Three clinical problems often arise in travelers soon after return. Fever is most important, since delay in the diagnosis of P. falciparum malaria can be fatal. Fever should always be considered malaria until proven otherwise in travelers returning from malaria endemic countries. Tuberculosis, hepatitis, amebic liver abscess, and typhoid fever should then be considered. Traveler's diarrhea that is unresponsive to antibiotics and persists until the traveler returns home is often caused by Giardia.
Antibiotic-resistant bacteria, amebiasis, temporary lactose intolerance, and bacterial overgrowth should then be considered. Eosinopilia in a returning traveler is less common but is usually-caused by helminth infections. A stool examination for ova and parasites may be negative during the tissue migrating phase of many parasites or in tissue nematode infections such as filariasis or onchocerciasis.
Finally, some diseases acquired abroad can take several years to manifest symptoms. All travelers should be advised to remind their doctor of past international travel when presenting with an unknown illness.
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