Free shipping over $75 USD

Get the most effective travel essentials here.

Shop Now

Learn about our story and our products.

About

  • Try FLIGHTFŪD We're currently experiencing turbulence

icon-bag-minimal

Your carry on baggage

Free US Shipping on Orders $39+

Before you take off, we think you may also love this.

The Travel Water Bottle Merch FLIGHTFUD

Water Bottle

  • Try FLIGHTFŪD
  • Swelling When Traveling? Here’s Why It Happens + What to Do

Jet lag , bloating , and a reduced immune system are all unfortunate but well-known side effects of travel. 

But there’s another common and equally annoying side effect: swelling.

If you’re a frequent flyer, you’ve likely been a victim of swelling at some point. Swollen feet after a long flight, swollen face after the loss of sleep , or swollen fingers from the heat of a tropical destination have probably happened to you before.

Swelling happens to us all differently, and it can be hard to predict when and where it will happen. This article will cover why swelling when traveling happens and 10 ways to prevent or treat it on your next trip.

Article Guide

Why does swelling happen when you travel, the effects of swelling on your body and your health, how to prevent swelling when traveling, where does swelling happen when traveling, the best ways to relieve swelling when traveling.

Swelling, also called edema, happens when fluids in the body pool in certain areas, causing them to become temporarily larger.

Sometimes swelling is mild and may go away on it’s own in a few hours. Other times it can be uncomfortable and lead to other problems.

While swelling can happen to the body anytime, traveling puts your body through specific conditions that trigger it.

To prevent swelling, we need to understand why it happens when we travel. These are the main travel related causes of swelling in the body.

#1. Swelling from Flying

Swelling is most common for travelers when they are flying. 

Those long hours spent sitting in your cabin chair causes blood to pool into your feet and ankles, also known as gravitational edema. 

It happens when you are in an upright position for a long time, but aren’t moving. 

The result is swollen feet that may even make wearing shoes uncomfortable. 

The lower air pressure and humidity inflight also promotes dehydration, which causes your body to retain water and swell. 

Read More :  Does Flying Dehydrate You? Your Guide to Air Travel Hydration

#2. Your Body Adjusting to a Sudden Change in Climate

Another common cause for swelling while traveling is that your body has to adjust to a sudden change in temperature and climate. 

If you aren’t used to hot or humid climates, or you’re flying from winter into a tropical place, swelling in the limbs can happen. 

It can affect any body part, from the face, hands, feet, arms or legs to your fingers and toes. This explains why so many travelers find it difficult to remove their rings during and after a trip to a warm-weather destination.

#3. Changes in Diet from Travel

One of the challenges of travel (and why FLIGHTFUD exists!) is that access to high-quality, healthy foods is so limited in airports and on most flights. 

While most airlines are improving their food options, historically, airplane food is known to be sodium-filled and made from unhealthy ingredients that can make you bloated and feel swollen in both the face and tummy.

Most people eat more healthfully at home then they do when traveling partially because of the lack of access to nutrient-rich foods. So your diet when you’re going places tends to differ from your normal eating patterns. 

swelling while traveling remedies

This can cause swelling as your digestive system and cells attempt to deal with the onslaught of nutrient-depleted, carbohydrate-heavy travel options.

Plus, if the cuisine in your destination is saltier or heavier than your usual diet, your body will retain water and the dreaded face swelling can happen. 

Generally, swelling is harmless and not life-threatening. 

Most travelers and frequent flyers will experience mild swelling at some point on their travels. Once relieved, they can go on enjoying their trip as usual. 

But sometimes swelling can lead to other issues. 

Foot and ankle swelling can make wearing your shoes unbearable, and in some cases it can be uncomfortable to walk for days.

In extreme cases, the swelling can become a serious condition. 

If swelling doesn’t go down within a few days after a flight, you seek medical attention. In rare cases, it can even lead to blood clotting. Thankfully, this is very rare and there are loads of ways you can prevent swelling from becoming serious, or from happening at all.

The best way to deal with swelling is to avoid it in the first place. 

Here are some key tips on how to lower your chances of experiencing this unfavorable part of travel.

#1. Stay Hydrated

travel swelling remedies

Cabin air on your flight is dryer than the Sahara desert, because it needs to be.

The dry air can lead to dehydration than you’d think.

Among keeping other crucial bodily processes running smoothly, water is vital to keeping your blood circulation from slowing, which is a culprit of swelling.

Since dehydration is such a prevalent travel side-effect that leads to so many other impaired bodily processes and symptoms, it’s crucial to stay hydrated and drink plenty of water before and during your flight.

This is why we developed Flight Elixir as a drink mix . We could have made it in any other form, but we wanted to encourage travelers to stay hydrated.

Ideally, you’ll drink the equivalent of 1, 8-oz glass of water for each in-flight hour.

Once at your destination, keep your Travel Water Bottle on hand so you can stay hydrated and can track how much water you’re drinking.

