THE TRAVELER RETURNING FROM THE TROPICS I N PRACTICE

Travellers returning from the tropics frequently consult a physician e ven if they have no actual symptoms. Physical check-ups in asymptomati c returnees rarely detect dangerous conditions. The most common labora tory finding is intestinal parasites. Blood eosinophilia may indicate helminthic infections, such as strongyloidosis, filariosis, schistosom iasis and others. If there are no diagnostically suggestive symptoms a systematic, step-by-step workup is recommended (stool parasitology, s erology, and special methods to demonstrate parasites in blood or tiss ues). The most common symptom of returnees from the tropics is diarrhe a, or other disorders of intestinal motility. Appropriate investigatio ns include parasitological and bacteriological tests, and - if the cou rse is more chronic - endoscopy. If diarrhea is associated with fever, systemic infections (e.g. falciparum malaria) must be considered. Fev er as a leading sign may mask a number of potentially dangerous infect ions. If there are no other obvious signs or symptoms indicating a par ticular etiology, the diagnostic approach should consider first of all those systemic infections, which are potentially life-threatening and can be cured by specific therapy, i.e. bacterial meningitis, falcipar um malaria, septicemia (including typhoid fever), extraintestinal ameb iasis, and African trypanosomiasis.