Distance Learning: Travel Medicine
You get out of this what you put in
Objectives
Differentiate between Malaria, Enteric Fever (Typhoid) and Dengue in returning travelers
Apply pathophysiology and epidemiology to improve your travel history
Develop a scheme for thinking about the traveler with a fever
Theory
Use the following to create a schema for yourself. All these diseases present with fever but what buckets do they fall into after? Start breaking them up even more:
Fever w/ Respiratory symptoms
Fever w/ Jaundice
Fever w/ Abdominal pain
Fever w/ Diarrhea
Thwaites, et al. Approach to Fever in Returning Traveler. NEJM 2017
Additional Resources
Mati has listened to a lot of CP Solvers and found these episiodes to have great schema for evaluating a traveler returning with a fever. When you have time this week, take a listen. Make sure to pause after each aliquot and think through your differential and next steps. Then read the NEJM review to fill in your knowledge gaps.
Episode # 3
Episode # 53
NEJM Review Article
History Activity
You are evaluating a patient who has just returned from a trip abroad and is now having fevers, headaches, and abdominal pain. You do not have labs yet and decide to take a thorough travel history to see if you can identify the causative agent without the crutch of lab work. After each question below, click on what remains on your differential, working left to right, click submit to see an explanation.
Q2: What did you do there? Went to a conference on water resources, stayed at the adjacent Hilton, but went to see the elephants in Chiang Mai on the weekend.
Q1: Where and when did you travel? I went to Laos, most of the time in Vientiane… got back about a week ago.
Q3: Tell me about your symptoms? It’s been real bad, mostly right behind my eyes. My stomach hurts too, kind of everywhere. I haven’t had any diarrhea though.
Q4: You decide to take vitals: 101.3, 107, 126/78, SORA. At the end of your exam, he has a very bruised arm.
Cases
Case 1: A 34 y/o previously healthy male presents with 2-3 days of fever, diarrhea, and hematuria. He recently returned from Madagascar two weeks prior to symptom onset. Exam significant for splenomegaly and scleral icterus.
Temperature: 101.2
Blood Pressure: 126/74
Heart Rate: 103
Respiratory Rate:
Interpreting the labs, describe your impression of this patient. Using the NEJM schema, how does the travel history narrow your differential?
Case 2: You are in the ED evaluating a 25 y/o previously healthy male who presented with 2 days of headache, new onset subjective fevers and abdominal pain. Was traveling in the Philippines up until 2 weeks ago. He has had some nausea and vomiting, as well as diffuse myalgias. CT of his abdomen showed showed mucosal thickening of the terminal ileum.
