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JAMA Clinical Challenge
April 4, 2017

Fever in a Traveler Returning From Africa

Author Affiliations
  • 1Division of Infectious Diseases, University of Michigan Health System, Ann Arbor
  • 2Department of Pathology, University of Michigan Health System, Ann Arbor
JAMA. 2017;317(13):1370-1371. doi:10.1001/jama.2016.19729

A 35-year-old man presented to the emergency department with 4 days of fever (temperature up to 39°C), extreme weakness, fatigue, and 1 to 2 days of progressive confusion. He was born in the United States but had traveled to Sierra Leone for a period of 3 weeks and had returned 1 week prior to presentation. He did not take any form of malaria prophylaxis, nor did he use insect repellent while traveling. He previously received the yellow fever vaccine but not hepatitis A or typhoid vaccination.