Practice Guidelines for Evaluation of Fever in Returning Travelers and Migrants

Background: Fever upon return from tropical or subtropical regions can be caused by diseases that are rapidly fatal if left untreated. The diff e rential diagnosis is wide. Physicians often lack the necessary knowledge to appropriately take care of such patients. Objective: To develop practice guidelines for the initial evaluation of patients presenting with fever upon return from a t ropical or subtropical country in order to reduce delays and potential fatal outcomes and to improve knowledge of physicians. Ta rget audience: Medical personnel, usually physicians, who see the re t u rning patients, primarily in an ambulatory setting or in an emergency department of a hospital and specialists in internal medicine, infectious diseases, and travel medicine. Method: A systematic review of the literature—mainly extracted from the National Library of Medicine database—was performed between May 2000 and April 2001, using the keywords fever and/or travel and/or migrant and/or guidelines. E v e n t u a l l y, 250 articles were reviewed. The relevant elements of evidence were used in combination with expert knowledge to construct an algorithm with arborescence flagging the level of specialization required to deal with each situation. The proposed diagnoses and treatment plans are restricted to tropical or subtropical diseases (nonautochthonous diseases). The decision chart is accompanied with a detailed document that provides for each level of the tree the degree of evidence and the grade of recommendation as well as the key points of debate. P a rticipants and consensus process: Besides the 4 authors (2 specialists in travel/tropical medicine, 1 clinical epidemiologist