Disseminated herpes simplex virus type 2 (HSV-2) infection in adults is rare but can result in severe complications including hepatitis, encephalitis, and sepsis-like illness. Early symptoms are often nonspecific and may mimic common conditions, leading to delayed diagnosis and treatment. We present the case of a 74-year-old woman with Sjögren's syndrome who initially developed left upper eyelid erythema and swelling, followed by a viral-like prodrome with fever and myalgia, and subsequent urinary symptoms prior to traveling abroad. She was hospitalized in Spain with fever, dysuria, and transaminitis. Abdominal ultrasound demonstrated gallbladder wall thickening and free fluid without biliary obstruction, and she was empirically treated with broad-spectrum antibiotics and corticosteroids for presumed urinary tract infection and biliary disease. A language barrier complicated communication and clinical evaluation. After approximately one week of persistent symptoms, she returned to the United States and was admitted to our institution, where she was found to have culture-negative sepsis, hyponatremia, encephalopathy, anasarca, and persistent transaminitis. Extensive bacterial and fungal infectious workup was negative. HSV-2 polymerase chain reaction (PCR) was positive, confirming disseminated HSV-2 infection. During the latter part of hospitalization, she developed a small cluster of vesicular lesions. The patient improved with intravenous acyclovir followed by oral valacyclovir. Diagnostic complexity was compounded by care across different healthcare systems and a language barrier. This case highlights the staged progression of disseminated HSV-2 infection, from localized mucocutaneous involvement through a systemic viral prodrome to organ-threatening disease, and underscores the importance of considering disseminated HSV-2 in patients presenting with culture-negative sepsis and transaminitis. Early recognition and prompt antiviral therapy are essential to reduce morbidity and mortality.

Alphavirus chikungunya is an arbovirus transmitted by Aedes mosquitoes and typically presents with acute-onset fever and severe polyarthralgia. In a subset of patients, joint symptoms may persist beyond the acute phase, leading to prolonged functional impairment. With increasing international travel, imported chikungunya infections have become an important consideration in non-endemic countries. In this report, we present a 58-year-old woman who was diagnosed with imported chikungunya infection after returning from Cuba, presenting with fever and widespread joint pain. On initial evaluation, C-reactive protein levels were markedly elevated, while procalcitonin levels remained within normal limits. The diagnosis was confirmed by demonstrating chikungunya virus-specific IgM positivity and IgG seroconversion in sequential serum samples. Viral RNA was not detected in molecular assays. Dengue, Zika, and other arboviral infections, as well as rheumatologic diseases, were excluded during the differential diagnosis. Despite treatment with antipyretics and non-steroidal anti-inflammatory drugs, the patient's joint pain persisted and significantly limited daily activities, necessitating opioid analgesics. Based on the persistence of symptoms beyond the acute phase but for less than three months, the clinical picture was consistent with subacute (post-acute) chikungunya-associated inflammatory arthralgia. Systemic corticosteroid therapy was initiated, resulting in partial clinical improvement. Disease-modifying antirheumatic drugs were not started, as the criteria for chronic chikungunya arthritis were not met. This case highlights the importance of considering chikungunya infection in travelers returning from endemic regions who present with fever and persistent arthralgia, even in the absence of rash. Early recognition and appropriate management during the subacute phase are crucial to improve patient outcomes and prevent progression to chronic disease.

In June 2026, an intensive care physician deployed in the Democratic Republic of the Congo and previously vaccinated against Ebola virus developed fatigue, nausea and headaches while returning to France. Bundibugyo virus was identified with RT-PCR. The patient was treated with remdesivir and recovered fully. Contact tracing identified five low-risk contacts and no secondary cases. Stringent infection prevention and control measures and multidisciplinary collaboration are important when managing suspected or confirmed Ebola disease cases, even with low viral loads.

