​Symptoms and Signs – Differential Diagnosis of Fever in Returning Travelers and Immigrants
Differential diagnosis of some selected systemic febrile illnesses to
consider in returned travelers and immigrants*
COMMON
• Acute respiratory tract infection (worldwide)
• Gastroenteritis (worldwide) [food-borne, water-borne, fecal-oral]
• Enteric fever, including typhoid (worldwide) [food, water]
• Urinary tract infection (worldwide) [sexual contact]
• Drug reactions [antibiotics, prophylactic agents, other] {rash
frequent}
• Malaria (tropics, limited areas of temperate zones) [mosquitoes]
• Arboviruses (Africa, tropics) [mosquitoes, ticks, mites]
• Dengue (Asia, Caribbean, Africa) [mosquitoes]
• Viral hepatitis (worldwide)
• Hepatitis A (worldwide) [food, fecal-oral]
• Hepatitis B (worldwide, especially Asia, sub-Saharan Africa)
[sexual contact] {long incubation period}
• Hepatitis C (worldwide) [blood or sexual contact]
• Hepatitis E (Asia, North Africa, Mexico, others) [food, water]
• TB (worldwide) [airborne, milk] {long period to symptomatic
infection}
• STDs (worldwide) [sexual contact]
LESS COMMON
• Filariasis (Asia, Africa, South America) [biting insects] {long
incubation period, eosinophilia}
• Measles (developing world) [airborne] {in susceptible individual}
• Amebic abscess (worldwide) [food]
• Brucellosis (worldwide) [milk, cheese, food, animal contact]
• Listeriosis (worldwide) [food-borne] {meningitis}
• Leptospirosis (worldwide) [animal contact, open fresh water]
{jaundice, meningitis}
• Strongyloidiasis (warm and tropical areas) [soil contact]
{eosinophilia}
• Toxoplasmosis (worldwide) [undercooked meat]
RARE
• Relapsing fever (western Americas, Asia, northern Africa) [ticks,
lice]
• Hemorrhagic fevers (worldwide) [arthropod and nonarthropod
transmitted]
• Yellow fever (tropics) [mosquitoes] {hepatitis}
• Hemorrhagic fever with renal syndrome (Europe, Asia, North
America) [rodent urine] {renal impairment}
• Hantavirus pulmonary syndrome (western North America, others)
[rodent urine] {respiratory distress syndrome}
• Lassa fever (Africa) [rodent excreta, person to person] {high
mortality rate}
• Other: chikungunya, Rift Valley, Ebola-Marburg, others (various)
[insect bites, rodent excreta, aerosols, person to person] {often
severe}
• Rickettsial infections {rashes and eschars}
• Leishmaniasis, visceral (Middle East, Mediterranean, Africa, Asia,
South America) [biting flies] {long incubation period}
• Acute schistosomiasis (Africa, Asia, South America, Caribbean)
[fresh water]
• Chagas’ disease (South and Central America) [reduviid bug bites]
{often asymptomatic}
• African trypanosomiasis (Africa) [tsetse fly bite] {neurologic
syndromes, sleeping sickness}
• Bartonellosis (South America) [sandfly bite; cb] {skin nodules}
• HIV infection/AIDS (worldwide) [sexual and blood contact]
• Trichinosis (worldwide) [undercooked meat] {eosinophilia}
• Plague (temperate and tropical plains) [animal exposures and
fleas]
• Tularemia (worldwide) [animal contact, fleas, aerosols] {ulcers,
lymph nodes}
• Anthrax (worldwide) [animal, animal product contact] {ulcers}
• Lyme disease (North America, Europe) [tick bites] {arthritis,
meningitis, cardiac abnormalities}