Fever in the Returning Traveller

Fever + travel to a malarious area = falciparum malaria until proven otherwise — films within 1 hour, three sets before exclusion. The travel itinerary, incubation windows and exposures build the differential: typhoid, dengue, rickettsia…

Imported Fever Pathway

The pathway

1 · Malaria first

Thick + thin films + RDT within 1h
Negative? Repeat ×3, 12–24h apart
Falciparum kills in 24–48h

2 · Forensic travel history

Countries, dates, rural/urban
Prophylaxis + adherence
Exposures: water, food, bites, animals, sexual contacts
VHF risk-assess FIRST if relevant area

3 · Screen

FBC (thrombocytopenia), U&E, LFTs, glucose, lactate
Blood cultures (typhoid)
Urinalysis, HIV test always offered

4 · Grade malaria severity

Severe: parasitaemia >2%, ↓GCS, glucose <2.2, AKI, acidosis, shock, ARDS
Severe → IV artesunate + HDU/ITU
Uncomplicated falciparum → artemether-lumefantrine (Riamet), usually admit

5 · Monitor complications

Glucose 2-hourly, GCS, renal function
Daily films to parasite clearance
Day-14 FBC — post-artesunate haemolysis

6 · Public health

Notify UKHSA (malaria, typhoid notifiable)
Warn co-travellers
Prophylaxis counselling for future travel

Drugs

Drug	Dose	Route	Notes
Artesunate	2.4mg/kg IV at 0, 12, 24h then OD	IV	Severe malaria — superior to quinine. Via ID team.
Artemether-lumefantrine (Riamet)	4 tabs at 0,8,24,36,48,60h	PO	Uncomplicated falciparum. Take with fat.
Quinine + doxycycline	Per BNF	IV/PO	If artesunate unavailable. Watch glucose + QT.
Ceftriaxone	2g OD	IV	Empirical typhoid cover for the toxic undifferentiated traveller — cultures first.

When to escalate

Parasitaemia >2% or ANY severity feature — ID + HDU now,VHF risk area within 21 days — isolate, call imported fever service BEFORE tests,Falling GCS, glucose <2.2, lactate rising,Undifferentiated fever not settling — ID referral

Reference: UK Malaria Treatment Guidelines 2016 (BIA) / UKHSA imported fever guidance

This page is the reference half

The app adds what a web page cannot: a VINDICATE differential builder, worked on-call scenarios with full A–E findings, recall practice, and all of it offline.