• Desert areas
– Coccidiomycosis
• Animals
– Brucellosis, rabies *, tularemia, Q fever, anthrax, plague, viral hemorrhagic fevers (Lassa, etc.), rabies
• Fresh water
– schistosomiasis, leptospirosis, hepatitis A *
• Crowded living conditions, group travel
• meningococcal disease *, influenza *, tuberculosis, Lassa, Marburg, ebola, hepatitis A *
• New intimacy
• HIV, hepatitis B *, other STDS: herpes, gonorrhea, syphilis, HPV *, etc.