Leptospirosis is an emerging zoonotic infectious disease in the adventure traveler with recreational freshwater exposure. We describe three cases of probable leptospirosis acquired during whitewater rafting trips in rural Ecuador. Rafting took place following periods of heavy rainfall and flooding of rivers, which are well documented risk factors for leptospirosis. Two of our patients presented to our rapid assessment clinic with acute febrile illness after travel to a region with a confirmed leptospirosis outbreak, while the third patient presented four weeks after a convalescent episode of acute febrile jaundice during a dramatic rise in reported leptospirosis cases in Ecuador. Delayed turnaround times for confirmatory microbiologic diagnostics in leptospirosis challenge its management and necessitate provisional clinical diagnosis and empiric antimicrobials based on compatible clinical symptoms, biochemical abnormalities, exposure history, and known outbreak epidemiology. We herein situate the presentations of our patients within the broader literature by reviewing the clinical, diagnostic, therapeutic, and prognostic considerations when caring for leptospirosis patients. Leptospirosis should be considered in the differential diagnosis of all patients presenting with acute febrile illness following adventure travel with freshwater exposure, and empiric treatment should be considered given the absence of readily available confirmatory microbiologic testing.

Dengue is a rapidly spreading mosquito-borne viral disease with increasing incidence in Europe, driven by international travel and climate-related expansion of Aedes mosquito habitats. Data on imported dengue in Central Europe remain limited. The aim of this study was to characterize clinical and epidemiological features of imported dengue infections in Austria and identify factors associated with dengue warning signs. A retrospective, single-centre observational study conducted from January 2013 to October 2024. We retrospectively analyzed 175 adults with confirmed travel-associated dengue treated in Vienna, Austria. Demographics, travel history, symptoms, laboratory values, and clinical outcomes were extracted from electronic records. WHO criteria were applied to classify dengue severity. Most infections were acquired in Southeast Asia (72.6%), particularly Thailand. Common symptoms were fever (97.1%), fatigue (97.1%), arthralgia (59.4%), and rash (53.8%). Dengue warning signs were observed in 16% of cases and associated with significantly prolonged leukopenia (p = 0.003), increased hospitalization rates (50.0% vs. 23.8%, p = 0.005), and higher frequencies of vomiting, abdominal pain, mucosal bleeding, and petechiae at first medical contact. Women reported rash, arthralgia, and retro-orbital pain more frequently, while men showed lower platelet counts. No cases of severe dengue or deaths occurred. Dengue should be considered in febrile returning travellers, particularly from Southeast Asia. The presence of warning signs predicts more complicated disease courses and should prompt closer clinical monitoring. These findings underscore the importance of awareness and preparedness for dengue in non-endemic European settings.

We report the case of a 36-year-old woman presenting with fever, jaundice, and haemolysis after recent travel to Ghana. She was ultimately diagnosed with concurrent infections: Plasmodium falciparum (P. falciparum), parvovirus B19, Epstein-Barr virus (EBV), respiratory syncytial virus (RSV), and Borrelia burgdorferi (Lyme disease). Her course was complicated by profound haemolysis, acute kidney injury, and persistent fever despite antimalarial therapy. This case highlights the diagnostic and therapeutic challenges of polymicrobial infections in returning travellers, the overlapping mechanisms of haemolysis, and the importance of a multidisciplinary approach to care.

Sarcocystosis is an emerging zoonotic disease caused by apicomplexan parasites of the genus Sarcocystis, which can infect a wide range of hosts, including humans, animals, reptiles, and birds. Humans may serve as either definitive or intermediate hosts, depending on Sarcocystis species. Consumption of undercooked beef containing mature sarcocysts of Sarcocystis hominis or Sarcocystis heydorni, or of raw or partially cooked pork containing Sarcocystis suihominis zoitocysts, may lead to intestinal sarcocystosis in humans. In contrast, muscular sarcocystosis follows ingestion of food or water contaminated with zoonotic Sarcocystis spp. sporocysts, as evidenced by infection outbreaks by Sarcocystis nesbitti among travelers returning from exotic destinations in Malaysia. Further, Sarcocystis fayeri, which cycles between horses and dogs, has been implicated in cases of food poisoning in humans following consumption of raw horse meat. Clinical features range from asymptomatic cases to acute symptoms, such as muscle pain, fever, and, in severe cases, neurological complications. Diagnosis relies on clinical presentation supported by microscopy, histopathology, serology, and advanced molecular techniques. Therapeutic options are limited; antiprotozoal agents including sulfadiazine, pyrimethamine, decoquinate, clindamycin, and triazine derivatives have shown high efficacies. Preventive measures focus on hygienic meat handling, thorough cooking, and restricting carrion scavenging by stray carnivores. Increasing human-wildlife interactions elevate the risk of cross-species transmission of novel Sarcocystis species. Adopting a One Health approach is fundamental for understanding the epidemiology and transmission dynamics of zoonotic sarcocystosis and reducing future outbreaks through effective diagnostics, therapeutics, and preventive interventions.

