Eve B. Hoover is completing a postgraduate academic fellowship at Midwestern University at Glendale, Arizona, and practices at Logistics Health, Inc, in Phoenix. The author has no significant financial relationships to disclose.
As the number of international travelers increases, so does the likelihood of transmission of illnesses to locations where they were previously rarely diagnosed. Clinicians at college health centers must be aware of tropical medicine diagnoses, especially in returning international students who have fever and other constitutional symptoms. This article provides a refresher regarding the diagnoses of malaria, dengue fever, and chikungunya.
Travel, whether for work, education, or pleasure, continues to increase, with the number of international travelers exceeding 1.1 billion in 2014.1 International travelers may unknowingly expose themselves and others to multiple health hazards previously thought to be foreign to the United States. Jane Zuckerman, who works with the World Health Organization (WHO), has noted that just over a century ago, the first human flew in an aircraft.2 Now, the sky is no longer the limit, and genes and micro-organisms travel as freely as their human hosts.
The international student population at American universities is at an all-time high (see Figure 1). Study abroad programs, which include American students who travel to developed and underdeveloped countries, also continue to increase. According to the CDC, the number of American students studying abroad has increased more than threefold in the past 20 years.3 According to the Institute of International Education, 304,467 American college students studied abroad in 2013/2014.4 Historically, most American students studied abroad in European countries, but in recent years the list of destinations has expanded, with increases in the percentage of students who travel to Africa, Asia, and the Middle East, and decreases in the percentage choosing Europe and Oceania.3
The sizable number of international students at universities, combined with the study abroad programs, have broadened the scope of the campus health care provider’s differential diagnosis. Diseases and infections that occur in developing countries can differ from those commonly seen in the US and Europe. It is important for health care providers to be reminded of conditions they seldom see and for a tropical medicine zebra to be considered in the appropriate patient population.
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