Evaluating a Sick Child after Travel to Developing Countries

Abstract

Every year, millions of children travel internationally with their families, many to developing countries. Although the vast majority experience uneventful travel and return home well, it is not uncommon for children to present as ill during or after travel. Although the majority of travel-associated illness is mild and self-limited, serious conditions regularly occur. Almost all life-threatening conditions after travel present with fever, and malaria is the most important of these to rapidly exclude. Gastrointestinal symptoms are common after travel in the developing world, and most diarrhea in child travelers has a bacterial source. Children who have a rash in association with fever or who appear ill should receive a priority work-up focused on ruling out serious conditions. Many children traveling internationally experience respiratory illness during or shortly after travel, mainly common upper respiratory infections, yet serious conditions, such as tuberculosis, may occur. Eosinophilia is common in the returned pediatric traveler, particularly those with prolonged stays in the tropics. Not all eosinophilia is caused by parasitic infection; drug reactions, asthma, and other allergic conditions are also common causes.

Morbidity among child travellers with sickle-cell disease visiting tropical areas: an observational study in a French tertiary care centre

“…In our study, the percentage of hospitalisations in child travellers was higher than that found in a multicentre study (14% of travelling children) 9. Diarrhoea and fever also accounted for the majority of diagnoses reported in children without SCD 9 10…”

Travelers’ Diarrhea in Children at Risk

“…Other studies show bacterial infections as the most prevalent cause of GI symptoms. 19 Laboratories of different centers attending post-travel diseases also use different techniques to study these infections. This fact could justify some of these controversial results.…”

Conducta práctica ante un niño febril al regresar de un viaje

“…Cuanto más largo sea el intervalo entre el regreso y el inicio de los signos, menos riesgo existe de que la sintomatología tenga relación con el viaje; • la existencia de otras personas del entorno con una sintomatología comparable. Deben precisarse las características del viaje [19][20][21][22][23][24][25] [19] ), especialmente graves y contagiosas, algunas de las cuales podrían justificar medidas de aislamiento inmediatas del viajero sospechoso, incluso antes de la confirmación microbiológica. Es posible informarse de las epidemias en curso en numerosos sitios web, como los de la Organización Mundial de la Salud (OMS) o el Ministerio de Asuntos Exteriores francés (Cuadro 1); • duración de la estancia: cuanto más prolongada sea la estancia, más aumenta la exposición al riesgo, sobre todo en medio tropical; • fecha de regreso (o de salida de la zona de riesgo): es importante compararla con la del inicio de los signos para definir el período de incubación, que puede orientar el diagnóstico.…”