Visual summary Fever in the returning traveller

Triage and initial assessment

1 AllTriage
febrile travellers
qSOFA score Follow local Immune status
2+ of the following sepsis pathway
should be assessed Use a lower threshold May be compromised by:
indicates severe infection: for admission in those
for evidence of sepsis Consider: Malignancy Transplant
Glasgow Coma Scale < 15 with compromised
Empirical therapy immune status, as Age HIV status Diabetes
Respiratory rate > 22 infection can present
Referral to intensive Immunosuppressive drugs
Systolic blood pressure < 100 treatment unit (ITU) atypically in this group (including steroids)

2 Isolation Isolate patient according to risk

Contact precautions are often requred until a
diagnosis is confirmed and treatment commenced Contact Droplet

Yes Single room or patient cohorting

Clinical presentation Standard contact precautions Hand hygiene Gloves Aprons
Are any of the following present?
No Surgical face mask
Rash Diarrhoea
Respiratory symptoms Haemorrhage

Gastrointestinal or respiratory secretions

Isolation
not required
Airborne + Enhanced
Negative pressure single room
FFP3 respirator Fluid repellant surgical face mask
Enhanced precautions for Eye protection Plastic apron

3 Travel risk assessment

aerosol-generating procedures
Hand hygiene Gloves

Focused Where did What did you When did you

you go? do there? become unwell?
travel history
Is the patient at risk of malaria?

Patient returns from

Is there risk of viral haemorrhagic fever?
Enhanced endemic country
Did the patient’s symptoms start Ebola and Marburg virus disease risk contact www.map.ox.ac.uk
precautions
within 21 days of travel to a VHF
Caves Contact with:
endemic country? or mines Inform
exposure Antelopes Bats Primates laboratory Urgent
Check www.promedmail.org Empirical
services diagnostic treatment
tests
Lassa fever risk CCHF risk (Crimean-Congo Haemorrhagic fever) Discuss with
Exposure to basic rural conditions Tick bite or contact Animal slaughter exposure local infection
service Any of these features may
suggest severe malaria:
Is there risk of an emerging severe acute respiratory illness? Notify public Parasite count:
health
Lower + Symptoms within 14 days of travel to Middle East MERS Exposure
>10% = severe >2% = at risk
respiratory
tract infection
+ Symptoms within 10 days of travel to China
influenza
to known
case
Specialist
tests required
Central nervous system:
+ Contact with birds GCS<11 Prostration Seizures

Organ dysfunction: Blood markers:

Is there risk of antimicrobial resistance?
Tailor empirical AKI Acidosis
therapy Jaundice Hypoglycaemia
Healthcare abroad
Travel to: Asia Africa Middle East Exposures: Consider rectal Pulmonary Anaemia
Antibiotic use during travel swab screening oedema

4 Diagnosis Examination Routine investigations Specialist

investigations
Once immediate risks
have been addressed, take Also consider: Respiratory virus swab Discuss with local
Consider empirical Blood
a more detailed travel history Focal microbiology or virology samples infection specialist, as
treatment for specific cultures quality and timing of
to help to identify the infection Imaging HIV test Routine blood tests
and guide management clinical scenarios samples are often crucial

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