[Fever in children returning from travel]

Abstract

Child travelers are numerous, exposed to the risk of diseases, both infectious and noninfectious, for which practitioners often lack experience. The assessment of febrile returning child travelers is becoming more frequent and challenging. The question of previous travel should be foremost in the checklist of the interview of any febrile child traveler, because this implies a possible tropical disease such as malaria that may be life-threatening. These need to be investigated and treated effectively and rapidly. There are highly contagious infections that could pose public health risks requiring implementation of hygienic and public health measures. A detailed immunization, medical, and travel history for exposure to infectious risks using geographic, seasonal, environmental, sociocultural, and epidemiological data are needed. Along with clinical examination and elementary first-line investigations, the history should guide second-line exams, which will provide the etiology and optimal treatment in approximately 75 % of cases. The majority of children will have a cosmopolitan infection that resolves spontaneously or is simple to treat. Malaria will need urgent and specific treatment. This article describes guidance on first-line evaluation and management of febrile child travelers as recommended in France.

Fig. 1

Algorithme de diagnostic d’une fièvre chez l’enfant de retour de voyage et principales causes. BU : bandelette urinaire ; Copro : examen de selles + coproculture ; CRP : protéine C réactive ; Eo : éosinophile ; Hb : hémoglobine ; Hc : hémoculture ; Imagerie : radio, échographie, tomodensitométrie, résonance magnétique nucléaire ; Le : leucocytes ; Ly : lymphocytes ; N : normal ; Ne : neutrophiles ; NFS : numération formule sanguine ; P : plaquettes ; TDR : test de diagnostic rapide ; GE : goutte épaisse ; sem : semaine. Période d’incubation moyenne (couleurs) :  : < 14 j ;  : 2–6 sem ;  : > 6 sem.