AKT – Travel Medicine

John Walsh, aged 28, presents for pre-travel advice before embarking on a six-month backpacking trip through sub-Saharan Africa.

He has no significant past medical history and takes no regular medications. He is up to date with all standard childhood and adult immunisations including COVID-19, and is a non-smoker with no allergies. He reports good health and no prior travel to tropical regions.

On review, he has a normal physical examination and his vitals are within normal limits. He plans to travel through Kenya, Tanzania, Uganda and Nigeria, mostly staying in hostels and local accommodation.

Which ONE of the following vaccinations is MOST appropriate to recommend in addition to standard travel vaccines?

Maya Sharma, aged 36, returns from a two-week trip to Thailand and presents with a 4-day history of fever, headache and a maculopapular rash. She reports myalgia and retro-orbital pain. She denies respiratory or urinary symptoms.

No significant past medical history. No regular medications. She received pre-travel vaccinations and took precautions against mosquito bites.

On examination: Temperature 38.6°C, pulse 95/min, BP 110/70 mmHg. She is alert but fatigued. There is a blanching rash on her trunk and limbs.

Which is the MOST likely diagnosis?

Peter Long, aged 52, presents for a review after returning from a cruise in the Caribbean. He developed profuse watery diarrhoea on day 3 of the cruise, which has persisted intermittently over 10 days. He is now back in Australia and reports 3–4 loose stools per day with urgency but no blood or fever.

He has mild hypertension on perindopril and no other conditions. Stool culture done overseas was negative. He is afebrile today, with stable vitals and mild abdominal tenderness.

What is the MOST appropriate next step?

Leanne Tam, aged 45, presents for travel advice prior to a three-week trip to India where she plans to volunteer in a rural health post. She has no medical conditions and is not on any regular medications. She has previously travelled to Southeast Asia without issue.

She is particularly concerned about preventing traveller’s diarrhoea.

Which ONE of the following is the MOST effective preventive measure?

Oscar Evans, aged 63, presents for advice about malaria prevention before a four-week trip to Papua New Guinea for volunteer work. He will be based in a rural village near sea level and will travel during the wet season. He has a history of controlled type 2 diabetes and takes metformin 500 mg BD.

He has normal renal function and no known allergies. He has previously tolerated chloroquine poorly with vivid dreams and insomnia.

Which is the MOST appropriate malaria chemoprophylaxis for him?

Eliza Martin, aged 31, presents after returning from a honeymoon in Bali. She reports three days of low-grade fever, malaise, and painful swelling in both ankles and wrists. She also mentions a pruritic rash that started on her arms and spread to her torso.

She has no past medical history and is not on any medications. She is not pregnant. Her vitals are within normal limits except for a temperature of 38.2°C. Examination reveals swollen, tender wrists and ankles with a faint blanching rash on the trunk.

What is the MOST likely diagnosis?

Mohammed Aziz, aged 67, presents for pre-travel consultation before visiting his extended family in rural Pakistan for two months. He has type 2 diabetes managed with gliclazide and metformin. He had childhood vaccinations in Pakistan but is unsure of his current status.

On review, he is well with stable glycaemic control and no recent infections. His last tetanus booster was over 15 years ago.

Which of the following vaccinations is MOST important to administer today?

Ashwin Rao, aged 24, returns from a surf trip to Costa Rica. He presents with a 5-day history of fever, chills, headache, and calf pain. He reports swimming in freshwater lagoons and hiking in muddy terrain. He denies cough, dysuria or rash.

On exam: T 38.7°C, HR 92/min, BP 120/78 mmHg. Scleral injection is noted. There is no meningism or focal neurological signs.

What is the MOST likely diagnosis?

Rachel Wong, aged 29, presents for travel health advice before a planned trek to the Annapurna Circuit in Nepal. She is generally fit and well, takes the oral contraceptive pill and has no medical conditions.

She asks about altitude sickness as the trek will involve passes up to 5,400 metres. She has never previously travelled above 3,000 metres.

What is the MOST appropriate pharmacological prophylaxis to consider for her?

Brian De Luca, aged 40, presents with a painful lesion on his lower leg two weeks after returning from a hiking trip in the Amazon. He initially noticed a small red bump which has now ulcerated with a raised edge and central scab. He denies systemic symptoms. No other lesions are present.

He has no medical history, is immunocompetent, and took malaria prophylaxis during travel.

