College Health May Be Full of Surprises: International Travelers and Tropical Diseases
Although accreditation for this CE/CME activity has expired, and the posttest is no longer available, you can still read the full article.
Expires January 31, 2017
As the number of international travelers increases, so does the likelihood of transmission of illnesses to locations where they were previously rarely diagnosed. Clinicians at college health centers must be aware of tropical medicine diagnoses, especially in returning international students who have fever and other constitutional symptoms. This article provides a refresher regarding the diagnoses of malaria, dengue fever, and chikungunya.
FOLLOW-UP
Malaria
Appropriate follow-up, need for hospitalization, and choice of medical treatment are determined by disease cause, severity of illness, and patient demographics. Follow-up is necessary to ensure improvement and no development of atypical symptoms. Additionally, the clinician needs to keep in mind the risk for malaria strains that can have a dormant stage.
Dengue fever
Clinicians must remind convalescing patients to watch for severe abdominal pain, vomiting, difficulty breathing, and signs of bleeding (epistaxis, bruising, bloody stool, and menorrhagia). Clinicians must also be attentive to changing lab values, including a decrease in platelet count and an increase in hematocrit, along with signs of hypovolemic shock, ascites, pleural effusions, and narrow pulse pressure.14
Chikungunya
Patients are reminded to keep themselves comfortable by rehydrating and treating the discomfort associated with arthralgias. In a longitudinal study of chikungunya patients, 60% experienced continued arthralgias three years after diagnosis.23,30 Patient education regarding the potential for long-term arthralgia is important, as it may impact activities of daily living and work.
Long-term NSAIDs have been used for patients with recurrent or even chronic arthralgia.31 There are limited data available on beneficial treatments, such as chloroquine sulfate or disease-modifying antirheumatic drugs, for chronic arthralgia associated with chikungunya.23 Depression and recurrent cutaneous lesions also are possible in patients with long-term symptoms.
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