Differential Diagnosis for Illness after Traveling to Egypt with Cough and Diarrhea

Single Most Likely Diagnosis

• Traveler's Diarrhea: This is the most common illness affecting travelers, often caused by bacteria such as E. coli, Salmonella, or Shigella, which can be contracted through contaminated food or water. The presence of diarrhea is a strong indicator, and the cough could be a secondary symptom or an unrelated viral infection.

Other Likely Diarrheses

• Respiratory Infections (e.g., Influenza, Common Cold): Travelers are often exposed to new pathogens, and respiratory viruses are highly contagious. The cough could be a primary symptom of such an infection, with diarrhea being a less common but possible symptom.
• Gastroenteritis due to Viral Infections (e.g., Norovirus, Rotavirus): These viruses can cause both diarrhea and, less commonly, respiratory symptoms like cough.
• Food Poisoning: Similar to traveler's diarrhea but often caused by toxins produced by bacteria or other pathogens in improperly handled or cooked food.

Do Not Miss Diagnoses

• Malaria: Although less likely if the traveler has been taking prophylaxis, malaria can present with a variety of symptoms including fever, chills, and flu-like symptoms, which might initially be mistaken for a respiratory infection or gastroenteritis.
• Tuberculosis (TB): Given the cough, TB should be considered, especially if the traveler has been exposed to someone with TB or has a weakened immune system. TB is endemic in many parts of the world, including Egypt.
• Schistosomiasis: This parasitic infection, common in Egypt, can cause a variety of symptoms including cough and gastrointestinal issues, especially if the traveler has been swimming in contaminated freshwater.

Rare Diagnoses

• Middle East Respiratory Syndrome (MERS-CoV): Although rare, this viral respiratory illness has been reported in the Middle East, including Egypt. It can cause severe respiratory symptoms and has a high mortality rate.
• Leishmaniasis: This parasitic disease, spread by sandflies, can cause a range of symptoms from skin lesions to systemic illness, including gastrointestinal and respiratory symptoms, depending on the form of the disease.
• Histoplasmosis: A fungal infection that can cause respiratory symptoms and, less commonly, gastrointestinal symptoms, typically after exposure to contaminated soil or bird droppings.