Table 6.

Tropical diseases associated with respiratory symptoms

Disease	Etiologic Pathogen	Geographic Regions	Vector or Exposure	Incubation Period	Presentation	Diagnosis	Management
Avian bird flu	H5N1 and H7N9 influenza A virus	East and Southeast Asia	Poultry	2–8 d	Fever, malaise, myalgia, headache, nasal congestion, cough, acute respiratory distress syndrome (ARDS)	RT-PCR	Supportive care
Diphtheria	Corynebacterium diphtheriae	Asia, South Pacific, Middle East, Eastern Europe, Caribbean	Person-to-person (oral or respiratory droplets), fomites	2–5 d	Fever, dysphagia, malaise, anorexia, pseudomembranes	Bacterial culture	Supportive care, equine diphtheria antitoxin (DAT), antimicrobial therapy (erythromycin, penicillin)
Coccidioidomycosis	Coccidioides immitis and Coccidioides posadasii	Central and South America	Inhalation of spores from soil	7–21 d	Fever, malaise, cough, headache, night sweats, myalgias, arthritis, rash	Culture, IgM and IgG ELISA, immunodiffusion and complement fixation	Supportive care, antimicrobial therapy if ill or at high risk of dissemination (amphotericin B, azoles)
Histoplasmosis	Histoplasma capsulatum	Worldwide, especially river valleys	Inhalation of spores from soil, bird droppings, bat guano	3–17 d	Fever, headache, cough, pleuritic chest pain, malaise	Culture, microscopic examination, PCR, EIA on serum or other samples, immunodiffusion complement fixation	Supportive care, antimicrobial therapy (azole for mild to moderate disease, amphotericin B for severe)
Legionellosis (Legionnaire’s disease and Pontiac fever)	Legionella species	Worldwide	Inhalation of freshwater aerosol	2–10 d	Fever, headache, myalgias, pneumonia, respiratory distress	Urine antigen assay, paired serologies, PCR	Antimicrobial therapy (fluoroquinolones, macrolides)
Melioidosis	Burkholderia pseudomallei	Central and Southeast Asia, northern Australia, South America	Subcutaneous inoculation, inhalation, ingestion; body fluids	1–21 d	Fever, cough, weight loss, pneumonia	Culture, indirect hemagglutination assay	Antimicrobial therapy (ceftazidime, meropenem)
Middle Eastern Respiratory Syndrome (MERS)	MERS coronavirus	North Africa, Middle East	Dromedary camel, person-to-person	2–14 d	Fever, cough, arthralgia, diarrhea, myalgia, acute respiratory failure, multiple organ dysfunction	RT-PCR	Supportive care
Pertussis (whooping cough)	Bordetella pertussis	Worldwide	Person-to-person (aerosolized respiratory droplets, respiratory secretions)	7–10 d	Paroxysmal cough, post-tussive vomiting, apnea in infants	Culture, serologies, PCR	Antimicrobial therapy (macrolides)

Adapted from Centers for Disease Control and Prevention. The yellow book: health information for international travel 2018. Philadelphia: Oxford University Press; 2017. p. 704. Available at: https://wwwnc.cdc.gov/travel/page/yellowbook-home. Accessed July 25, 2017; with permission