2nd August 2023

Introduction

The increase in international travel over recent decades has led to higher numbers of travellers developing a febrile illness during or soon upon returning to the UK. There is an extensive list of differential diagnoses to consider, and therefore a systematic approach to patient management will enable timely and suitable treatment.

As discussed earlier, most patients with febrile illnesses presenting to a UK hospital with a travel history do not end up with a clear-cut pathogenic diagnosis. Of those that do, malaria is the most common and prudent to consider, given the possibility of severe disease progression. All patients with a travel history in countries with known malaria transmission should have multiple sets of blood cultures & malaria screens. Other diagnoses, inclusive of dengue, enteric fever (typhoid & paratyphoid), HIV seroconversion and rickettsia infections, are also important considerations due to their common importation into the UK. The more esoteric pathogens may require serological or molecular testing at specialist reference laboratories.

In all cases of a returned febrile traveller, a detailed and structured history should include the following:

• Geographical locations visited
• Dates of travel and onset of illness
• Pre-travel preparation (including malaria prophylaxis)
• Activities during travel/type of travel
• Risk assessment of viral haemorrhagic fever (due to the very serious nature of these infections)
• Patient immune status
• Bites and wounds