Travel related and tropical infections

Travel related and tropical infections include:

• Malaria
• Dengue fever
• Chickungunya
• Typhoid
• Cholera
• Schistosomiasis/bilharzia
• Ebola (very rare)
• Lyme disease

Most tropical diseases will present with an acute illness and may require urgent transfer through Emergency. However, others present with  early, low grade symptoms that may provide an opportunity to investigate and initially manage within a primary care setting.

Other important information for referring practitioners

Medical management

An extensive review of tropical disease is outside the scope of these ID guidelines but the following may help in logical diagnosis and management based on main symptoms.

Diarrhoea

• Most commonly caused by E.coli as traveller’s diarrhoea. Most cases resolve spontaneously. However, if:
  • Frequent bowel action, vomiting, fever or blood in stool, may benefit from antibiotic treatment
    • Use ciprofloxacin 500mg bd or norfloxacin 400mg bd for 3-5 days
• If persistent investigate with:
  • Stool microscopy and culture and PCR
  • If diarrhoea is chronic, consider stool for lactose intolerance testing
  • Consider abdomen U/S and or endoscopy (upper and/or lower)

Respiratory disease

Commonly caused by:

• Influenza
• Bacterial pneumonia
• Rarely TB, Pandemic respiratory illness
• Investigate with:
  • Sputum Micro C&S
  • CXR

Lymphadenopathy

• Consider Dengue, rickettsial infection, HIV, brucellosis, leishmaniasis, lymphogranuloma venereum, plague

Skin rash

• Can be non-specific or heat related
• If petechial consider meningococcal disease, yellow fever, rickettsial infection of viral haemorrhagic fevers
• Generalised rash can be seen in dengue fever, measles, rubella

Jaundice

• Consider viral hepatitis, cholangitis, liver abscess, typhoid fever, leptospirosis, yellow fever, dengue fever and haemoglobinopathies. Rarely malaria.

Hepatosplenomegaly

• Consider viral hepatitis, malaria, brucellosis, typhoid fever, leishmaniasis, schistosomiasis and toxoplasmosis

Gross Splenomegly

• Consider malaria, visceral leishmaniasis, trypanosomiasis, typhoid, brucellosis, typhus and dengue fever

Anaemia

• Consider hookworm, malaria and visceral leishmanisis

Referral requirements

A referral may be rejected without the following information.