Fever in Returning Traveler

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍hourday history of fever

Returned from ‍ ‍ ‍daysweeks ago

Peak temperature recorded: ‍° ‍not measured

Pattern of fever: ‍persistentintermittent

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍runny nose, ‍clearcolored

‍sore throat

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍body ache

‍joint pain

‍night sweats

‍fatigue

‍rash

‍loss of appetite

‍decreased fluid intake

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍dysuria

‍frequency

‍flank pain



Contributing factors:

‍recent travel

‍similar symptoms in close contacts

‍insect bites

‍unprotected sex

no history of: ‍STIs, ‍recent infection, ‍HIV, ‍immunodeficiency, ‍malignancies

no use of: ‍immunosuppressants





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Fever in the returning traveler ‍likelysuspectedpossible

DDx: malaria, dengue fever, chikungunya, typhoid fever, schistosomiasis, leishmaniasis, traveler's diarrhea, leptospirosis, influenza, hepatitis A, tuberculosis, HIV acute infection, Ebola hemorrhagic fevers, yellow fever, Q fever, brucellosis, histoplasmosis, malignancy, medication-induced fever, heat stroke, pulmonary embolism





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍LFTs, ‍blood culture

- Malaria smear

- Dengue fever serology

- Typhoid fever serology

- Chest X-ray

- Covid test

- Urine: ‍urinalysis, ‍urine culture

- Stools: ‍bacterial culture, ‍parasitic culture

Treatments:

- ‍Acetaminophen as needed

- ‍Ibuprofen as needed

- Over-the-counter cold and flu remedies

- Encourage hydration

- Antibiotics if bacterial infection suspected

- Antimalarial medication if malaria suspected

- Avoid contact with others

Further care:

- Referral to infectious disease specialist

- Referral to tropical medicine specialist

- Follow-up in ‍ ‍hoursdays

- Return if fever persists for more than 3 days, if new symptoms develop, or if condition worsens

- Referral to ER if severe headache, stiff neck, or other signs of serious illness occur