#2. Wear Loose Clothing

Besides being incredibly uncomfortable, wearing tight clothing, especially jeans or anything that constricts your mid-section, can impair blood circulation which is necessary for keeping fluids flowing in your body and preventing swelling. 

This can lead to swelling in the lower body. 

Skip the jeans and restrictive clothing and opt for joggers, leggings, or loose-fitting pants to avoid this. Tight shoes and socks should be avoided as well.

#3. Avoid Salty Food

Airplane food is notorious for being salty and just not very healthy overall. 

You don’t have to go on a food strike while you fly, but it’s wise to avoid stopping at the convenience store on your way through the airport to grab even more salty snacks. In flight, this means avoiding the peanuts, chips, and pretzels that are commonly given on-board. 

While in your destination, it may be harder to say no to the cuisine. After all, a big part of travel is trying new food! But it does pay to be mindful of what you eat, and try to avoid mindlessly snacking.

#4. Drink Alcohol Wisely

One of the best parts about flying is that you can sit back, relax, and order a drink. And we’re realistic. We’re not going to tell you to avoid the inflight indulgences. 

Just be aware that alcohol dehydrates your body, which is the main reason you might experience a headache when you overindulge the night before. In response, your body may also react by retaining fluids. 

Alcohol depresses the nervous system as well, which can make you more likely to fall asleep in a bad sitting position in-flight after a few drinks, which may cause ankle and foot swelling. 

So while we’re not saying you have to skip the wine, definitely consume your spirits wisely inflight (and in general). 

Drink in moderation, and drink an extra glass of water for each drink. 

It doesn’t hurt to ensure you’re drinking your Flight Elixir as well; with coconut water crystals for electrolytes and vitamins to support your body while you travel, we’ve stacked it with the ingredients you need to help you balance your body.

#5. Come Prepared

Travel can be hard on the body . It promotes dehydration, impairs circulation and exposes you to pollutants which have negative health impacts.

Boost your body’s immunity and function by bringing your own micronutrient supplements.

We’ve created our own all-in-one Flight Elixir made to support the body’s specific needs during travel, with ingredients such as papaya for bloating and indigestion and goji berry, which dilate blood vessels promoting optimal circulation and blood flow.

Another supplement to consider bringing is probiotics, which promote gut health. This will help lessen the impacts of swelling from the foreign food. Omega-3 is also known to be an effective anti-inflammatory to reduce swelling and pain.

Swelling can happen anywhere on the body depending on the cause. 

Flying usually leads to swelling in the ankles and feet, while a new travel diet can lead to swelling in the stomach and face. If the weather or change in climate is the cause of swelling, it can happen anywhere in the body, from the neck, limbs, or even hands.

If you do experience swelling during your travels, there are a few ways to find relief quickly. Here are some key tips on what to do if you start to swell.

#1. Stretch and Change Positions 

If you feel your ankles and feet swelling in the airplane cabin, try to stretch it out before it gets worse. 

Start by rolling your ankle around in a circular motion, extend your legs and stretch, then change positions. 

It also helps to continue changing positions and stretching frequently until landing. This keeps blood circulation up, and prevents it from pooling into the lower body again.

#2. Go for Walks in the Airplane Cabin

If you feel the onset of swelling coming, get up and go for a walk. 

Even in the flight cabin when there’s limited space, just going for a short walk to the bathroom or down the aisle and back will help. 

Walking helps to bring back proper blood circulation, which stops the swelling from getting worse.

#3. Do Cardio

If you find yourself swelling during your trip because of hot weather or from the foreign cuisine, opt for some cardio. 

Swimming is a great counter to swelling, so is hiking and jogging. 

If the swelling is too painful to do those, going for a brisk walk also works. Exercise helps improve blood flow giving relief from swelling. Plus, the salt your body loses from sweating helps to release excess fluids your body may be holding onto.

#4. Elevate the Limbs

Elevating the swollen body parts will help drain the extra fluid pooled into that area. 

If possible, elevate the swollen limb above the heart, on a chair or cushion in bed. If swelling persists, you can elevate the limb overnight while sleeping.

#5. Use Compression Socks

If you are a frequent flyer who often experiences swelling, it may be worth it to get compression socks. 

These help to both prevent and relieve swelling. If you find your feet and ankle swelling mid-flight, slip on the compression socks and they’ll safely help to push the extra fluid out of the ankle and foot.

travel related edema

Sarah Peterson

Sarah Peterson is the co-founder and head of marketing at FLIGHTFŪD. She's a travel health expert and after having visited 20+ countries as a digital nomad and flying every 4-6 weeks for business, she became passionate about empowering others to protect their bodies on the go.

Hi Patrick! We discussed via email, but in case anybody else has experienced this problem, we definitely recommend visiting a doctor who specializes in circulatory issues. Circulation can become impaired when you fly and left unchecked, issues can become more serious.

