2nd August 2023

Focusing on Infection

The list of potential infectious diseases is exhaustive. Therefore, marrying the pattern of pyrexia with associated symptoms and clinical history will help guide your diagnosis.

For example, abscesses and TB may result in a daily temperature spike, as can Schistosomiasis. Additionally, the recently returned traveller with a high enteric fever is far more likely to have Salmonella typhi infection than cytomegalovirus colitis in the absence of immunosuppressive predisposition.

Of the 25% of fevers with an established diagnosis in the UK, the most important identifiable imported cause is Malaria. Malaria classically presents with intermittent fevers and should resolve after a course of appropriate treatment. If a patient complains of recurrent feverish episodes years after initial malaria diagnosis and supposed treatment – be sure to rule out Plasmodium ovale or Plasmodium vivax as their hypnozoites may have been stirred into acute infective action.