SORT Recommendations54 for the Evaluation and Treatment of a Child Who Presents as Ill after International Travel
| Recommendation | SOR* |
|---|---|
| Malaria may develop even when antimalarial prophylaxis has been properly taken. It must be excluded in any ill, febrile child who has traveled in a malaria-endemic zone in the year during presentation. | A |
| Nonsevere dengue is self-limited and care is supportive, whereas severe dengue (heralded by hemoconcentration—rising hematocrit or thickening of the gallbladder wall on ultrasound) requires hospitalization and intensive management focused on early recognition and treatment of shock. | A |
| Most traveler's diarrhea in children is caused by bacteria, but in children younger than age 2, viral etiologies may be more common, as may atypical and/or prolonged episodes of traveler's diarrhea. | B |
| Noninfectious etiologies should be considered when diarrhea persists and repeated investigations for infection are negative. | A |
| An child who appears ill and who has a rash (particularly if petechial or hemorrhagic) in association with fever should receive a priority work-up focused on ruling out serious conditions. | C |
| High absolute eosinophil counts (>1,000) in a returned pediatric traveler are predictive of parasitic infection, particularly with stays in the tropics of more than 3 months. | B |
* Strength of recommendation (SOR): A, good-quality patient-oriented evidence; B, inconsistent or limited-quality patient-oriented evidence; C, consensus, usual practice, opinion, disease-oriented evidence, case series.