What is the MOST likely diagnosis?

Danielle Petros, aged 22, presents with fever, fatigue and a generalised maculopapular rash that developed three days after returning from Brazil. She is sexually active and uses condoms inconsistently. She is unsure of her immunisation history. She denies sore throat or respiratory symptoms.

On examination: T 38.3°C, pulse 86/min, BP 110/70 mmHg. There is a faint, non-pruritic rash over her arms, trunk, and face, with bilateral posterior auricular lymphadenopathy. She is not pregnant.

What is the MOST likely diagnosis?

Colin Jenkins, aged 60, is planning to travel to the Philippines for four weeks. He has a history of ischaemic heart disease and is on aspirin, atorvastatin and bisoprolol. He mentions he often needs medication for travel-related motion sickness.

Which is the MOST appropriate agent to manage motion sickness in this patient?

Sophie Nguyen, aged 19, presents requesting travel vaccines prior to a 4-month volunteer teaching placement in rural Cambodia. She has no significant medical history. She has had all childhood vaccines and a recent COVID-19 booster.

Which ONE of the following vaccines is MOST important for this destination and length of stay?

Thomas Bell, aged 37, presents with two days of fever, chills, and headache. He returned five days ago from Papua New Guinea where he was working in construction. He took malaria prophylaxis but missed several doses. Examination reveals a temperature of 39.2°C and mild splenomegaly.

What is the MOST appropriate next investigation?

Katherine O’Brien, aged 34, presents after a recent trip to South-East Asia. She has developed paraesthesia and weakness in her lower limbs that started five days ago. She also reports low-grade fever and malaise before onset. She has no significant past history.

Neurological examination reveals symmetrical lower limb weakness, areflexia, and preserved sensation. Cranial nerves are intact.

What is the MOST likely diagnosis?

Helen Zhou, aged 44, presents two days after returning from a business trip to Vietnam with painful swelling around an insect bite on her right calf. She recalls being bitten by a mosquito five days ago and reports increasing redness and warmth around the site. She is systemically well with no fever.

On examination, the bite area is erythematous, tender, and approximately 5 cm in diameter with no central necrosis or fluctuance. No lymphangitis is observed.

What is the MOST appropriate next step in management?

Samuel Hayes, aged 58, presents after developing shortness of breath and dry cough while trekking in the Andes in Peru at altitudes above 3,500 metres. He has returned to Lima and reports persistent dyspnoea, mild cough, and fatigue. He is otherwise fit and on no regular medications.

On examination: oxygen saturation is 92% on room air at sea level, and chest auscultation reveals bilateral crackles at the bases.

What is the MOST likely diagnosis?

Maria Gonzales, aged 33, presents one week after returning from Mexico with low-grade fevers, abdominal bloating, and intermittent loose stools. She has no blood in stool and no significant vomiting. She reports drinking bottled water but eating street food frequently.

On examination, she is afebrile, with mild abdominal tenderness and no signs of dehydration. Stool microscopy is pending.

What is the MOST likely diagnosis?

Andrew Tsi, aged 26, presents for advice before embarking on a surfing holiday to Fiji. He has no past medical history and takes no medications. He plans to surf in remote locations and camp along the coast for three weeks.

Which of the following is the MOST appropriate vaccination to offer in addition to routine travel vaccines?

Olivia Turner, aged 38, presents with persistent eosinophilia detected on routine blood tests three weeks after returning from hiking in Laos. She feels well and has no gastrointestinal or respiratory symptoms. She recalls walking barefoot in muddy areas during the trip.

What is the MOST likely cause of her eosinophilia?

Louis Ferris, aged 47, presents after returning from a 2-week trek in Uganda. He developed an acute febrile illness 3 days after returning to Australia, with headache, myalgia, and nausea. He did not take malaria prophylaxis and stayed in rural lodges. On examination: T 39.1°C, HR 104/min, BP 110/68 mmHg. He appears flushed and mildly dehydrated. No rash or lymphadenopathy noted.

What is the MOST appropriate next investigation?

Jessica Lin, aged 30, presents with a painful genital ulcer that developed one week after returning from a trip to Thailand. She had unprotected sex with a new partner while overseas. The lesion is tender, with a ragged base and purulent discharge. She has unilateral tender inguinal lymphadenopathy and no systemic symptoms.

What is the MOST likely diagnosis?

