Case 2: A five-year-old boy with fever after travel to South America

Abstract

A five-year-old boy presented with daily fevers (39°C to 41°C), leg pain and poor appetite after having returned from Venezuela five days previously. There were no other symptoms, and he was well between the episodes of fever. There was no rural exposure. The child and his parents drank bottled water, but shaved ice was consumed. They were exposed to mosquitos and had contact with sea turtles. They ate many different types of foods, including fresh fruits and vegetables, in a family setting. The mother experienced fever and diarrhea, and the father experienced a mild febrile illness during travel. The child was born in Canada and was previously well. His routine vaccinations were up to date but no pretravel care was provided. Examination revealed fever and mild, right upper quadrant abdominal tenderness. The remainder of the examination was otherwise unremarkable. Enteric fever was suspected and treatment was commenced with intravenous ceftriaxone. Laboratory investigations revealed a slightly low hemoglobin level with normal platelet levels and white blood cell count. His lactate dehydrogenase and C-reactive protein levels, as well as his erythrocyte sedimentation rate, were elevated. Urinalysis, liver enzymes and liver function tests were all normal. Three malaria smears were negative. His serology for acute cytomegalovirus, Epstein-Barr virus, dengue and parvovirus were negative. Three stool cultures and tests for ova and parasites were negative. A further test yielded the diagnosis.