Fever

Fever commonly accompanies serious illness in returned travelers, and the most common life-threatening tropical disease associated with fever in returned travelers is malaria. Because an increased temperature can signal a rapidly progressive infection, clinicians must initiate early evaluation, especially in people who have visited areas with malaria in recent months (see Chapter 4, Malaria). The initial focus in evaluating a febrile returned traveler should be on identifying infections that are potentially life-threatening, treatable, or transmissible. In some instances, public health officials must be alerted if the traveler was possibly contagious while traveling or infected with a pathogen of public health importance (such as yellow fever or Ebola viruses) at the origin or destination. During an outbreak such as the Ebola epidemic in West Africa, special screening protocols may be needed. It is important to know that a specific cause for fever may not be identified in approximately 25% or more of returned travelers.