Timing Questions: Fever since when, is it all the time or does it come and go, how often, when do they have fever, when is it worst, is it getting worse
How high have they recorded it? Any chills/shakes, night sweats, weight loss, anorexia, fatigue
When did they leave the UK and when did they return? Where did they go? Did they go directly there? Any stopovers? How long spent in each place? Exact dates of arrival and departure in each place. When did they become unwell?
Any other trips abroad in last few years? Where? Well during those trips?
Purpose of travel
Where did they stay? (hotel, dormitory, campsite etc)
Rural/urban, rich/poor area, poor sanitation
Mode of transport eg. plane,cruise, bus, train
Bites- insects/reptiles/mosquitos/ticks/flies/mites/fleas
Animals-bites/licks/other contact eg. dead/slaughtered/game parks/safaris/farms/caves. Which animals? Eg. antelope/bats/primates/sheep/cattle/rats/poultry/birds
Exposure to ill people eg. TB, duration of exposure. Are the rest of those who travelled well? Degree of contact with local people
Food and drink- raw/undercooked food, unbottled water, unpasteurised dairy, bush meat, shellfish, street food
Activities whilst away- fresh/salt water exposure eg. boating/swimming in lakes/rivers/scuba diving, soil, dust exposure eg.caving/mining/deserts, sports, walking eg. forests
Sex abroad- with/without condom, with a male/female partner, how many partners with an IVDU, with a sex worker, with a person with HIV
Any recreational drug use, needle sharing/tattoos/piercings/acupuncture
Any injuries/illnesses/hospital admission, tests and treatment eg. transfusions/surgery. Any contact with hospitals, dental work
Any funerals abroad/contact with blood/body fluids/specimens from live/dead person/animal known/suspected to have Ebola or other VHF
Any flooding/sewage exposure
Timing, nature and duration of associated symptoms:
CVS: CP, SOB, palps, syncope, ankle swelling, orthopnoea, PND
Resp: cough, sputum, SOB, pleuritic CP, sore throat, coryza, wheeze, haemoptysis, exercise tolerance
Abdo: N+V, abdo pain, constip/diarrhoea +/- blood, jaundice
Neuro: headache, weakness, sensory, seizures, neck stiffness, confusion, photophobia
Urinary: frequency, urgency, dysuria, colour, haematuria, itching
Haem: bleeding eg. from gums/nose/bowel etc, bruising
MSK/Rheum: joint pains/swellings, rash, red eye, mouth ulcers, hair loss, back pain, raynauds, myalgia
Derm: rash, ulcer, itch
GU: discharge, dysuria, testicular pain or swelling/pelvic pain
Dx: including pre travel advice and vaccine history (dates of vaccines pre-travel), malaria prophylaxis (which pill, start and stop dates, side effects, adherence, repellent, nets), antibiotics so far
PMH: including TB, HIV
Fx: including TB
Sx: alcohol, smoking, drug use, occupation eg. farmer, food handler, country of birth and when came to the UK, driving, sexual hx if not covered already previous travel history, pregnancies/conception plans
ICE (ideas, concerns, and expectations)
Systems review (if not already covered)
Investigations (select according to most likely cause):
FBC+differential, U+E, LFT, CRP, Clotting
Malaria blood films x3 and rapid diagnostic test
Blood cultures x3
Stool m,c,s and ova, cysts and parasites, virology, C Diff testing
Chest radiograph
Sputum m,c,s and AFBs x3 (and urine for AFBs)
Viral throat swab
Respiratory atypical screen (and urine antigen for legionella)
Urine dipstick and MSU for m,c,s
EBV, CMV
HIV, Hep B and C (+/- Hep A, D, E), syphilis test+ STI screen
Abdominal USS/CT abdomen
Serologic tests e.g. Dengue, chikungunya, amoebic, brucella, Ricketssial Abs, Q fever, leptospirosis, histoplasma, filarial, leishmania, hydatid, schistosomal, borrelia Abs
Examination of cerebrospinal fluid
Doppler USS leg+/- CTPA
Biopsy of skin lesion, lymph nodes, other masses, bone marrow