Sounds more like a dvt / a blood clot. Get to a US doctor ASAP

Greetings, I just flew from Bali had a stop over in Istanbul went into Los Angeles and now into Puerto Vallarta. It’s been 5 days and I have my left arm swollen and dark blue as perhaps a capillary broke. I’ve gone to the doctor here in Puerto Vallarta and it seems my pulse and my blood flow is good and although the swelling has lessened it’s still numb tingly and discolored. I understand you’re not positions and not legally entitled to give that advice but what do you suggest I should do? Thank you for your time, Blessings to you and your loved ones sincerely Patrick

Leave a comment

Explore more.

  • Healthy Travel
  • things to do
  • Travel Destinations
  • travel essentials
  • Where to eat
  • where to stay

Popular posts

Bloating After Flying: What Causes Jet Belly &  How to Prevent it

Featured product

Flight Elixir FLIGHTFUD

FLIGHT CHECK IN

Check into the VIP News Room. Stay up to date on all flight changes.

Care-Med LTD

How to Prevent Swelling During Travel

Travel-induced edema.

Travel-induced edema, a common concern for many travellers, especially during long flights or car rides, can significantly hinder what should be an exciting journey. This type of swelling, often seen in the legs and feet, is usually a result of prolonged periods of inactivity, which can impede blood circulation and lead to fluid accumulation in the lower extremities. Such conditions not only cause discomfort but also pose potential health risks, making it crucial for travellers, especially those with pre-existing conditions, to find effective ways to prevent swelling during their journeys. To address this, various methods ranging from simple exercises to dietary considerations and the use of compression wear are recommended.

These strategies are specifically geared towards minimizing the risk and impact of travel-induced edema. By understanding and implementing these measures, travellers can play a significant role in managing edema, ensuring that their travel experiences remain both comfortable and enjoyable.

Causes of Travel-Related Edema

Edema during travel, particularly on long flights or car rides, is primarily caused by prolonged periods of inactivity.

When you’re seated for an extended duration, the lack of movement can lead to poor circulation, especially in the lower extremities. This reduced circulation can cause blood to pool in the leg veins, leading to increased pressure and fluid leakage into the surrounding tissues, resulting in swelling. Additionally, the cabin pressure and dry air in airplanes can contribute to dehydration, which exacerbates the swelling.

The combination of these factors often leads to the uncomfortable and sometimes painful condition known as travel-induced edema.

Risk Factors

Several factors can increase the risk of experiencing travel-induced edema, including:

  • Prolonged Immobility : Sitting still for hours without moving your legs.
  • Pre-existing Medical Conditions : Such as varicose veins, heart disease, or kidney problems.
  • Age : Older adults are more susceptible to edema.
  • Pregnancy : Pregnant women often experience increased swelling.
  • Medications : Certain medications, like those for high blood pressure, can increase the risk.
  • Dehydration : Not drinking enough fluids can lead to poor circulation and swelling.
  • High Salt Intake : Consuming salty foods before or during travel can contribute to fluid retention.

Preventing Swelling from Travel-Induced Edema

Effectively managing travel-induced edema involves adopting certain preventative measures that can significantly reduce the risk and severity of swelling. Two key strategies in this regard are staying hydrated and ensuring regular movement and stretching during travel.

Stay Hydrated

Hydration plays a crucial role in preventing travel-induced edema. Adequate fluid intake helps maintain normal circulation and prevents the blood from becoming too thick, which can exacerbate swelling. Here are some hydration tips:

  • Drink Water Regularly Aim to drink water consistently throughout your journey. Avoid waiting until you feel thirsty, as thirst is already a sign of dehydration.
  • Limit Caffeine and Alcohol Both caffeine and alcohol can lead to dehydration. It’s best to limit these beverages, especially on long flights or drives.
  • Choose Hydrating Foods Incorporate fruits and vegetables with high water content into your travel snacks. Foods like cucumbers, oranges, and watermelon can contribute to your overall hydration.

Regular Movement and Stretching

Regular movement and stretching are vital in preventing the pooling of blood in the legs, a common cause of edema during long periods of travel. Here are some effective ways to keep moving:

  • Leg and Foot Exercises Perform simple exercises such as ankle circles, foot pumps, and knee lifts while seated. These movements help stimulate blood flow in the lower extremities.
  • Frequent Breaks If travelling by car, take frequent breaks to get out and walk around. On a plane, try to stand, stretch, and walk along the aisle every hour or so.
  • Stretching Exercises Gentle stretching exercises can be done even in a limited space. Stretch your arms, back, and neck regularly to keep the blood circulating throughout your body.

By staying hydrated and incorporating regular movement and stretching into your travel routine, you can significantly reduce the risk of developing travel-induced edema. These simple yet effective measures can make your travel experience more comfortable and enjoyable.

Using Compression to Prevent Swelling During Travel

Compression wear serves as a vital tool to prevent swelling during travel, offering several benefits that enhance the overall comfort and health of travellers. These garments, such as compression socks or sleeves, exert gentle pressure on the legs and arms, which aids in promoting better blood flow.

