Box 1: Differential diagnosis for infectious causes of fever and rash in the returned traveller68
DiseasePathogenRashClinical featuresDiagnosis
MalariaPlasmodium speciesUncommon; petechial hemorrhage may be seen in severe casesCyclic fever, headaches, myalgiasThick and thin blood smears; rapid antigen test
Dengue feverFlavivirusMaculopapular rash over the trunk with sparing of the palms and solesFever, retro-orbital pain, severe myalgia (“break-bone fever”)Serology
Chikungunya feverChikungunya virusMaculopapular rash with discrete areas of sparingFever, headache, severe arthralgia and arthritisSerology
Infectious mononucleosisEpstein–Barr virusMaculopapular urticarial rash associated with antibiotic useFever, pharyngitis, lymphadenopathy, hepatitisMonospot test; serology
Scarlet feverβ-hemolytic Streptococcus pyogenes“Sandpaper-like rash” on the trunk, spreading to the extremitiesFever, headache, exudative pharyngitis, cervical lymphadenopathy, strawberry tongueThroat culture; rapid antigen test; antistreptolysin O titres
Erythema infectiosumParvovirus B19“Slapped-cheek” rash progressing to lacy reticular rash over the trunk and extremitiesFever, headache, coryza, arthritis, arthralgiaSerology
Rubeola (measles)Measles virusMaculopapular rash beginning on the face and neck, spreading centrifugallyFever, coryza, conjunctivitis, Koplik spotsSerology
RubellaRubella virusPink maculopapular rash beginning on the forehead, then spreading over the trunkFever, lymphadenopathy, arthralgias, arthritis, petechiae on the palateSerology