Patrick Bourke, aged 63, presents for travel health advice before a three-month trip to India. He has type 2 diabetes and well-controlled hypertension. He plans to visit both urban and rural areas and spend time with local communities. He is unsure about his previous BCG status and is concerned about tuberculosis risk.

What is the MOST appropriate next step regarding TB prevention?

Aliyah Hassan, aged 26, presents with fevers, arthralgia, and conjunctivitis four days after returning from Tonga. She is 10 weeks pregnant. She used mosquito repellent but was bitten several times. Examination reveals a faint rash on her arms and mild joint swelling in both wrists.

What is the MOST appropriate next step?

David Nair, aged 35, presents after returning from Papua New Guinea where he worked in remote areas. He reports a painless scrotal swelling that developed slowly over 3 weeks. There is no fever or dysuria. On exam, the right hemiscrotum is enlarged and non-tender with a thickened spermatic cord.

What is the MOST likely diagnosis?

Grace Holloway”

Vinay Rao, aged 31, presents after returning from South America with fever, jaundice, and malaise. He spent time in rural Brazil, including jungle areas. He did not receive any vaccinations prior to travel. On examination: T 38.9°C, scleral icterus, and hepatomegaly. No rash is noted.

Which is the MOST likely diagnosis?

Emma Singh, aged 22, presents for travel advice before a 6-week university exchange in the Solomon Islands. She will be living in student accommodation with local families and consuming local food and water. She has never had hepatitis A or typhoid vaccinations.

Which of the following vaccinations is MOST essential before travel?

Michael Tran, aged 36, presents with a persistent dry cough and low-grade fever three weeks after returning from Afghanistan. He spent several nights sleeping in crowded shelters. He is otherwise healthy and a non-smoker. His CXR reveals right upper lobe infiltrates and cavitation.

What is the MOST likely diagnosis?

Sophie Delaney, aged 49, presents with a chronic non-healing ulcer on her forearm after returning from a remote region in Iran. The lesion began as a small red papule and slowly enlarged. She denies systemic symptoms. She tried topical antibiotics with no improvement.

What is the MOST likely diagnosis?

Timothy Scott, aged 29, presents with a low-grade fever, fatigue, and lymphadenopathy two weeks after returning from Kenya. He volunteered at a wildlife sanctuary and had frequent exposure to cats and dogs. He also reports a painless ulcer on his arm that developed after a scratch from a stray kitten.

On examination, he has a 1.5 cm ulcer with a crusted centre and tender axillary lymph nodes on the same side.

What is the MOST likely diagnosis?

Naomi Feldman, aged 38, presents with a four-week history of eosinophilia detected on blood tests. She recently returned from visiting family in rural Laos, where she swam in local rivers and walked barefoot. She has no symptoms, and her physical examination is normal.

What is the MOST appropriate next investigation?

Angus Fraser, aged 42, presents after a trip to rural Indonesia. He has fever, confusion, and neck stiffness. His wife reports he had a high fever for two days, and today became drowsy and disoriented. He is normally well and takes no medications.

On examination: T 39.5°C, GCS 13, photophobia, and positive Kernig’s sign. There is no rash. He received standard immunisations before travel but declined optional vaccines.

What is the MOST likely diagnosis?

Isla Buchanan, aged 55, presents with fever, abdominal pain, and watery diarrhoea two weeks after returning from a trip to Egypt. She ate from street vendors and had a few days of self-limiting diarrhoea while travelling, which has now recurred. She feels lethargic and has mild right upper quadrant tenderness.

What is the MOST likely diagnosis?

Leo Zhang, aged 27, presents for review one week after returning from a jungle trek in northern Queensland. He reports a red eschar on his right leg and several days of fever, headache, and a generalised maculopapular rash. He recalls being bitten by insects despite using repellent.

On examination, there is a black eschar at the bite site and a faint rash over the trunk and limbs.

What is the MOST likely diagnosis?

Amira Soliman, aged 33, presents for a travel consultation. She is planning a 6-week stay in a rural village in Bangladesh, working in a community health project. She will be staying with a local host family and eating home-cooked meals. She has no medical conditions and her last vaccinations were in high school.

Which of the following vaccinations is MOST important to provide before travel?

Marcus Dinh, aged 21, presents with high fevers, retro-orbital pain, severe myalgia, and a blanching rash after returning from a music festival in Thailand. He is febrile at 39.5°C and has a petechial rash on his legs. Platelet count is 75 × 10⁹/L.