This improved circulation is crucial in reducing the risk of blood pooling, a common issue during prolonged periods of sitting. As a result, compression wear effectively helps in preventing the buildup of fluid in the tissues, thereby reducing swelling.

Additionally, for those travelling by air, wearing compression garments can significantly lower the risk of developing Deep Vein Thrombosis (DVT), a serious condition often associated with long-haul flights.

Beyond these health benefits, compression wear also contributes to improved comfort during travel. By minimizing the discomfort typically associated with swelling, these garments make long journeys more bearable, allowing travellers to arrive at their destinations feeling more refreshed and less fatigued.

Choosing the Right Compression Wear

Choosing the right compression wear for travel is a key step in ensuring its effectiveness and your comfort during long journeys. To select the best compression socks or sleeves for your needs, consider the following aspects:

  • Correct Fit It’s essential that your compression wear fits well. The ideal fit should be snug, providing enough pressure without being uncomfortably tight. Compression wear that is too loose or too tight can either be ineffective or cause discomfort.
  • Appropriate Compression Level Compression garments are available in various pressure levels, typically measured in mmHg. For travel purposes, a mild to moderate compression level, ranging from 15-30 mmHg, is usually adequate.
  • Material and Breathability Opt for materials that are breathable and comfortable for extended wear. This is particularly important in fluctuating temperatures, ensuring comfort throughout your journey.
  • Ease of Use The ease with which you can put on and take off the compression wear is an important consideration, especially in confined spaces like airplane cabins or car seats.
  • Style and Design Compression wear is available in a variety of styles and colours. Choose a design that aligns with your personal taste and complements your travel attire.

Dietary Considerations for Edema Management

Managing travel-induced edema isn’t just about physical activity and compression wear; your diet also plays a crucial role. Certain foods and drinks can exacerbate swelling , while others can help in managing it. Being mindful of your dietary choices, especially while travelling, can significantly impact your comfort and health.

Foods to Avoid

Some foods and drinks can contribute to fluid retention and swelling, and should be limited or avoided, especially when travelling. These include:

  • Salty Foods High sodium content can cause the body to retain water, leading to increased swelling. Avoid processed foods, chips, and salty snacks.
  • Alcohol Alcohol can lead to dehydration and worsen edema. It’s best to limit or avoid alcoholic beverages during travel.
  • Caffeinated Beverages Similar to alcohol, caffeine can contribute to dehydration. Try to reduce the intake of coffee, tea, and caffeinated sodas.
  • Refined Carbohydrates Foods like white bread and pastries can contribute to inflammation and swelling.

Edema-Friendly Snacks

Choosing the right snacks can help in managing edema during travel. Opt for these edema-friendly options:

  • Fresh Fruits and Vegetables Foods like cucumbers, celery, berries, and oranges are high in water content and can help with hydration.
  • Nuts and Seeds Almonds, walnuts, and chia seeds are good options as they contain anti-inflammatory properties and essential nutrients.
  • Low-Sodium Snacks Opt for low-sodium versions of your favourite snacks to avoid excess salt intake.
  • Yogurt Rich in protein and calcium, yogurt can be a healthy snack option. Choose plain yogurt over flavoured varieties to avoid added sugars and salts.
  • Whole Grains Snacks made from whole grains, like oatmeal or whole-grain crackers, are healthier alternatives to refined carbohydrates.

Practical Tips for Long Flights and Car Rides

Long flights and car rides can be challenging for those prone to edema. However, with some practical tips and adjustments to your travel environment, you can significantly reduce the discomfort associated with swelling. Here’s how to optimize your travel environment and prevent swelling effectively during layovers or breaks.

Optimizing Your Travel Environment

Creating a comfortable travel environment is key to preventing and managing edema. Consider these tips for your seating position and environment:

  • Choose the Right Seat If possible, select an aisle seat on flights for easier access to move around. In cars, try to sit where you can stretch your legs occasionally.
  • Elevate Your Legs When space allows, elevate your legs to improve circulation. In a car, you can use a cushion or travel pillow under your legs.
  • Stay Cool Keep the environment cool to prevent excess swelling. Use air conditioning or a fan in a car, and adjust the air vents on a plane.
  • Wear Loose Clothing Tight clothing can restrict blood flow. Opt for loose, comfortable clothing to facilitate better circulation.
  • Use a Footrest If your feet don’t reach the floor, use a footrest or a small bag to support your legs and reduce pressure on your thighs.

Managing Swelling During Layovers

Layovers and breaks during your travels present a valuable opportunity to effectively manage and prevent swelling. To make the most of these periods, consider adopting the following strategies:

  • Walk and Stretch Use this time to walk around and stretch your legs. This helps stimulate blood flow and reduce swelling.
  • Hydrate Drink water during layovers to stay hydrated. Avoid salty snacks and caffeine.
  • Perform Leg Exercises Do some simple leg and ankle exercises to keep the blood circulating. Even a few minutes of movement can be beneficial.
  • Elevate Your Legs If you have a longer layover, find a place to sit and elevate your legs for a while.
  • Consider a Short Massage If available, a brief leg massage can stimulate circulation and provide relief from swelling.

