Fever in the Returning Traveler: A Practical Overview for Initial Management and Assessment in the ED

Background: International travel has increased over recent decades, leading to a rise in the number of patients presenting to emergency departments (EDs) with fever after returning from abroad. Evaluating fever in returning travelers is challenging because the differential diagnosis is broad, and exposure to tropical diseases limited, among most ED clinicians. Objective: This article aims to provide a practical overview of the most common travel-related causes of fever. The tool is intended to support targeted diagnostics and timely treatment and/or timely specialist referral, while emphasizing that non-travel-related infections must also be considered. Methods: We created a clinical summary of the most common causes of fever in returning travelers based on epidemiology, incubation periods, clinical features, and diagnostic approaches. A practical overview was created to aid ED clinicians in evaluating stable patients, incorporating travel history, exposure risks, and key clinical findings. Results: Malaria, dengue and typhoid fever are among the most common diagnoses in travelers returning from abroad, excluding non-travel-related diseases. These conditions share overlapping symptoms. Diagnosis relies on clinician awareness and a combination of exposure history, clinical evaluation, and targeted laboratory testing. Treatment depends on the causative pathogen and disease severity, but often requires early empiric therapy and supportive care. Conclusions: This article presents a systematic, pragmatic approach to the evaluation of fever in the returning traveler. This overview is designed to help ED clinicians recognize and make appropriate initial management and referral decisions when assessing a stable traveler. Nevertheless, we recommend specialist advice for most cases.