Fever in the Returned Traveler — Laboratory and Diagnostic Testing — Clinical Pathway: Emergency Department

Fever In the Returned Traveler — Emergency Department

Laboratory and Diagnostic Testing, Disease Specific Testing

Febrile children with recent travel to areas with endemic disease often require a more comprehensive diagnostic workup compared to the febrile children who have not traveled, regardless of how well the child appears, to rule out tropical diseases with significant and rapidly progressing morbidity and mortality.

Laboratory and Diagnostic Testing
  • Clinical Indications
  • Test as indicated after clinical evaluation
  • Evaluate for the usual causes of fever in a child. Fever Pathway
  • Recommended for all Febrile Children
    • POC glucose, especially if at risk for malaria or child presents with seizure, AMS
    • CBC w/differential
    • Comprehensive metabolic panel
    • Blood culture, especially if any concern for typhoid
    • “Blood Parasite” test for malaria if child travel to endemic area
    • Stool culture (e.g., typhoid, E. coli)
    • Urinalysis
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  • Targeted Testing
    • Measles, hepatitis, pertussis, other
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  • Additional Testing to Consider
    • Chest X-ray
    • Monospot/EBV titers
    • HIV, if considering acute seroconversion illness, add viral load
    • PT/INR, PTT if concern for sepsis/coagulopathy/hemorrhagic fever or high suspicion for or confirmed malaria
    • LP if change in mental status (arboviruses, meningococcemia)
    • Other testing per child’s identified risk factors
      • (e.g., schistosomiasis if swimming in fresh water, etc.)
  • Disease-specific Testing if Concern for a Specific Tropical Disease
    • ID consultation available to provide guidance for testing