Harefuah
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The authors review a case of an Indian tourist couple both presenting a clinical picture of intermittent fever, thrombocytopenia and relative leukopenia several days after their arrival to israel. The diagnosis of Plasmodium vivax (P.vivax) malaria was established in both patients and antimalarial treatment with chloroquine was initiated. Shortly after initiating the treatment, the husband developed clinical acute respiratory distress syndrome (ARDS). ⋯ The diagnosis of P. vivax was confirmed by PCR, and was shown to be a single infection with no Plasmodium falciparum as co-infection. Although P. vivax is considered as having a benign course, in contrast to P. falciparum infections, in recent years there have been an increased number of reports of complicated P. vivax malaria, mainly ARDS. Physicians should be aware of the possible complicated course of P. vivax malaria.
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Fever is one of the most common complaints in returned travelers and accounts for about 25% of cases seeking medical care. Fever is one of the most challenging conditions since fever may be the manifestation of a self-limited, trivial infection, or on the other hand, can be the presenting sign of an infection that could be rapidly progressive and lethal. The list of infections that should be considered includes common, worldwide (cosmopolitan) infections as well as unique tropical diseases, related to specific regions (malaria, dengue fever, enteric fever, schistosomiasis, leptospirosis, rickettsia). ⋯ A routine laboratory work-up may offer important clues to the final diagnosis. Initial attention should focus urgently on infections that are treatable, transmissible, and that cause serious sequelae or death. Finally, malaria must be ruled out in any febrile traveler returning from endemic regions.
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In recent years infections with Rickettsia africae (African tick bite fever) have become a common and important cause of febrile illness among travelers returning from Sub-Saharan Africa, primarily from South Africa. ⋯ African tick bite fever is frequent among Israeli travelers to Sub-Saharan Africa. Travelers should be counseled on tick bite prevention. Increased awareness of the disease among Israeli physicians may prevent diagnostic delays.