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The syndrome of fever and rash in the returning traveller presents a diagnostic challenge that requires a thorough history with special attention to travel and exposures alongside physical examination to distinguish between infectious and non-infectious causes. The most common febrile illnesses that present with a rash in the returning traveller are arboviral infections (dengue, Chikungunya, Zika)...
This chapter provides an overview of liver lesions in returned travellers. Symptoms suggestive of liver disease include right upper quadrant abdominal pain, nausea, vomiting, and sometimes fever. Some liver lesions are asymptomatic and detected incidentally. Important lesions in febrile returned travellers are amoebic and bacterial liver abscesses. Others, such as tuberculosis and hydatid disease,...
Eosinophilia is a common problem in travellers and migrants returning from the tropics. It usually signifies an underlying helminth infection, although it is still important to bear in mind the possibility of a non-infectious cause in this group of patients. It is frequently asymptomatic, but deserves investigation to prevent significant disease in the future. The presentation of helminth infections...
Hepatitis is an important cause of infection in the returning traveller. Patients present with either a primary liver infection accompanied by jaundice, or a systemic febrile illness complicated by hepatitis (liver inflammation). Rarely, it can result in life-threatening fulminant liver failure. An accurate history narrows the differential diagnosis and allows the selection of appropriate investigations...
The care of people who have recently migrated from resource-poor countries requires careful consideration by healthcare providers. Innovative approaches are called for to reduce the significant inequalities in health compared with UK-born and long-term migrant populations. Primary care physicians are best positioned to improve the early diagnosis of imported infections such as tuberculosis, HIV, malaria,...
This article provides a practical approach to the management of travellers returning from tropical countries and presenting with confusion or reduced consciousness. The most common treatable causes of neurological symptoms in this cohort are malaria, bacterial meningitis and viral encephalitis. There is an extensive list of less common causes including HIV, leptospirosis, rickettsia, syphilis, tuberculosis...
Malaria remains a leading cause of mortality worldwide and a cause of morbidity in returning travellers in the UK. The management of malaria, recent advances in diagnosis and current areas of controversy are summarized, primarily for clinicians in countries where malaria is non-endemic, who do not routinely encounter it. The most important message is that malaria is very common and its presentation...
Global travel continues to increase, particularly to tropical destinations that have different health risks from those encountered closer to home. Currently, over a billion people travel annually, with over 65 million visits made from the UK. Seeking pre-travel advice should be an essential part of any trip for a traveller. The key elements of pre-travel advice are health risk assessment, health promotion...
Millions of people travel to the tropics each year and a significant minority of them become ill, either during their stay or shortly after their return. Most have mild, self-limiting illnesses, but a few have a life-threatening condition. This article outlines how to evaluate fever in the returning traveller and discusses important infection control and public health measures. A detailed travel history,...
Travellers' diarrhoea is a common illness, particularly among travellers visiting low-income countries, and is generally self-limiting and uncomplicated. However, it has a disproportionate impact on well-being, occurring as it does during holidays or business trips, and can result in severe dehydration. Most causes of acute travellers' diarrhoea are bacterial or viral, and the pathogen is often not...
Here, we review the common presentations and pitfalls in diagnosing tropical skin infections. We highlight some of the features in the history and examination that are key to reaching the final diagnosis. We focus on common and important conditions in greater depth, and present diagnostic algorithms for the major presenting syndromes, including ulcers and weeping spots, patches and plaques, papules...
Systemic sclerosis (SSc) differs from other multisystem connective tissue/autoimmune diseases in that its clinical features result mainly from a combination of fibrosis and vascular abnormality (rather than from inflammation). This has major implications for management. SSc is associated with high morbidity and mortality, and is often very painful and disabling. There are two major subtypes, defined...
Initial characterization of autoimmune rheumatic disease through clinical assessment and investigation including serological measurements offers a vital opportunity to personalize treatment regimens, contributes to accurate prognosis and therefore optimizes outcomes. Disease monitoring using serological tests as biomarkers also contributes to earlier recognition of disease relapse or remission, and...
Sjögren's syndrome (SS) is a systemic autoimmune disorder characterized by focal inflammation of the exocrine glands, leading to dry eyes and dry mouth. Two forms of the syndrome have been defined: primary (pSS), in which dysfunction of the exocrine glands occurs in the absence of other autoimmune diseases, and secondary, in which patients suffer additional autoimmune processes, especially connective...
Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia characterized by venous or arterial thrombosis, and/or pregnancy loss or complications in the presence of persistently positive antiphospholipid antibodies. Patients can also develop other organ involvement, referred to as non-criteria manifestations, including livedo reticularis, thrombocytopenia and nephropathy. Non-thrombotic...
Polyarteritis nodosa (PAN) and Kawasaki's disease are primary systemic vasculitides with predominant medium-sized vessel involvement. PAN typically affects muscular arteries, causing aneurysms (nodosa). There are no specific serological markers, and diagnosis depends on clinical presentation, angiography and tissue biopsy. Exclusion of hepatitis B infection is important. Treatment with corticosteroids...
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