Answer 91 - Fever, diarrhoea and eosinophilia:
Fever, diarrhoea and eosinophilia in a returned traveller may be due to each of the following as the sole causative agent:
True a. Strongyloides stercoralis
False b. Aeromonas hydrophila
True c. Schistsoma mansoni
True d. Capillaria philippinensis
False e. Plasmodium falciparum
The combination of fever, diarrhoea and eosinophilia is suggestive of invasive helminthiasis:
| Helminth infections |
| Helminth infection |
Additional prominent symptoms/ signs |
| Strongyloides stercoralis |
upper abdominal pain |
| Capillaria philippinensis |
chronic fatty diarrhoea |
| Fasciola hepatica |
hepatomegaly |
| Schistosoma mansoni |
hepatomegaly, urticaria |
| Schistosoma japonicum |
hepatomegaly, urticaria |
The precise travel history may exclude some diagnoses.
Although there is no eosinophilia in malaria, it should be assumed that this is the cause of any fever in a returned traveller until proven otherwise. Not uncommonly multiple infections are acquired so the malaria patient, for example, may also have hookworm infection.
Aeromonas species may cause travellers' diarrhoea but not eosinophilia.