The 2026 Ebola outbreak caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda has prompted European countries and the United States to revise measures for travellers, healthcare workers and humanitarian personnel returning from affected areas. We compare current procedures and protocols with those implemented during the 2013-2016 Ebola outbreak. Despite some national differences, policies have largely converged towards risk-based management, early case detection, rapid isolation, exposure-based monitoring and healthcare preparedness, rather than routine border screening.

African tick bite fever (ATBF) is a spotted fever group rickettsiosis caused by Rickettsia africae and is often identified among travelers returning from sub-Saharan Africa. Clinical presentation may be mild or nonspecific, often delaying diagnosis despite characteristic findings such as inoculation eschars. A 52-year-old male presented to the preoperative holding area prior to a scheduled left-sided inguinal hernia repair after recently returning from a game-hunting trip to Africa. During preoperative intake, he was noted to have a fever of 106 °F despite being otherwise asymptomatic. Physical examination revealed two black eschars on the patient's back and right shin. Given the presence of high-grade fever, the scheduled procedure was canceled, and the patient was discharged for outpatient evaluation. He was subsequently treated with a 10-day course of doxycycline for suspected African tick bite fever. At two-week follow-up, the patient remained asymptomatic, his fever had resolved, and repeat preoperative evaluation was unremarkable. Surgical repair of the inguinal hernia was performed without complications. Although laboratory confirmation was not obtained, the clinical presentation, including characteristic eschars, high-grade fever, and recent travel to sub-Saharan Africa, was highly suggestive of ATBF. This case underscores the importance of maintaining clinical suspicion for ATBF in returning travelers and highlights the diagnostic value of inoculation eschars, even in the absence of systemic symptoms. Early recognition of suspected ATBF and empiric doxycycline therapy may result in rapid clinical improvement and help prevent unnecessary delays in care.

Background: International travel has increased over recent decades, leading to a rise in the number of patients presenting to emergency departments (EDs) with fever after returning from abroad. Evaluating fever in returning travelers is challenging because the differential diagnosis is broad, and exposure to tropical diseases limited, among most ED clinicians. Objective: This article aims to provide a practical overview of the most common travel-related causes of fever. The tool is intended to support targeted diagnostics and timely treatment and/or timely specialist referral, while emphasizing that non-travel-related infections must also be considered. Methods: We created a clinical summary of the most common causes of fever in returning travelers based on epidemiology, incubation periods, clinical features, and diagnostic approaches. A practical overview was created to aid ED clinicians in evaluating stable patients, incorporating travel history, exposure risks, and key clinical findings. Results: Malaria, dengue and typhoid fever are among the most common diagnoses in travelers returning from abroad, excluding non-travel-related diseases. These conditions share overlapping symptoms. Diagnosis relies on clinician awareness and a combination of exposure history, clinical evaluation, and targeted laboratory testing. Treatment depends on the causative pathogen and disease severity, but often requires early empiric therapy and supportive care. Conclusions: This article presents a systematic, pragmatic approach to the evaluation of fever in the returning traveler. This overview is designed to help ED clinicians recognize and make appropriate initial management and referral decisions when assessing a stable traveler. Nevertheless, we recommend specialist advice for most cases.

Visceral leishmaniasis (VL) is a rare but increasingly recognized parasitic infection in non-endemic European regions, including Romania. We report two cases of VL diagnosed in Timiș County, Western Romania, in 2020: a 57-year-old male presenting with fever, massive splenomegaly, and severe pancytopenia, and a 51-year-old male presenting atypically with fatigue, bicytopenia, and absence of organomegaly. Both patients were diagnosed through bone marrow aspirate examination revealing Leishmania amastigotes. Both cases were classified as imported VL, with exposure linked to endemic regions of eastern Spain (Castellón and València). These cases highlight the importance of maintaining a high index of clinical suspicion for VL in patients presenting with unexplained cytopenias and elevated inflammatory markers, even in the absence of classic features such as hepatosplenomegaly. The present report underscores the relevance of travel history in non-endemic regions such as Romania and the need for clinical awareness of imported VL in patients returning from endemic areas of southern Europe.