Navigating Travel with Ease

Whether it’s optimizing your travel environment, staying hydrated, using compression wear, or making dietary adjustments, each of these measures plays a crucial role in combating the discomfort associated with long periods of travel. Remember, the key to a pleasant journey lies in being prepared and mindful of your body’s needs.

If you’re looking for more personalized advice or custom compression wear to manage travel-induced edema, don’t hesitate to contact Care-Med . We’re here to help you travel comfortably and with ease.

Share This Story, Choose Your Platform!

Care-Med - Custom Orthotics, Body Braces, Compression Wear & more

For personalized care and to find the best Orthotics, Body Braces, or Compression Wear in Toronto, reach out to Care-Med LTD. Email us at [email protected] or if you prefer a personal consultation that necessitates an appointment, call our office at Care-Med today at 416-782-5353. Experience the difference of tailored solutions for your needs.

Related Posts

Ensuring the Perfect Fit with Compression Apparel

Ensuring the Perfect Fit with Compression Apparel

Back Brace Support for a Healthy Spine

Back Brace Support for a Healthy Spine

Walk, Run, Work with Tailored Foot Support

Walk, Run, Work with Tailored Foot Support

Care-Med Ltd - Custom Orthotics, Compression Wear, Body Braces

Partners: Soft Touch Mastectomy

Mon: 9:30am – 7:00pm Tue: 9:30am – 5:30pm Wed: 9:30am – 5:30pm Thu: 9:30am – 5:30pm Fri: 9:30am – 2:30pm Sat, Sun: Closed

3077 Bathurst St. Suite #203, 2nd Floor Toronto ON, M6A 1Z9 Directions

CBRB Best Businesses in Canada Verification Certificate

© Copyright 2008 - 2023 | Care-Med LTD. All Rights Reserved

We offer long distant compression garments consultation and measurements through Zoom meetings for patients out of province and country.

Book Virtual Appointment

Why Do My Feet Swell When I Travel?

Why Do My Feet Swell When I Travel?

Feet swelling is something that most regular fliers may experience at some time. Foot swelling is known medically as dependent edema and is usually innocuous during plane travel. The fluid accumulation is due to inactivity and gravity’s effect on your body’s fluids. You have undoubtedly experienced the discomfort of swollen feet after a long journey. We cannot always anticipate when or where our swelling will occur because of our unique nature of each of us. This article will discuss the causes of and solutions for travel-related foot swelling.

Table of Contents

Are Feet Swelling During Travel Threatful?

In most cases, swelling is neither harmful nor fatal. There will inevitably be some modest swelling for the majority of passengers and regular fliers. As soon as they feel better, they can go back to having fun on their vacation. However, swelling is not always the problem. Swelling in the feet and ankles may make wearing shoes painful, and in extreme situations, walking may be painful for many days.

The swelling might become life-threatening if left untreated. You should consult a doctor if the swelling does not go down after a few days following a flight. Rarely, it might cause blood clotting. Fortunately, this is quite uncommon, and there are several measures one may take to forestall the onset or worsening of edema.

Reasons for Foot Swelling During Travel

Following are the common reasons why the foot swells during air or other types of travel. All of these reasons have been backed by medical evidence for the validity of claims.

Leaving your body idle for a long period of time

Flying is associated with an increase in the frequency and severity of swelling for many passengers. Gravitational edema occurs when blood pools in your lower extremities due to prolonged sitting. It occurs while you are sitting still for an extended period. The end effect is swelling in the feet, which may make shoes unpleasant to wear. According to a study by Partsch (2008), foot Swelling or Leg edema is often observed in severe Chronic Venous Insufficiency (CVI) and is a recognized effect of immobility and extended sitting, which causes venous stasis (CVI).

Some people refer to this kind of leg edema as “dependent edema,” “gravitational edema,” “filtration edema,” “armchair leg,” etc., although most doctors are not familiar with it. Due to this, it is often treated with the inappropriate use of pharmaceuticals like diuretics, antibiotics, etc. for longer periods than is necessary, and without sufficient compression or physical therapy.

Drastic Changes in Temperature of the Human Body

thermometer slightly higher than normal feet

The body’s attempt to adapt to a drastically different environment is another typical cause of edema when traveling. Swelling of the limbs may occur if you are not accustomed to hot or humid settings, or if you go directly from a cold region to a warm one, such as a tropical country.

It is possible to get it anywhere on your body, including your fingers, toes, palms, palmar surface, palm dorsum, and palmate surface. This explains why so many vacationers have trouble taking off their rings before, during, and after a trip to a warm-climate country.

In a study conducted by Mittermayr et al. (2003), the authors along with other reasons, also consider the change in temperature as an important reason for foot swelling during travel.

