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This review will be focused on the acute respiratory tract infections as aetiology of acute respiratory distress in the returned traveller. Besides influenza and respiratory syncytial virus (RSV) infections, other aetiologies including Hantaan virus, hantavirus, coronavirus, chlamydia, mycoplasma and rickettsiae can affect the respiratory tract [ 82 ]. For information on the management of acute respiratory infections refer to standard guidelines [ 83 ].
Returning travellers with chronic pulmonary diseases such as COPD present a special challenge to clinical management. Care should be taken to exclude asthma in the returned traveller [ 54, 84 ]. Many patients with COPD are not aware of their condition and may not present with respiratory symptoms. The clinical suspicion of COPD in the returned traveller should not be overlooked; once COPD is suspected non-specific symptoms such as cough, breathlessness and sputum production should be sought. Non-specific COPD exacerbations are commonly managed with bronchodilators, such as albuterol and ipratropium bromide [ 85 ]. Azithromycin, either alone or in combination with a β2-agonist, may be useful for COPD exacerbation [ 85 ].
Common infectious causes of fever in the returned traveller should be considered in patients presenting with a febrile illness. A systematic approach to the diagnosis of fevers in the returned traveller is essential [ 86 ]. The most common infections are due to common viral and bacterial pathogens [ 87 ]. 3d9ccd7d82
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