Approach to Patients with Fever

Fever is one of the most common complaints in returned travelers and accounts for about 25% of cases seeking medical care. Fever is one of the most challanging conditions because it may be the manifestation of a self-limited, trivial infection, on one hand, or on the other hand, it can be the presenting sign of an infection that could be rapidly progressive and lethal. The list of infections that should be considered include common, worldwide (cosmopolitan) infections as well as unique tropical diseases related to specific regions. Many febrile infections are associated with focal signs and symptoms, which help to limit the differential diagnosis. However, returning travelers with undifferentiated fever are the largest group of those with febrile infections, and among them, malaria is the most common specific pathogen. The approach to patients must include consideration of the geographic area visited, the estimated incubation period, the mode of exposure, and the impact of pre-travel vaccination. A routine laboratory work-up may offer important clues to the final diagnosis. Initial attention should focus urgently on infections that are treatable and transmissible and that cause serious sequelae or death.