This study concluded that, in addition to the hypobaric-hypoxic environment on board the aircraft, other factors may contribute to fluid accumulation in the superficial tissues. These include an uncomfortable, cramped sitting position, the ambient temperature near the seat, and the constant vibration of the underlying surface of the aircraft.

Editor’s Pick: Here’s Where You Can Go For Camping in Minnesota

On-Board Food and Refreshments

Food at Business Class singapore

High-quality, nutritious food is hard to come by at airports and on most flights. While in-flight meals are becoming better on most airlines, they still have a bad reputation for being high in salt and produced with toxic components that may lead to bloating and swelling in the foot and face. Due to the lack of availability of nutrient-rich foods and the availability of salty, sodium-rich food, most individuals eat more healthfully at home than they do when abroad.

As a result, when you travel, you probably eat differently than you do at home. The body’s response to the barrage of nutrient-depleted, carbohydrate-heavy travel alternatives may lead to edema as the digestive system and cells work to cope. If the food is saltier or heavier than what you are used to eating, your face may bloat up in an unattractive way.

Brown (2021) conducted a study that shows that around four extra pounds of fluid retention (edema) may be linked to excessive salt intake (as may occur during binge eating). In certain cases, edema of foot swelling is accompanied by polyuria, which is an increase in the frequency and/or volume of urination. Sodium chloride consumption has been linked to increased foot edema frequency.

However, certain airlines hold the record for serving the best food in the air and we recommend you to choose from them.

How to Avoid Swelling on Feet While Traveling?

Preventing edema is preferable to treating it after it has already appeared. Here are some helpful hints for minimizing your exposure to this frustrating facet of travel.

Stay Hydrated During Travel

glass of water

It may seem paradoxical to drink extra fluids while your body is holding water, but the Cleveland Clinic says doing so may help flush out excess salt, which leads to fluid retention. To avoid feeling weak and dizzy at the beginning of your journey, make sure to drink enough water the day before and the day of your departure. If you want to keep hydrated throughout the flight, pack a large bottle of water and refill it as necessary. You will be more likely to get up and go for a stroll to the restroom when you need to use it if you drink a lot of water.

Wear Appropriate Clothing and Footwear

comfortable all day long shoes

Wearing flexible, comfortable clothing and shoes will help you manage any edema that may occur. On days when you will be traveling, slip-on shoes are ideal since they can be quickly removed for foot massages and foot exercises. You can increase blood flow by massaging your feet, but remember to be considerate to your neighbors while doing so. That helps avoid swelling and also lessens the likelihood of blood clots forming in flight.

Consume Alcohol Wisely

Consume Alcohol Wisely

The ability to relax and enjoy alcohol while flying is a major perk and most of us, realistically, consider it as part of their air travel. Do not worry, we will not urge you to pass up the snacks and drinks on board. Keep in mind that alcohol dehydrates your body, making headaches the most likely consequence after a night of heavy drinking.

As a result, your body could respond by accumulating extra fluid. Having a few drinks might make it easier to relax and fall asleep in an uncomfortable sitting posture, which can lead to fluid retention in the legs and feet due to prolonged sitting. To sum up, we are not suggesting you go without wine on your flight, but you should use caution while imbibing alcoholic beverages.

Drink moderately and follow each alcoholic beverage with a glass of water. You should also be sure you drink a lot of such drinks which have been loaded with electrolyte-rich coconut water crystals and immune-boosting vitamins to help keep your body in check during the flight.

Come Prepared

Come Prepared

A person’s physical health might be impacted due to traveling. Traveling is not good for your health since it encourages dehydration, slows your circulation, and puts you in contact with potentially harmful contaminants. Bring your micronutrient supplements to help your body’s immunity and performance.

With components like papaya, which aids in digestion and prevents gas and bloating, and goji berry, which dilates blood vessels and improves circulation, you can maintain hydration. You may also want to carry some probiotics, which are good for your digestive system. If you do this, you may decrease the effects of edema caused by the exotic cuisine. Omega-3 is also a potent anti-inflammatory, meaning it may lessen things like swelling and discomfort.

Reduce the Amount of Salt in Your Diet

Free sea salt in pestle and mortar image, public domain CC0 photo.

The food served on planes is notoriously salty and often unhealthy, mainly when it is in economy class. You do not need to go without food on your flight, but you may want to hold off on picking up any additional salty snacks at the airport’s convenience shop.

On a flight, this means passing up the peanuts, chips, and pretzels that are handed out to passengers. It may be more difficult to resist the local fare when you are already there. After all, sampling local cuisine is an essential aspect of every trip. However, it is beneficial to pay attention to your food intake and limit mindless nibbling.

Take the Opportunity to Stretch

Take the Opportunity to Stretch

Do not give in to the temptation of sleeping for the whole journey. Despite the temptation to stick to your seat with a good book, a movie, or even sleep during the flight, getting up and walking the aisle a few times after the captain gives the all-clear sign; can do wonders for your feet and ankles. For flights lasting more than two hours, it is recommended that passengers get up and traverse the aisle every hour or so.

