Types of Fever in Returning Travelers

Fevers caused by infection are especially common in people who have traveled to developing countries or parts of the world where health care resources and sanitation are limited. Any international traveler who develops fever in the weeks after returning home should be evaluated.

Doctors at NYU Langone can identify the many types of travel-associated infections that cause fever. The most common of these include malaria, dengue, typhoid fever, and chikungunya.

Malaria

Malaria is a parasitic disease spread by mosquitoes in tropical and subtropical climates. It causes a high fever, chills, and flu-like symptoms. It can also lead to anemia, a condition in which the body lacks red blood cells, causing weakness or tiredness. 

The disease is spread when a mosquito infected with a malaria parasite bites a person, depositing the parasite into the bloodstream. The parasite then travels to the liver, where it multiplies. These parasites infect red blood cells, which burst and go on to infect more red blood cells in the body.

Symptoms usually begin within 10 days to 4 weeks after an infected mosquito bites a person. These include recurrent fevers as high as 106 degrees, chills and sweats, muscle aches, nausea, vomiting, and diarrhea. Severe infection may also cause jaundice, a yellowing of the skin that can indicate liver dysfunction or severe destruction of red blood cells. 

Some types of malaria may cause more serious problems, such as damage to the heart, lungs, kidneys, or brain. Without treatment, the cycle of red blood cell destruction and fever can be fatal. Rapid diagnosis and treatment are critical. 

Malaria is a common cause of fever in returning travelers, especially among people who have traveled to sub-Saharan Africa, Asia, or Latin America, where the disease is a major public health concern. However, all travelers to countries where malaria is present are at risk of infection.

Dengue 

Dengue fever is a viral infection that causes flu-like symptoms. It occasionally develops into a potentially lethal infection called dengue hemorrhagic fever. The infection is passed to humans through the bite of specific types of mosquitoes infected with one of four closely related dengue viruses. 

Dengue causes a fever of 104 degrees or higher, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and, sometimes, mild bleeding in the gums or from the nose. Generally, in younger children and those experiencing a first dengue infection, the illness is milder than in older children and adults. 

The same viruses that cause dengue fever can also cause dengue hemorrhagic fever, a more severe form of the infection. It can be fatal if not properly treated within days of symptoms first appearing. 

Symptoms of dengue hemorrhagic fever include a fever that lasts from two to seven days along with the general signs and symptoms of dengue fever. When the fever declines, a person may experience symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing. 

This marks the beginning of a 24 to 48 hour period when the body’s smallest blood vessels, called capillaries, become excessively “leaky,” allowing fluid to escape from the blood vessels into the areas around the abdomen and lungs. This may lead to failure of the circulatory system and shock.

People with dengue hemorrhagic fever may also bruise easily or have other types of skin hemorrhages, such as a bleeding nose or gums. They may possibly have internal bleeding.

Dengue is found in tropical and subtropical climates worldwide, mostly in urban areas. People with weakened immune systems as well as those with a second or subsequent dengue infection are believed to be at greater risk of developing dengue hemorrhagic fever.

Typhoid Fever

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. It is spread by ingesting food or water contaminated with sewage or feces infected with these bacteria. People with typhoid fever carry the bacteria in their bloodstream and intestinal tract. 

After Salmonella Typhi bacteria are ingested, they multiply in the intestinal tract and spread into the bloodstream. The body reacts with fever and malaise, but abdominal pain and headache can also occur.

If left untreated, typhoid fever can be fatal. It begins 7 to 14 days after ingestion of the bacteria, peaks at 103 to 104 degrees, and may be accompanied by small, rose-colored spots on the skin of the chest and abdomen.

Typhoid fever occurs worldwide, primarily in developing nations with poor sanitation, where hand washing is less common and water is likely to be contaminated with sewage. 

Chikungunya

Chikungunya is a viral disease spread by infected mosquitoes that causes fever and severe joint pain, especially in the small joints of the hands and feet. It can also cause muscle pain, fatigue, headache, nausea, and a rash. 

Symptoms usually begin three to seven days after being bitten by an infected mosquito and can be severe. Joint pain caused by chikungunya is often debilitating, usually lasting from a few days to a few weeks. Most people recover fully, but joint pain may persist for several months, even years. 

Chikungunya may cause eye problems such as redness or blurred vision, neurological complications such as facial paralysis and Guillain–Barré syndrome, and gastrointestinal symptoms such as nausea and vomiting.

Chikungunya most often occurs in travelers to Africa, Asia, and the Indian subcontinent.

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