Dr. Doan presented an intersting and complex case of fever and malaise in a recently returned traveler. She talked us through some "don't miss" diagnoses, including malaria and enteric fever, and we discussed frameworks for travel-related illness, with a focus on predominant symptoms, geographic location, and incubation periods. Here are some takeaways:
Below is a sample approach from a NEJM article: "Approach to Fever in the Returning Traveler". You should memorize this algorithm. Just kidding! But do know that resources are available on the CDC website (or in articles like this one), if you find yourself grappling with fever in a returned traveler.
Lastly...A Word on Leptospirosis
Reminder-a zoonosis (mammal urine-remember from Step 1?) that causes a nonspecific febrile illness. Dr. Obley dropped some knowledge bombs for us on leptospirosis.
-Frequently see conjunctival suffusion (redness)
-Weil's disease: leptospirosis complicated by jaundice and renal failure
-Serology: timing of testing matters! antibodies appear in ~5-7 days then can be missed. Need both acute and convalescent samples for diagnosis.