What is the MOST likely diagnosis?

Elena Marques, aged 40, presents with a two-week history of dry cough, low-grade fever, and fatigue. She returned from Vietnam one month ago where she worked in a TB clinic. CXR shows apical opacities and a cavitating lesion in the right upper lobe. She is otherwise well and has no past medical history.

What is the MOST appropriate next step?

Lucia Romano, aged 34, presents with fever, abdominal cramps, and bloody diarrhoea after returning from a trip to Peru. She ate from street vendors and did not take any prophylactic medications. On examination: T 38.4°C, mild abdominal tenderness, no signs of dehydration.

What is the MOST appropriate empirical antibiotic therapy?

Richard Nkomo, aged 46, presents with persistent fever, dry cough, and malaise two weeks after returning from Nigeria. He visited family and attended a funeral in a rural village. On examination: T 38.7°C, BP 102/66 mmHg, HR 104/min, and he appears flushed. No focal signs. A malaria smear is negative.

What is the MOST appropriate next investigation?

Charlotte DeWitt, aged 32, presents with fever, chills, and a persistent cough with blood-streaked sputum. She recently returned from a two-month backpacking trip in Bolivia, where she hiked in high-altitude rural areas. She did not receive any pre-travel vaccinations. On examination, she is febrile at 38.6°C with oxygen saturation of 94% on room air.

Which is the MOST likely diagnosis?

Sanjay Mehta, aged 50, presents with fatigue, anorexia, and dark urine two weeks after returning from a business trip to Egypt. He reports having shared meals with local colleagues and eating seafood. On examination, he is jaundiced with mild RUQ tenderness. His LFTs show elevated transaminases and bilirubin.

What is the MOST likely diagnosis?

Emily Tran, aged 24, presents for travel advice prior to a 4-month internship in Cambodia. She will be based in Phnom Penh and also spend weekends in rural villages. She is fully vaccinated for routine Australian immunisations including hepatitis B. She is a vegetarian and plans to eat locally prepared food.

Which of the following vaccinations should be prioritised?

Mohammed Al-Khatib, aged 60, presents with progressive lower limb swelling and a dragging sensation in his groin. He recently returned from visiting family in coastal India for two months. Examination reveals unilateral scrotal swelling with non-pitting oedema and thickened skin. He is afebrile and systemically well.

What is the MOST likely diagnosis?

Yuki Sato, aged 26, presents with a week of worsening headache, fever, and vomiting. She recently returned from a hiking trip in rural Nepal. She is drowsy, photophobic, and has neck stiffness on examination. CT brain is normal. CSF analysis shows elevated protein, low glucose, and lymphocytic predominance.

What is the MOST likely diagnosis?

Rina Patel, aged 39, presents with low-grade fevers, night sweats, and a dry cough for three weeks. She returned from a visit to her family in rural Pakistan one month ago. She stayed in a crowded household and had contact with a relative who was coughing persistently. Examination is unremarkable. Chest X-ray shows right upper lobe infiltrates with cavitation.

What is the MOST likely diagnosis?

Jeremy Ng, aged 34, presents with fever, myalgia, and severe headache after returning from a jungle expedition in northern Queensland. He has a crusted eschar on his right calf and a faint maculopapular rash over his trunk. Examination shows mild lymphadenopathy and temperature of 38.7°C.

What is the MOST likely diagnosis?

Sofia Mendes, aged 29, presents one week after returning from Cambodia with watery diarrhoea, nausea, and bloating. She denies fever or blood in the stool. She took no antibiotics and has been drinking oral rehydration salts. Examination is unremarkable. Stool microscopy shows flagellated trophozoites.

What is the MOST likely diagnosis?

Rachel Kemp, aged 44, presents with low-grade fever, malaise, and hepatosplenomegaly two weeks after returning from Sudan. She spent time in rural areas and recalls numerous insect bites. She is pale and mildly jaundiced. Her blood film reveals intracellular amastigotes.

What is the MOST likely diagnosis?

Tomoko Arai, aged 58, presents after returning from the Philippines with a 6-day history of fever, headache, and vomiting. She is confused and has a seizure in the waiting room. Her travel was to rural rice farming areas, and she has not had any vaccinations in over 10 years. CSF shows elevated lymphocytes and protein with normal glucose.

What is the MOST likely diagnosis?