SFGH 12.15 pearls: Fever in returned traveler

  • Mycosis fungoides is a sub-type of cutaneous T-cell lymphoma (CTCL). The presenting skin lesions vary widely (from a few papules to erythroderma), as does the prognosis. MF is a life-limited condition for only about 20% of those affected and early disease is treated with topical therapy (steroids, retinoids, topical chemo or phototherapy)
  • Remember to check the CDC website for your returning traveled patients for help with your differential based on geographic regions (http://wwwnc.cdc.gov/travel/destinations/list/)
  • For returned traveled with fever and systemic illness, the most common diagnoses are malaria, dengue, mono, rickettsial infection and typhoid or paratyphoid fever
    • No definitive diagnosis is found in 30% of cases of fever in a returning traveler
    • Remember to think about illnesses that could have been acquired at home (Lyme, cocci, etc) in addition to those in the region visited
  • Dengue classically presents with fever, myalgias, arthralgias and headache with onset 4-7 days after mosquito bite, but incubation can be up to 14 days. If symptoms develops >14 days after returning home, Dengue is extremely unlikely.
    • Fever usually lasts 5-7 days, and this period can be followed by days or weeks of profound fatigue
    • Leukopenia, thrombocytopenia and AST elevation are the most common lab findings in Dengue
    • Hemagglutinin inhibition (HI) testing is the gold standard for diagnosis, but not widely available. The IgM ELISA can detect acute dengue and is generally the most useful and available test. Direct viral detection testing exists, but timing and sample quality limit the utility of this.

Evernote link: https://www.evernote.com/shard/s300/sh/2ef311f5-9849-4302-913e-c15e951fe0ac/935d6c38505a4f66c98adb371cdc0259



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