TABLE 94.20 DIAGNOSIS AND TREATMENT OF COMMON INFECTIONS IN RETURNED TRAVELERS Disease ED-based testing Definitive diagnosis Treatment Amebiasis Stool (better for colitis) or serum (better for hepatic abscess) antigen detection Serology (better for hepatic abscess) Ancillary: leukocytosis, anemia, elevated ALT; abdominal imaging to help differentiate from pyogenic abscesses, Echinococcus, and malignancy Thick and thin smears with Giemsa/Wright staining Anemia, low haptoglobin, elevated lactate dehydrogenase, and reticulocyte count; thrombocytopenia common Serology (acute and convalescent titers) Lab should be notified that Brucella is suspected as cultures require an incubation of wks minimum Microscopy to detect eggs in stool or antigen detection (stool, serum) or serology Noninvasive or asymptomatic disease: p a luminal agent) Colitis: metronidazole Amebic abscess: metronidazole + parom luminal agent Serology Trimethoprim-sulfamethoxazole and rifa wks Addition of an aminoglycoside should b days in case of suspected meningitis, e osteomyelitis Campylobacter Stool culture Stool culture Chagas Giemsa Staining or direct Giemsa staining wet mount Serology testing available by CDC for chronic cases Fluid resuscitation Azithromycin (10 mg/kg) × days Benznidazole for 60–90 days or Nifurtimox available through CDC; seek Chikungunya Usually a clinical diagnosis: fever + severe arthralgia/arthritis + travel to or residence in endemic area within 15 days of symptom onset + virologic evidence Stool culture with use of salt-containing media (TBS) Ancillary: may see hypoglycemia, hypokalemia, and other electrolyte disturbances secondary to dehydration Stool culture for oocysts Babesiosis Brucella Cholera Cryptosporidium Visualization of Mild–moderate: atovaquone + azithromy trophozoites quinine for 7–10 days (Maltese cross) If parasitemia >10% (especially in asple Antibody detection by significant anemia, or hepatorenal or p indirect compromise, exchange transfusion sh immunofluorescence assays PCR is preferred in Supportive, nonsteroidal anti-inflammato early stages Small series have noted possible benefit Serology: IgM usually chloroquine, but these have not been v detectable in 2–7 days (lasts