If you have swelling, getting your blood pumping by standing or going to the restroom may help reduce it. To keep your foot muscles strong, you may exercise them even if you cannot walk. If you want to get your feet moving, try pointing them up and down and then side to side. Here, you will work on flexing your feet, calves, and legs to wake up those muscles after a long time of inactivity.

Free Up More Space for Your Legs

legroom airplane

If your feet have to squeeze past your carry-on luggage, they may end up in an uncomfortable posture that prevents blood from reaching them. To avoid cramping your feet and toes throughout the trip, remove any belongings from the seat in front of you.

While on your stroll, perform some simple stretches in the open area behind the galley to keep the blood pumping to your muscles and organs. If you have to sit for long periods, try not to cross your legs to impede your circulation even worse (studies have also revealed that persons with hypertension have a dramatic rise in blood pressure when their legs are crossed at the knee).

Some airlines like Emirates offer a better legroom as well, even in the economy premium class. You can learn more about it in our guide to the difference between Emirates Economy and Emirates Premium Economy Class .

Wearing Compression Socks May Help

Wearing Compression Socks May Help

Compression socks that go above the knee should be part of your pre-flight attire. Compression socks, also called compression stockings, come in a variety of lengths and are meant to provide a slighter more gentle pressure to the legs than regular socks. As a result, blood flows more smoothly through the legs.

Since these compression socks are used by endurance athletes both during and after races, they come in a variety of fun styles and hues. The APMA provides a directory of approved hosiery and socks. If swelling persists more than a few hours after landing and getting back to your routine, it might be a sign of something more severe like a blood clot (also known as deep vein thrombosis).

Swelling in just one leg, or swelling accompanied by leg discomfort or shortness of breath, are other indications of this illness. If you are experiencing any of these symptoms, you should see a doctor at once. If you are considering donning a pair of compression stockings, it is best to get a medical opinion first.

Knowing the distinctions between the different pressures is crucial since certain individuals cannot withstand high pressure. Stockings with either an open or closed toe are on offer. If a patient has trouble bending down or pulling the stockings up their legs, a Velcro strap alternative is available.

Perform Cardiovascular Exercise

Perform Cardiovascular Exercise

Endurance exercises can reduce the chances of foot swelling while traveling. If the problem of foot swelling persists one or two days after traveling or if you feel that your body is bloating in the hot climate or from eating too much salty food, you should do some cardio. Exercises like swimming, hiking, and running all help reduce edema. If the swelling makes such activities too uncomfortable, a quick stroll might help.

As a result of increased blood flow, exercise may reduce edema. In addition, the salt you lose via perspiration might assist in flushing out any extra fluids your system may be trying to hang on to.

Editor’s Pick: Flying for the First Time in Emirates Business Class? | Here’s a Guide to Help You!

Raise the Extremities

Raise the Extremities.

The accumulation of fluids in the swollen areas may be reduced by placing the affected body parts at a higher level. It is recommended that the swollen leg be propped up in a comfortable position, either on a chair or a cushion in bed, above the level of the heart. If swelling continues after a day of elevation, try sleeping with the affected limb elevated.

These suggestions may be useful, but there are still risks associated with flying if you have leg edema. Talk to your doctor about whether or not flying is safe for you if you are expecting a child or have just had significant surgery. Hormonal contraception increases the risk of blood clots. Other risks to think about include being overweight, having cancer or a blood clotting condition, heart failure, being over 60 years old, and sitting for lengthy periods.

When considering the larger picture, it is important to prioritize preventative actions like regular exercise and healthy dietary choices. If you have any prior health concerns, it is very important to consult with your doctor before flying. The demands of daily life might make it easy to neglect these procedures, but doing so is dangerous. Even if you are in excellent condition, taking some simple precautions may reduce the risk of edema and other consequences.

Why Do My Feet Swell When I Travel? - FAQs

You have been sitting for too long, and as a result, your blood and other bodily fluids have drained down to your feet. Varicose veins and hormone fluctuations are two more causes of bloating.

These are the signs of edema: across the afflicted region, the skin is glossy and taut; skin that retains its dimpled appearance; aches and decreased mobility symptoms affecting lung function, such as coughing or shortness of breath.

Yes. Swelling of the feet makes it difficult to walk. Plus, it could hurt also.

Mild swelling of the lower legs usually is not serious. However, you should see your primary care physician if the swelling in your feet and ankles is severe, causes you discomfort, or lasts for more than a few weeks.

Photo of Areeba Naveed

Related Articles

Can You Text On a Plane?

Can You Text On a Plane? FAA Rules Explained

Does Rain Delay Flights? Here's The Answer

Does Rain Delay Flights? Here’s The Answer

How Many Inches of Snow Will Cancel a Flight?

How Many Inches of Snow Will Cancel a Flight? | ANSWERED

Why Travelling is Important?

