The Things Kids Bring Home From Abroad: Evaluating The Returning Child Traveler With Fever

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The Things Kids Bring Home From Abroad: Evaluating The Returning Child Traveler With Fever

December 2005

WITH the increasing ease and popularity of international travel, ED physicians are seeing greater numbers of patients who present with fever after returning from foreign travels. Most frequently, the fever is caused by common community-acquired illnesses, such as viral upper respiratory tract infections, pneumonias, or urinary tract infections. Nonetheless, fever in returned travelers  should always raise concern for a possibly severe or even life-threatening infection of "exotic" origin.

While it is fortunate that these "exotic" diseases are encountered relatively infrequently, it is their very infrequency that can put the patient and the treating physician at a disadvantage. The list of possible diseases is long and diverse and can seem daunting. An organized approach can make diagnosis and treatment much more manageable. In addition to the usual medical history, physicians should obtain a careful travel history, including information about travel dates, geographic locations visited, pretravel immunizations, chemoprophylaxis during travel, and activity-based risk factors, such as insect bites, contact with animals, freshwater exposure, and any history of sexual contact. The evaluation and treatment of the returned traveler with a febrile illness requires an understanding of the common as well as uncommon etiologies, their epidemiology, their modes of presentation, and a systematic approach to diagnosis and treatment.

This issue of Pediatric Emergency Medicine PRACTICE focuses on the identification, evaluation, and treatment of diseases in the returning  international child traveler who presents with fever. A review of the most common tropical diseases that affect returning travelers will be provided. Based on a critical evaluation of the pediatric literature and the adult literature as it applies to pediatric patients, we have developed an evidence-based approach to the evaluation of the returning child traveler with fever.

Abbreviations Used In This Article

CBC Complete blood count
CDC Centers for Disease Control and Prevention
CNS Central nervous system
DHF Dengue hemorrhagic fever
DSS Dengue shock syndrome
DIC Disseminated intravascular coagulation
EHEC Enterohemorrhagic Escherichia coli
ELISA Enzyme-linked immunosorbent assay
EPEC Enteropathogenic E coli
ETEC Enterotoxigenic E coli
GPIA Gelatin particle indirect agglutination
ICU Intensive care unit
ISTM International Society for Travel Medicine
MAT Microscopic agglutination test
NIH National Institutes of Health
ORS Oral rehydration salts
PCR Polymerase chain reaction
RBCs Red blood cells
RDT Rapid diagnostic test
RMSF Rocky Mountain spotted fever
SARS Severe acute respiratory syndrome
TMP/SMX Trimethoprim-sulfamethoxazole
VHF Viral hemorrhagic fever
WBCs White blood cells
WHO World Health Organization
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