Feeling feverish after that trip abroad? Get thee to a doctor

YOU’VE been back for a few weeks from Vietnam, where you chilled out on the beaches, took in the sights and dined out in Ho Chi Minh City.

You’re de-stressed, but suddenly not feeling well. You’re tired, nauseated and have abdominal pain. Now, you’re looking jaundiced. Could you have picked up something on your vacation?

Definitely. Pay close attention to post-trip symptoms such as these, travel medicine experts say. With reemerging diseases such as dengue fever and newer threats such as bird flu on the rise in some parts of the world, you may have brought home more than great memories. Among other things, a traveler to Vietnam may contract hepatitis A, a viral liver infection with an incubation period of 28 days.

These days, many travelers worry about coming home with bird flu, and it’s wise to take precautions to prevent getting the disease, especially because it seems to be spreading outside Asia. However, a traveler’s risk of contracting other ailments, such as hepatitis or malaria, is usually greater, experts say.

A body temperature of 100.5 degrees or higher is the No. 1 symptom that spells trouble after overseas visits, said Dr. David Spees, director of the travelers’ clinic at the Sharp Rees-Staley Medical Group in San Diego and a family practice physician specializing in travel medicine.

“People with high fever and chills following travel to an area where there is a risk for malaria need to see a healthcare provider immediately,” says Dr. Phyllis Kozarsky, a professor of medicine at Emory University and a consultant for the federal Centers for Disease Control and Prevention in Atlanta.

“People can die from malaria within 24 to 48 hours,” she says. “That’s a medical emergency.”

Tell the doctor where you’ve been, which pre-trip vaccines you received and whether you followed instructions about taking anti-malarial medicine or other preventive drugs.

A blood test can determine quickly whether malaria is the problem, Spees says, and prescription drugs can be used to treat the disease, which is caused by a parasite transmitted through the bite of an infected mosquito.

Don’t ignore a headache that accompanies a fever, Spees says, because these symptoms could point to malaria or dengue fever. Dengue fever, spread by the bite of infected Aedes mosquitoes, has recently plunged Singapore into a public health crisis.

“Dengue comes on pretty quickly, usually in a few days [after a bite],” Kozarsky says. Symptoms are similar to malaria, typically a high fever and chills.

But unlike malaria, she says, there is no specific treatment for dengue. Those who contract the disease are given supportive care, such as intravenous fluids and fever reducers. Some may need to be hospitalized.

Water hazard

PARASITES are another nasty hitchhiker, and they can show up 10 to 30 days after a trip, Spees says.

Giardia, an organism found in drinking water and affecting the intestines, is the most common, he says. Backpackers who drink untreated water can ingest the parasite and contract giardiasis. Symptoms include cramps, diarrhea and an upset stomach. It’s treated with prescription anti-protozoal agents.

Travelers who become jaundiced and easily fatigued should be checked out for hepatitis A or E, both viral infections of the liver that can be contracted through contaminated food or drink. Hepatitis E is uncommon in the United States, according to the CDC, but occurs in developing countries, especially in South Asia and North Africa.

Hepatitis A outbreaks can occur in the United States, and some travel medicine experts advise patients to get vaccinated against the infection even if they are not traveling. A hepatitis E vaccine is under development.

Have a doctor check out respiratory illness, especially if it’s accompanied by fever, Kozarsky says. It could be just influenza or sinusitis, but it could also be something more serious, such as severe acute respiratory syndrome. SARS surfaced in Asia in 2003 and spread to more than two-dozen countries during a lethal outbreak that left more than 700 dead.

As for bird flu, Kozarsky advises travelers to put the fear in perspective. “Avian flu still has only been in a handful of countries in Asia and Southeast Asia in humans,” she says. “Even in these countries, there is a very low risk” unless travelers have been in direct contact with infected birds, such as at live poultry markets.

As of mid-October, the World Health Organization had confirmed 117 cases of bird flu worldwide and 60 deaths. On Oct. 13, WHO said that tests had confirmed the presence of the H5N1 avian influenza in Turkish birds.

Kozarsky advises travelers to visit www.cdc.gov/travel/other/avian_influenza_se_asia_2005.htm, a CDC Web page on avian influenza for pre- and post-trip information. The CDC advises travelers who have been in infected areas to monitor their health for 10 days after a trip and to consult with a healthcare provider if they develop a cough, fever, breathing difficulty or any other illness during the period.

To find a doctor with travel medicine expertise, log on to the websites of the American Society of Tropical Medicine and Hygiene, www.astmh.org, and the International Society of Travel Medicine, www.istm.org. Both list members and note which have earned a certificate indicating they have passed the organizations’ professional exams.

Healthy Traveler appears every other week. Kathleen Doheny can be reached at kathleendoheny@earthlink.net.