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Feature Article

Fever in the returned child traveller

Ameneh Khatami, David Isaacs, Ben Marais

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Abstract

Fever is common in children after overseas travel. Although usually a symptom of a nonspecific self-limiting condition, it can signify a serious illness such as malaria, dengue fever, enteric fever, rickettsial disease, tuberculosis, yellow fever or hepatitis. A detailed travel history and examination for specific symptoms and signs can help guide investigations and the decision to refer to hospital.

Key Points

  • High or persistent fever can be a marker of serious illness in children who have returned from overseas travel, and requires prompt assessment.
  • A detailed history of travel, immunisations, prophylaxis and exposures, and thorough medical examination will help focus investigations.
  • First-line investigations include a full blood count, white blood cell differential count, blood and stool cultures, blood films and a rapid antigen test for malaria.
  • Respiratory and urinary tract infections are common; consider viral studies of a nasopharyngeal aspirate, chest x-ray and urine dipstick or culture.
  • Malaria should be ruled out in anyone presenting with persistent or recurrent fever after travel to a malaria- endemic region in the previous year.
  • Other common infections in travellers include dengue fever, typhoid fever and rickettsial infections.
  • Children who are systemically unwell with a fever require hospital admission.

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