How should I manage a patient presenting with a fever and rash after returning from a tropical country?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

When managing a patient presenting with a fever and rash after returning from a tropical country, it is crucial to:

  • Enquire about recent travel abroad and consider the possibility of imported infections, taking into account the specific region visited .
  • Assess for signs of serious illness, using a systematic approach to identify 'red', 'amber', or 'green' features .
  • Specifically consider meningococcal disease if the patient has a fever and a non-blanching rash . This is particularly important if the child appears ill, has lesions larger than 2 mm (purpura), a capillary refill time of 3 seconds or longer, or neck stiffness .
  • Look for other specific symptoms and signs that may indicate serious conditions, such as those associated with bacterial meningitis, herpes simplex encephalitis, pneumonia, urinary tract infection, septic arthritis, or Kawasaki disease . For Kawasaki disease, be aware of fever lasting 5 days or longer, along with features like bilateral conjunctival injection, cracked lips, strawberry tongue, oedema/erythema of hands/feet, polymorphous rash, or cervical lymphadenopathy .
  • Manage according to the identified risk of serious illness:
    • If symptoms or a combination of symptoms suggest an immediately life-threatening illness, refer immediately for emergency medical care, typically via a 999 ambulance .
    • If there are any 'red' features but the illness is not immediately life-threatening, the patient should be urgently assessed by a healthcare professional in a face-to-face setting within 2 hours, or referred urgently to a paediatric specialist .
    • If 'amber' features are present without any 'red' features, a face-to-face assessment by a healthcare professional is needed, with the urgency determined by clinical judgement . A 'safety net' should be provided, which may include verbal/written information on warning symptoms, arranging follow-up, or liaising with other healthcare professionals .
    • If only 'green' features are present, and no 'amber' or 'red' features, the patient can be cared for at home with appropriate advice for parents and carers .

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Educational content only. Always verify information and use clinical judgement.