Assessing patients with symptoms

Symptoms in migrants should be assessed as for non-migrant patients; however, where infectious disease is suspected the differential diagnosis should not only include infections commonly acquired in the UK, but also those that may occur in their country of origin. Migrants may present with infectious diseases on first arrival to the UK or following subsequent return visits to their home country after visiting friends and relatives (VFR). Healthcare practitioners should remain vigilant for this and investigate and manage appropriately. 

The following algorithms aim to assist the primary care practitioner in initial management of symptomatic migrant patients. They have been taken or adapted from those used in the UK Yellow Book [external link] 'Health Information for Overseas Travel' which has been produced by the National Travel Health Network and Centre for the initial management of returning travellers. Early referral to a specialist centre for advice and management is essential for those practitioners with little or no experience in managing infectious diseases acquired abroad. To find your local infectious disease specialists please see NHS choices [external link]

Dermatology algorithm (PDF, 16 KB)

Diarrhoea algorithm (PDF, 41 KB)

Eosinophilia algorithm (PDF, 51 KB)

Fever algorithm (PDF, 28 KB)

Respiratory diseases algorithm (PDF, 22 KB)

Schistosomiasis algorithm (PDF, 26 KB)

Note 1. A patient with a febrile illness who has arrived from or travelled to a malarious area must be urgently assessed for malaria. Malaria can be rapidly fatal if the diagnosis is delayed. Since 2005, the annual number of cases of imported malaria in the UK has been approximately 1,500. Those visiting friends and relatives accounted for more than 70% of cases. The majority of patients diagnosed with malaria in the UK have not taken chemoprophylaxis.

Algorithm for the Initial Assessment and Management of Malaria in Adults

Note 2. Eosinophilia in a migrant patient requires further investigation. Those potentially exposed to schistosomiasis should be screened. Helminth infections and strongyloides should be excluded with a concentrated stool examination and strongyloides serology respectively. Other investigations need to be tailored to the country of origin and referral to a specialist centre should be considered.

Note 3. Some migrants or VFR travellers may present to their GP without symptoms, but be concerned that they may have been exposed to one or more infections abroad. Please see the UK Yellow book [external link] for advice on asymptomatic post travel screening.

Note 4. Post-exposure prophylaxis for rabies may be required by migrant patients with a history of an animal bite abroad either before arrival in the UK or during travel to see friends and relatives. Please see the HPA's clinical rabies service guidelines.

Note 5. A searchable database of outbreaks occurring in the world is available on the NaTHNaC [external link] website. This is updated on a daily basis so can provide you with current information about possible infectious hazards.

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