What infectious disease tests would you order for someone who recently traveled to Guatemala and Belize?

Infectious Disease Testing for Recent Travelers to Guatemala and Belize

For travelers returning from Guatemala and Belize, testing should prioritize malaria, dengue fever, and gastrointestinal pathogens, as these represent the most common infectious diseases acquired in Central America. 1

Priority Tests Based on Regional Risk

Vector-Borne Diseases

• Malaria testing - Although the overall risk is low in Mexico and parts of Central America, Guatemala has a higher prevalence (PM 34.4 per 1000 ill returned travelers) with Plasmodium vivax being the most common species 2

  • Order thick and thin blood films (repeat testing every 12-24 hours for a total of 3 exams if initial tests are negative) 1
  • Consider rapid antigen detection tests as a screening tool 1

• Dengue fever testing - High priority as it represents 8-13% of febrile illnesses in travelers returning from Latin America 1

  • Order dengue rapid test (combined NS1 antigen and IgG) if malaria testing is negative 1
  • Consider NAAT (nucleic acid amplification test) if within 7 days of symptom onset 1
  • IgM antibody testing if more than 7 days since symptom onset 1

• Chikungunya testing - Consider if patient presents with fever and joint pain 1

  • Order serology or PCR depending on timing of symptoms 1

Gastrointestinal Pathogens

• Stool culture for bacterial pathogens including:

  • Salmonella, Shigella, Campylobacter, and Yersinia 1
  • Vibrio species if patient has large volume rice water stools 1

• Stool examination for parasites if diarrhea persists for 14 days or longer 1

  • Specifically test for Giardia and Entamoeba histolytica 1
  • Consider Cryptosporidium, Cyclospora in persistent diarrhea 1

• C. difficile testing if the traveler received antibiotics during or after travel 1

Other Important Considerations

• Hepatitis testing (A, B, E) if patient presents with jaundice or elevated liver enzymes 1

  • Hepatitis A and E are transmitted through contaminated food/water 1

• Leptospirosis serology if patient has fever and has been exposed to fresh water 2

• Rickettsioses testing if patient presents with fever and rash 1

  • Particularly important if patient reports tick bites 1

Testing Strategy Based on Clinical Presentation

For Febrile Patients

• Malaria testing should be performed urgently (within hours) as the highest priority 1
• Dengue testing should follow immediately if malaria is negative 1
• Blood cultures if patient appears septic or has persistent fever 1
• Consider typhoid testing (blood culture and serology) 1

For Patients with Respiratory Symptoms

• Standard respiratory viral panel including influenza 1
• Consider tuberculosis testing if cough persists more than 2-3 weeks 1

For Patients with Rash or Skin Lesions

• Consider testing for dengue, chikungunya, and rickettsioses 1
• Skin scraping or biopsy may be needed for cutaneous leishmaniasis 1

Special Considerations

High-Risk Exposures

• Freshwater exposure: Add leptospirosis and schistosomiasis testing 2
• Cave exploration: Consider histoplasmosis testing 2
• Animal bites: Rabies post-exposure assessment 3
• Sexual contact: HIV, syphilis, and other STI testing 1

Timing Considerations

• Some infections may not manifest until weeks or months after return (e.g., malaria, tuberculosis) 1
• Repeat testing may be necessary if initial tests are negative but symptoms persist 1

Common Pitfalls to Avoid

• Failing to consider malaria in any febrile returning traveler - this is the most critical diagnosis not to miss 1, 4
• Relying solely on rapid diagnostic tests for malaria without microscopic confirmation 1
• Not considering dengue in patients with normal white blood cell counts and thrombocytopenia 1
• Overlooking parasitic causes of persistent diarrhea 1
• Assuming that fever in a returning traveler is always due to a tropical disease - common infections like influenza and urinary tract infections still occur 1, 3

By following this structured approach to testing based on regional risks and clinical presentation, you can efficiently diagnose infectious diseases in travelers returning from Guatemala and Belize while avoiding unnecessary testing.