Symptoms

• high fever, chills, rigor, sweating, headache

• usually abrupt onset

• can have atypical presentations, e.g. diarrhoea, abdominal pain, cough

Table 12.5 Fever and malaise in the returned traveller: diagnostic strategy model

Note: All fever in a returned traveller is malaria until proved otherwise!

Q. Probability diagnosis

Viral respiratory illness, e.g. influenza A. Hepatitis (may be subclinical) Gastroenteritis

Q. Serious disorders not to be missed

Malaria Typhoid

Japanese B encephalitis A. Meningococcal meningitis Melioidosis

Amoebiasis (liver abscess) HIV infection

Q. Pitfalls (often missed)

Ascending cholangitis Infective endocarditis Dengue fever Lyme disease Bronchopneumonia Ross River fever Rarities

Legionnaires' disease Schistosomiasis African trypanosomiasis Yellow fever Rift Valley fever Spotted fever Lasa fever

Note: Three causes of a dry cough (in absence of chest signs) are malaria, typhoid, amoebic liver abscess.

Q. Seven masquerades checklist A.

Drugs x (reaction to antimalarials)

Urinary infection x

Investigations (if no obvious cause)

• Full blood examination

• Thick and thin blood films

• Blood culture

• Liver function tests

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