Upon Return

Most posttravel illnesses are mild and self-limited, and many are noninfectious. Seek medical care if an illness is severe or does not improve after 3 or 4 days. Provide details on destination(s), activities, duration of stay, what was consumed, and whether or not any insect bites occurred during travel. However, fever in a traveler who has recently returned from the tropics is a potential emergency and must be evaluated immediately so that antimalarial or other definitive treatment can be initiated rapidly if indicated.

Some illnesses can emerge weeks or even months after returning home. For example, hepatitis B symptoms typically appear 3 to 4 months after infection. Keep this time lag in mind, especially in the case of intestinal illness. The approach to the illness requires knowledge of world geography, the epidemiology of disease patterns in 230 or so countries, and the clinical presentation of a wide spectrum of disorders; evaluation by a travel medicine specialist may be indicated.

Remember that travelers who become ill during (or any time up to several months after) a trip abroad will frequently associate that illness with a possible travel-specific etiology. This may be the case, but often it is not and the illness is simply a common illness acquired during or at some time after the trip.

Completely asymptomatic returned travelers may desire a checkup for possible tropical disease. The limited number of available cost-effectiveness studies have yet to show significant benefit to this approach on a population basis. Neither a clinic visit nor any nondirected laboratory screening of returned very short-term travelers is indicated. Exceptions are those with known discrete high-risk exposure events in situations conducive to transmission of specific agents. This would include testing for HIV and other sexually transmitted infections, a TB blood or skin test or a schistosomiasis blood test for those with fresh-water exposure (Africa only).

For those who have spent 6 months or more under any conditions in a developing country, a TB blood or skin test is the highest priority, even without a specific exposure. For those living under harsher conditions, a general screening (including stool for parasites and a complete blood count) is indicated and certain blood tests for possible parasites according to possible exposures at the specific destination might be ordered by the travel medicine specialist. Malaria smears are not indicated in asymptomatic travelers, even those with a remote history of malaria exposure during travel.