Management in travelers returning from tropical countries with fever

Nandini Chatterjee, MD, is a professor of medicine in the Institute of Post Graduate Medical Education and Research (IPGMER) in Kolkata, India, and editor in chief of the McMaster Textbook of Internal Medicine South Asia Edition.

What key points should physicians practicing in nonendemic areas keep in mind when treating patients returning from a tropical country with fever?

The key points are that we should keep in mind that many tropical infections have overlapping features, so we should not miss the syndromic approach to the diagnosis of fever. We need to have a meticulous examination for the associated symptomatology and see whether the fever is associated with either a renal syndrome, or a hepatic syndrome, or an encephalitic syndrome.

We can accordingly think of various differential diagnoses. It is mandatory that we should exclude malaria and dengue very early. We have the rapid diagnostic test for malaria, which has to be done immediately on getting the patient and also sent for thick and thin smears for diagnosis. Also, we should do the enzyme-linked immunosorbent assay (ELISA) for the dengue nonstructural protein-1 (NS-1) antigen that becomes positive within the first 1 to 2 days of the disease. Once we have excluded dengue and malaria, we need to look for other options like the scrub typhus, leptospirosis, and chikungunya.