Table 3.
Syndromic Approach to Illness in Returning Travelers
| Syndromic Presentation | Possible Infectious Disease | Incubation (Range in Days)** | Unique Risk Factors | Discriminating Physical Signs and Symptoms† |
|---|---|---|---|---|
| Systemic Febrile Illness with Non-Focal Symptoms | Malaria | 7–30 (Most 12–14) | Endemic areas | Often none; focal signs rare in children, V/D, occasionally pallor, jaundice |
| Dengue | 4–7 | Endemic areas | Macular rash, petichiae, lymphadenopathy | |
| Leptospirosis | 2–21 | Freshwater activities | Conjunctival suffusion, jaundice if severe | |
| Typhoid fever | 6–30 | Highest in S. Asia, vaccine only 50% effective | Evanescent macules – “Rose spots” | |
| Chikungunya | 3–7 | Up to 60% infected in endemic regions | Maculopaular rash, small joint arthritis | |
| Acute HIV Infection | 10–28 | Sexual contact, transfusion, piercings, recent tattoos | Lymphadenopathy, “mono-like” illness | |
| Rickettsial disease | 5–14 | Rural Africa, game parks | Petichial rashes, focal eschars | |
| East African Trypanosomiasis | 7–14 | African/Asian game parks | Inoculation chancre | |
| Schistosomiasis (Katayama fever) | 14–84 | Swimming/wading in fresh water - Africa | Pruritic papular rash within a day after water contact | |
| Ebola, other VHFs | 2–21 | Outbreaks, traditional burial practices, bush meat | Petichae, purpura, conjunctival hemorrhage, other bleeding problems | |
| Fever with CNS Involvement | Malaria | 7–30 (Most 12–14) | Endemic areas | Fundoscopy: papilledema, retinal pallor, hemorhages |
| Meningococcal meningitis | 3–4 | Meningitis belt (Africa) | Petichiae, purpura | |
| Japanese encephalitis | 5–15 | Rural areas of south and southeast Asia | Multi-focal encephalitis, extrapyramidal signs | |
| West Nile Virus | 3–14 | Americas, Africa, Europe, west and central Asia | Rash | |
| E. Africa Trypanosomiasis | 7–14 | E. Africa/Asia game parks | Inoculation chancre | |
| Angiostrongyliasis | 7–21 | Raw vegetables, snails | Asymmetric paresthesias, fever rare | |
| Rabies | 21–60 | Animal bites, bat exposure | Paresthesias (at bite), progressive altered mental status, autonomic instability | |
| Fever with Respiratory Involvement | Influenza | 1–4 | New serotype outbreaks, poultry, pig exposure | Cough, myalgias, hypoxemia if severe |
| Bacterial pneumonia | 1–3 | Cough, hypoxemia if severe | ||
| Malaria | 7–30 (Most 12–14) | Endemic areas | Tachypnea, ARDS if severe | |
| Tuberculosis -primary | 2–12 Weeks for TST positivity | Expatriates, exposure to high risk groups, VFR | Hilar adenopathy, occasionally mild hepatomegally | |
| Q Fever | 14–21 | Regional risk/farm animals | *Can occur without obvious animal exp. | |
| Fever and Skin Rash | Dengue | 4–7 | Endemic areas | Macular rash, petichiae, lymphadenopathy |
| Mononucleosis | 4–8 Weeks | Variable “morbilliform” rash | ||
| Measles | 7–21 | Outbreaks, Still endemic in parts of Asia | Oral Koplik spots early, then “Head to Toe” spread, | |
| Typhoid fever | 7–21 | Highest in S. Asia | Evanescent macules – “Rose spots” | |
| Chikungunya | 3–7 | Endemic regions | Maculopaular rash, small joint arthritis | |
| Rickettsia diseases | 5–14 | Rural areas, game parks | Petichiae or Eschar with most species | |
| Acute HIV infection | 10–28 | Sexual contact, transfusion, piercings, recent tattoos | Lymphadenopathy, “mono-like” illness; non-specific eczematous rash upper body | |
| Dermatologic Findings without Fever | Bacterial Skin Infections/Abscess | Varied | Skin injury, bites, eczema | Varied – erythema, pain |
| Cutaneous larva migrans | 1–5 | Barefoot walking | Serpiginous “creeping” eruption | |
| Tungiasis | 1 day | Barefoot walking | Tender nodule, possible black center | |
| Myiasis | 1–12 Weeks | Africa, C. and S. America | Looks like and abscess, but “motile” | |
| Scabies | 2–6 Weeks | Crowded, poor hygiene | Serpiginous burrows | |
| Cutaneous leishmaniasis | 2–8 Weeks | Endemic regions, outdoor exposure | Progression of papule – painless ulcer; intranasal lesions in some new world inf. | |
| Diarrhea with or without fever | Viral gastroenteritis | 1–2 | Ubiquitous | Non-bloody diarrhea, dehydration |
| Bacterial gastroenter. | 2–4 | Ubiquitous | Non-bloody to bloody w. tenesmus | |
| Cyclosporiasis | 2–10 | Contaminated food, water | Profuse watery diarrhea, cramping | |
| Cryptosporidium | 4–10 | Contaminated food, water | Myalgias, arthralgias, and fever may occur | |
| Giardiasis | 7–21 | Ubiquitous | Watery diarrhea, steatorrhea. Bloating | |
| Amebiasis | 14–21 | Poor sanitation, Oral-Anal exposures | Bloody diarrhea; RUQ pain - liver abscess |