Typhoid fever vs. malaria in a febrile returning traveler: Typhomalaria revisited - An Oslerian perspective

Diagnostic efforts are usually centered on malaria in febrile travelers returning from the tropics. However, by focusing on malaria other important diagnostic considerations are easily overlooked. Patients returning from malarial areas are also exposed to other tropical diseases which have features in common with malaria, e.g., typhoid fever, dengue fever, chikungunya fever. However, there are a few key findings that clinically differentiate these infections from malaria. We present a case of a traveler with fever returning from India without localizing signs with persistent monocytosis initially thought to have malaria. (C) 2012 Elsevier Ltd. All rights reserved.