Where in the world? Where patients have been affects what they might have

With new and old infectious diseases emerging around the globe, public health officials are urging physicians to take a good travel history. Doctors say it's not that simple.

By Victoria Stagg Elliott, AMNews staff. June 21, 2004.

The patient had a fever and chills and kept coughing. Initially, he was prescribed antibiotics to treat a possible case of pneumonia. A week later, the patient still had symptoms.

It was only when Hilary Gagnon, MD, a staff doctor at Bell Medical Center in Negaunee, Mich., and her colleagues started to ask the patient questions about travel did they realize he had just returned from a long stint in South America.

Diagnosis: malaria.

This example is not an unusual one. Most of the time, the index of suspicion for exotic illnesses is low because the chances of exposure are slim.

"Malaria is very unusual for this area of Michigan," Dr. Gagnon said. "You don't think of malaria first off." But she might be more aware of such possibilities than most because of personal experience. She contracted African tick typhus while a medical volunteer in Africa in the late 1990s.

Still, most physicians will never see a serious travel-related illness such as SARS. Even more common ones such as malaria could be a once-in-a-career event. Many of these ailments also have very nonspecific symptoms, and doctors tend to go for the more likely diagnosis. Sometimes, though, the illness will turn out to be a zebra.

As a result, public health officials increasingly have been exhorting physicians to take a good travel history to note possible contact with novel infectious diseases such as severe acute respiratory syndrome and avian influenza or control old foes such as measles and malaria. "It constantly comes up now," said Phyllis Kozarsky, MD, chief of travelers health at the Centers for Disease Control and Prevention. "We are truly a global village."