Fever is a common presentation in people who have recently arrived in Britain from tropical countries. The most common diagnoses are listed in table. The most important is malaria, because untreated Plasmodium
| Causes of fever imported into the UK | |
|---|---|
| Frequency | Cause |
| Common | Malaria Presumed viral |
| Frequent | Bacterial dysentery, upper respiratory tract including diphtheria, pneumonia, urinary tract. typhoid Proven viral hepatitis A, HIV, Epstein-Barr virus, aseptic meningitis, dengue |
| Occasional | Tuberculosis, toxoplasmosis, rickettsial |
| Rare | Brucellosis, amoebic abscess, visceral leishmaniasis |
| INVESTIGATION AND MANAGEMENT OF FEVER FROM THE TROPICS |
|---|
| On admission |
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| Over the next 3 days |
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| After 3 days |
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| After 10 days |
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falciparum infection in a non-immune patient (including expatriates and immigrants of over 3 years' duration) may become rapidly fatal. P. falciparum malaria usually presents within 2 months of arrival but occasionally up to 6 months later, rarely longer. The clinical features of malaria they may include fever, cough and diarrhoea. The pattern of fever does not distinguish malaria from other imported or domestic fevers such as influenza, but splenomegaly, thrombocytopenia and hyperbilirubinaemia strongly suggest the diagnosis Asian immigrants are at especial risk of tuberculosis and Africans of HIV infection Physical examination should be directed especially towards:
The investigation and management of fever from the tropics are shown in the information box.