Table 71-6.

Selected Infections Associated with Foreign Travel

Disease	Initial Symptoms	Complications	Diagnosis	Treatment
Typhoid fever	Fever increase over 2–3 days, headache, malaise, cough, rose spots. After 1st week: coma, abdominal distention, “pea soup” diarrhea, respiratory distress	Intestinal hemorrhage, intestinal perforation, acute renal failure, myocarditis, DIC	Stool culture for Salmonella; serologic tests (ELISA); elevated ESR, PT/PTT, LFTs; hyponatremia, hypokalemia, anemia	Ciprofloxacin, chloramphenicol, cefotaxime, ampicillin
Malaria	Paroxysms of fever, chills, sweats; flulike symptoms, vomiting and diarrhea, febrile seizures, meningitis, anemia, jaundice	Toxicity, high fever, dehydration, severe anemia, seizure/coma, pulmonary edema, renal failure, shock, bleeding diathesis	Blood smear (thick/thin); serologic tests (ELISA)	Chloroquine, quinine, quinidine, mefloquine, halofantrine
Dengue fever	Fever, headache (frontal/retro-orbital), generalized macular rash, bone pain, nausea/vomiting, anorexia, cutaneous hyperesthesias	Dehydration, bleeding diathesis, DIC, shock, myocarditis, encephalopathy, liver failure	Serologic tests (ELISA); leukopenia, thrombocytopenia; elevated BUN, LFTs	Supportive care

Abbreviations: BUN, blood urea nitrogen; DIC, disseminated intravascular coagulation; ELISA, enzyme-linked immunosorbent assay; ESR, erythrocyte sedimentation rate; LFTs, liver function tests; PT, prothrombin time; PTT, partial thromboplastin time.