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MCQs in Travel Medicine$
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Dom Colbert

Print publication date: 2012

Print ISBN-13: 9780199664528

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199664528.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 22 January 2022

The Returned Traveller

The Returned Traveller

Chapter:
(p.189) chapter 16 The Returned Traveller
Source:
MCQs in Travel Medicine
Author(s):

Dom Colbert

Publisher:
Oxford University Press
DOI:10.1093/oso/9780199664528.003.0020

Respiratory illness, fever, diarrhoea, and dermatitis are the four most frequent medical problems in the returned traveller. Unexplained fever is the most urgent of these because febrile conditions such as malaria, meningitis, and typhoid can all deteriorate rapidly and become life-threatening. Respiratory infections are also very common and are often viral in origin. A persistent cough or a doubtful CXR warrants further investigation. Diarrhoea that persists may well be helminthic in origin with giardiasis high on the list. In cases already treated with antibiotics one must consider C. difficile infection while the unmasking of inflammatory bowel disease or irritable bowel syndrome is probably more common than supposed. Dermatitis is often due to exacerbation of an existing condition, e.g. psoriasis or eczema. Tropical-related dermatitis is most frequently due to infected arthropod bites. CLM is the main parasitic cause. Exanthems and enanthems occur in a variety of systemic conditions ranging from acute HIV to dengue fever to coxsackie infection. Rashes are seldom diagnostic unless the cause is obvious, e.g. scabies or typhoid (rose spots). In all cases the practitioner should adhere to a strict protocol that involves a good history, careful physical examination, and routine screening and microscopy of blood, urine, and stool. Simple X-rays and ultrasound examination may also be considered. In no case should the practitioner hesitate to refer the patient to a specialist physician. Nowadays computer-assisted diagnosis is becoming more popular and more reliable. The Kabisa Travel System, developed in Antwerp, has been shown to perform equally well with travel physicians in diagnosing the cause of fever in those returned from a tropical environment. Kabisa is the Swaili word for ‘hand in the fire, I am absolutely certain’!

Keywords:   Calabar swelling, Ebola fever, IgG and IgM, Widal test, abscess, liver, amoebic abscess, malaria, returned, schistosomiasis

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