• Eyal Leshem and Eli Schwartz.
• The Center for Geographic Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. leshem@gmail.com
• Harefuah. 2010 Sep 1;149(9):598-603, 618.

AbstractFever is one of the most common complaints in returned travelers and accounts for about 25% of cases seeking medical care. Fever is one of the most challenging conditions since fever may be the manifestation of a self-limited, trivial infection, or on the other hand, can be the presenting sign of an infection that could be rapidly progressive and lethal. The list of infections that should be considered includes common, worldwide (cosmopolitan) infections as well as unique tropical diseases, related to specific regions (malaria, dengue fever, enteric fever, schistosomiasis, leptospirosis, rickettsia). Many febrile infections are associated with focal signs and symptoms, which help to limit the differential diagnosis. However, returning travelers with undifferentiated fever are the largest group of those with febrile infection and among these patients, malaria is the most common specific pathogen. The approach to patients must include consideration of the geographic area visited, the estimated incubation period, mode of exposure and impact of pre-travel vaccination. A routine laboratory work-up may offer important clues to the final diagnosis. Initial attention should focus urgently on infections that are treatable, transmissible, and that cause serious sequelae or death. Finally, malaria must be ruled out in any febrile traveler returning from endemic regions.

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