a leukocytosis with a neutrophilic predominance, and blood cultures (aerobic and anaerobic) should be obtained, as bacteremia is present in a majority of cases Fasciitis is a medical and surgical emergency Debridement is needed in many instances to prevent spread to adjacent tissues Antimicrobial therapy should be targeted toward GAS, S aureus, and anaerobes, especially with fasciitis of the head and neck (or any area with evidence of gas production in the tissues) Multidrug empiric therapy with penicillin (which is more bactericidal for GAS than clindamycin or vancomycin), clindamycin (for anaerobic coverage), and vancomycin (for MRSA) should be initiated Contact precautions should be used INFECTIONS IN RETURNED TRAVELERS Introduction Over the last 20 years, there has been an enhancement of medical provider networks designed to improve surveillance and medical care for international travelers More than 80% of U.S citizens visiting pretravel clinics are traveling to resource-poor countries, with Africa being the most commonly visited region Approximately 38 million residents of the United States traveled internationally in 2017, with approximately 9% reporting travelassociated illnesses While most are mild, self-limited conditions, such as traveler’s diarrhea, a proportion of these individuals will present to the ED after returning home Pediatric travelers may be classified into several groups: children returning from international travel; children returning from visiting friends and relatives (VFRs) in the child or parents’ country of origin; international adoptees; and recently emigrated children These groups may have distinct risk factors for infection and certain groups (VFRs) historically have been at higher risk for travelassociated infections because their families infrequently seek medical attention prior to international travel It is critical for the emergency medicine provider to ask families not only about locations to which the child has traveled ( Table 94.18 ) for infections common in specific regions, but what regions (e.g., urban vs rural) the child visited and what activities were undertaken Knowing when a child returned home can help determine the possible incubation period, narrowing the differential diagnosis to certain pathogens The incubation period and symptoms of most common diseases in the returned traveler are summarized in Table 94.19 , and the diagnosis and treatment of these diseases are presented in Table 94.20 These diseases are categorized in one of three ways: diseases endemic in both industrialized and developing nations; vaccine-preventable illnesses more common internationally; and diseases endemic only outside industrialized nations