The Post-Travel Period

The most frequent health problems in returned travelers are gastrointestinal illness, fever, and skin lesions/rashes. By far, gastrointestinal upset is the most frequent problem, but a febrile illness is the most serious since the infection may be life threatening to the patient (malaria) or a pose a serious public health hazard (viral hemorrhagic fever). The most frequent "tropical" causes of fever are malaria, dengue fever, typhoid fever, and rickettsial infections. However, nontropical entities such as viral upper respiratory or urinary tract infections account for a large proportion of febrile illnesses in returned travelers. The most frequent causes of persistent gastrointestinal illness are postinfectious irritable bowel syndrome and postinfectious lactose intolerance. The former often presents as intermittent diarrhea but may actually be a manifestation of constipation associated with episodic, rapid expulsions of loose stool. Although infections such as giardiasis or cyclosporiasis are often treated on the basis of clinical findings (without the benefit of laboratory confirmation) intestinal parasitic infections are uncommon causes of persistent diarrhea. Most post-travel skin ailments are insect bites, pyoderma, scabies, and cutaneous larva migrans.

Some diseases might not manifest themselves immediately. If travelers become ill after they return home, even many months after travel, they should be advised to tell their physician where they have traveled. Fever in a traveler returned from a malarious area should be considered to be a medical emergency; malaria should be evaluated by appropriate laboratory tests. Most travelers infected abroad become ill within 12 weeks after returning to the United States. However, some diseases such as malaria might not cause symptoms for as long as 6-12 months after exposure. Since most primary-care physicians have little expertise in tropical diseases, a newly returned, ill international traveler should be evaluated by an infectious disease or tropical medicine practitioner.

It may be prudent for asymptomatic international travelers who have been abroad for many months, particularly in developing countries, to be screened for certain diseases. The decision to screen for particular pathogens will depend on the travel and exposure history. For example, travelers who have engaged in unprotected sex or have received an injection, a body piercing, or a tattoo may be screened for HIV, hepatitis C and other STDs, and if necessary, hepatitis B. Travelers who have been exposed to fresh water in areas endemic for schistosomiasis should be screened for this infection by serology and appropriate stool and/or urine tests. Eosinophilia in a returned traveler suggests the possibility of a helminth infection, of which the most important is strongyloidiasis. If left untreated, this infection may last for the lifetime of the host and in an immunocompromised person has the potential to disseminate. Serology is the most sensitive diagnostic test.

Health Information for Internation Travel 2003-2004

© 2003