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After Your Return: Fever

Fever in a returning traveller is malaria until proven otherwise. Malaria may occur as soon as ten days after entering a malarious area, but sometimes not for several months after exposure. This time difference may depend upon the strain of malaria, as well as other factors including whether or not antimalarials have been taken. P. falciparum, the most serious strain, will usually cause symptoms within 60 days of being exposed. P. vivax, which is no pleasure to have but which will rarely prove fatal, may persist in the liver for many months before entering the bloodstream and causing symptoms.

Aside from fever, malaria may also present with symptoms such as headache, chills, sweats, feeling hot and cold, muscle aches and pains, and more. The fever may occur on alternate days as it does in the textbooks, but this is not always the case. Several other infections, such as dengue fever, typhoid fever, hepatitis and the flu may present with similar symptoms. Non "tropical" infections, such as mononucleosis, kidney infections and pneumonia may also be associated with fever.

If you have returned from a malarious area and develop a fever, do the following:

  • seek medical attention and request / demand that you have a blood smear for malaria
  • if the results are not immediately available, make sure that the doctor will follow up with you within 24 hours
  • if the test is negative for malaria parasites, and you continue to have fever, it should be repeated; the first smear will not always be positive
  • if you do have malaria, be certain that your doctor has experience in dealing with this infection, or gets it quickly from someone else

North Americans occasionally die from malaria, because of:

  • improper or inadequate malaria prophylaxis
  • delay in seeking medical attention
  • missed or delayed diagnosis on the part of the doctor
  • inadequate medical treatment

If you do not have malaria, other investigations such as testing for hepatitis antibodies, blood, stool and urine cultures, x-rays or ultrasound may be necessary.

Content (c) Mark Wise
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