Emergency Department Evaluation and Management of Serious and High-Risk Infections in the Febrile Returning Traveler (Infectious Disease CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: May 2026 (Volume 28, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 05/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits and 2 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Abstract

Fever in the returning international traveler presents a diagnostic challenge in the emergency department due to the wide range of potential infectious diseases that may be encountered abroad, many of which may manifest with nonspecific presentations. Malaria remains the most common and life-threatening tropical cause of fever and must be ruled out in all febrile patients returning from malaria-endemic regions. Other key infections to consider in returning travelers include dengue, enteric fever, and leptospirosis. Early recognition and treatment of these diseases can reduce morbidity and mortality and may help contain disease outbreaks. This review presents a structured, systematic approach to the timely evaluation of fever in returning international travelers, including evidence-based recommendations for the diagnosis and treatment of malaria, dengue, enteric fever, and leptospirosis.

Case Presentations

A 32-year-old woman presents with subjective fevers, myalgias, headache, and mild cough for 2 days…

• She immigrated to the United States from Ghana as a child and recently traveled back there for her grandmother’s funeral, returning 3 days ago after a 2-week stay.
• Her vital signs are: temperature, 37.7°C; heart rate, 110 beats/min; blood pressure, 110/65 mm Hg; respiratory rate, 20 breaths/min; and oxygen saturation, 98% on room air. The physical examination is benign.
• Your initial impression is that she has an influenza-like illness. As you await the result of a rapid test for influenza and COVID-19, you try to recall other travel-related infections that you need to consider…

A 46-year-old woman with a history of hypertension presents with 3 days of fever, headache, and myalgias, as well as 1 day of vomiting...

• She returned from the Dominican Republic 1 week ago.
• Her vital signs are: temperature, 38.2°C; heart rate, 120 beats/min; blood pressure, 100/78 mm Hg; respiratory rate, 22 breaths/min; and oxygen saturation, 100% on room air.
• On examination, her mucous membranes appear dry. She is tachycardic. Her lungs are clear. There is diffuse abdominal tenderness. You note a petechial rash on her arm distal to the blood pressure cuff.
• Based on her travel history and presentation, you suspect that your patient may have dengue, but you wonder which laboratory tests you should order…

A 70-year-old man with a history of hypertension and diabetes mellitus presents with 4 days of fever, fatigue, headache, and abdominal pain...

• He recently returned from a 3-week trip to Pakistan, where he was visiting family and friends.
• His vital signs are: temperature, 38.9°C; heart rate, 52 beats/min; blood pressure, 130/70 mm Hg; respiratory rate, 22 breaths/min; and oxygen saturation, 98% on room air.
• On examination, his abdomen is diffusely tender and slightly distended with no peritoneal signs. There is a blanching maculopapular rash on his abdomen.
• The patient meets the criteria for systemic inflammatory response syndrome, so you order basic laboratory studies and blood cultures, and initiate resuscitation with IV crystalloid fluids. You consider which empiric antibiotics would be most appropriate for this patient…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.