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Pre-travel vaccinations and malaria meds General health and immune system status PHYSICAL Vital signs Skin findings including bite marks Joint, respiratory, GI, Neuro symptoms LABS Eosinophilia Leukopenia, Thrombocytopenia LFTs Stool studies Incubation periods <21 days Malaria, Dengue Yellow fever, Japanese encephalitis Meningococcemia Leptospirosis Typhoid fever East African trypanosomiasis Incubation periods <21 days Malaria (esp. after ineffective prophylaxis) Acute HIV Acute systemic Schistosomiasis (Katayama fever) Viral hepatitis (A, B, C, D, E) Tuberculosis Leishmaniasis West African trypanosomiasis CASE 1: 21 y/o male nursing student returns from 3 week stay with relatives in rural India No mosquito bites and took malaria prophylaxis daily Had Hepatitis A vaccine prior to leaving HR 60, BP 90/60, appears very ill N,V,D CASE 2::26 y/o. anthropology TA returns from 10 day dig in Bolivia with multiple insect bites Rural areas, stayed in local housing Sudden onset fever, H/A, myalgias Anemia and thrombocytopenia Bites are not infected, no purpura, no cough CASE 3: 22 y/o woman is seen in December after return from Botswana for 3 months July - September Hiking, had to cross small stream early in her trip Fever, headache, myalgias, sore throat, joint aches, fatigue and swollen cervical nodes VS Temp 100.7, RR 20, Pulse 80, BP 100/72 Appear slightly ill Skin warm, dry, no rash or obvious bites +cervical nodes, injected pharynx Heart, lungs, abdomen, joints normal Illness related to EXPOSURE Food and water hepatitis A*, toxoplasmosis,trichinella, enteric fever (typhoid, paratyphoid) *, bacterial gastroenteritis, amoebiasis Unpasteurized Dairy Brucella (dogs, goats, cattle, horses),enteric fever *, Salmonella gastroenteritis, tuberculosis (bovis) Mosquitoes Malaria, dengue, filariasis, loa loa, yellow fever *, Japanese encephalitis*, Chikungunya Ticks tick typhus, Rocky Mountain spotted fever, Crimean-Congo hemorrhagic fever, lyme disease, relapsing fever (Borrelia spp.), tularemia, babesiosis Sand flies Leishmaniasis, sandfly fever, bartonellosis (Oroya fever) Black flies onchocerciasis (river blindness) Tsetse flies African trypanosomiasis (African sleeping dz) Reduvid bugs American trypanosomiasis (Chagas disease) Chiggers scrub typhus Caves rabies (bat bite, or bat guano inhalation) *, histoplasmosis Desert areas Coccidiomycosis Animals Brucellosis, rabies *, tularemia, Q fever, anthrax, plague, viral hemorrhagic fevers (Lassa, etc.), rabies Fresh water schistosomiasis, leptospirosis, hepatitis A * Crowded living conditions, group travel meningococcal disease *, influenza *, tuberculosis, Lassa, Marburg, ebola, hepatitis A * New intimacy HIV, hepatitis B *, other STDS: herpes, gonorrhea, syphilis, HPV *, etc.  ( ) * 4 5 X Y r  [ w   6 = H c y       & ( * - 9 @ c ~    鴻° hsAhA ( hsAhsAhA (hj hA (hLX h'hLXh'hLXhLX6] hLXhLX hQhLXh5E hQh 4hLXhFh 4 hQhQhQ>5 ) 5 Y  " 0 > [ w  & FgdLXh^hgdLX & FgdLXh^hgd 4 & FgdQh^hgdQw  6 7 8 9 : ; < =     & FgdsAgd5Eh^hgdj & Fgdj & FgdLXgdLX & FgdLX   t +?hSg & Fgd<)w & Fgd<)w & F gd<)w & F gd<)wgd 4 & F & Fgd 4 & FgdD & FgdA (gdDh^hgdj & FgdLX & FgdsA      $ & L M i s t | +1MPwzSg6<ôk&h<)wh<)w6CJOJQJ]^JaJ h<)wh<)wCJOJQJ^JaJ#h<)wh<)w>*CJOJQJ^JaJ#h<)wh<)w5CJOJQJ^JaJhF5CJOJQJ^JaJh<)w5CJOJQJ^JaJh<)w hQh 4hA ( hQhA (hLXh'h 4hFhDhj*6<?Lz (0 & Fgd<)w & Fgd<)w & Fgd<)w & Fgd<)w & Fgd<)w & Fgd<)w & Fgd<)w?Lglz(0Vcܽ h 4h<)wCJOJQJ^JaJh<)wCJOJQJ^JaJ h<)wh<)wCJOJQJ^JaJ#h<)wh<)w>*CJOJQJ^JaJVc & Fgd 4 & Fgd<)w & Fgd<)wK1h0:p<)w= /!"#$% P0 8 01h0:p<)w= /!"#$% @@@ NormalCJ_HaJmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k@(No List &M&"vv6 5)5Y"0>[w 6789:;<= t+?hSg6<  ? 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