TOP 9 Reasons Why Travelling is Actually Important

Can You Bring Cigarretes on a Plane? Latest TSA Guide

Can You Bring Cigarettes On a Plane? Latest TSA Guide

hotels that let you check in at 18

14 Hotels You Can Book at 18 – Guide for Young Travelers

Everyday Health Logo

10 Ways to Avoid Swollen Feet and Ankles During Travel

Cramped seats, salty snacks, and long periods of sitting are a recipe for uncomfortable swelling. But these expert tips can help you prevent discomfort and deal if you experience the condition.

Claire Young

When you fly, you're trapped in a tiny seat in an enclosed area without much room to move — so it’s no wonder you may land with swollen feet. And although leg and foot swelling during air travel is common and typically harmless, per the Mayo Clinic , it can still put an uncomfortable damper on your travel plans.

Luckily, there are things you can do to prevent it. Here, three doctors share their tips on how to avoid swollen feet and ankles during air travel and what you can do if you do experience some swelling.

Why Do Your Feet Swell When You Fly?

It comes down to inactivity during flights, says Lauren Wurster, a doctor of podiatric medicine and an Arizona-based podiatrist and spokesperson for the American Podiatric Medical Association (APMA) . “The longer you are sitting still, the more gravity pulls fluid down to your feet and ankles,” she explains. “Also, the position you are sitting in, with your legs bent, increases the pressure on the veins and increases swelling.”

When sitting, the muscles that help pump fluid out of your legs are not active, says Timothy Ford , a doctor of podiatric medicine and an associate professor in the department of orthopedics at the University of Louisville School of Medicine. As a result, blood may pool in your feet, leading to swelling, medically known as edema.

Travel day habits can also contribute to feet swelling, says Todd Taylor, MD , an associate professor at Emory University’s department of emergency medicine. “As we travel, we tend to eat in restaurants, eat snacks, and consume other processed foods high in salt. This will raise our salt level in our body, increasing the fluid and again contributing to dependent edema [leg swelling].”

Finally, Dr. Wurster notes, there are certain health conditions that can cause swelling in your legs or feet regardless of your altitude, including heart, liver, thyroid, and kidney conditions; pregnancy; and venous insufficiency. (That said, if minor swelling occurs only during air travel, it’s more likely due to the lack of mobility in your legs than an underlying medical concern.)

Fortunately, there are steps you can take to reduce the likelihood of leg swelling during travel and potentially reduce swelling when it happens. Read on for the experts’ tips.

10 Ways to Prevent Swollen Feet During Travel

1. drink water throughout your travels.

Even though it might feel counterintuitive to add more fluids to your body when it’s retaining fluid, the  Cleveland Clinic notes that drinking more water can help clear your system of excessive sodium, which contributes to fluid retention . Drink plenty of water the day before and the day of the trip so that you don't start out dehydrated. Bring a big bottle of water with you on the plane, and refill it as needed to stay hydrated. Another plus to drinking a lot of water: It’ll motivate you to get up and walk to the bathroom when nature calls.

2. Watch Your Diet and Avoid Salty Foods

Avoid salt as much as possible on the day of and even the day before. Salt can cause you to retain fluid, notes the Mayo Clinic , which can make your feet swell even more.

3. Reach for a Pair of Compression Socks

Your flight day outfit should include compression socks that reach up to your knees. “I really love this one as they are really effective,” says Dr. Taylor. And these days, they don’t have to be boring! Endurance athletes use compression socks during and after racing, so you can find cool colors and patterns. The APMA also offers a list of its approved socks and hosiery . “Avoid normal socks that constrict above the ankle," suggests Ford.

4. Stretch Your Legs on Long Flights

If possible, get up to walk the aisle every hour or so, especially on flights over two hours, recommends Dr. Ford. Standing or walking to the bathroom can get your blood flowing and help combat swelling.

5. Give Your Feet a Seated Workout

Even when you can't get up and walk around, you can work the muscles in your feet. Point your toes up and down, then side to side to get your feet moving. The focus here is flexing the muscles in your feet, calves, and legs to get them engaged after a long period of inactivity, says Wurster.

6. Stow Bags Overhead to Maximize Legroom

If your feet are fighting for space with your carry-on bags, they'll be cramped even more into awkward positions that cut off the blood supply. Store your bags overhead.

7. Don't Cross Your Legs

Your circulation is already slower when you're sitting for hours, so don't cut it off even more by crossing your legs. ( Past research has also suggested crossing the leg at the knee results in a significant increase in blood pressure for people with hypertension .)

8. Shift Positions Regularly While Seated

The position of your legs when you are seated increases pressure in your leg veins, explains the Mayo Clinic, so don’t stay locked in one position for too long. Wurster advises shifting your seated position frequently to avoid being in one position for too long.

9. Elevate Your Feet to Help Blood Flow Return

Keeping your legs raised can help improve circulation, per the Cleveland Clinic . Wherever possible, try to raise your legs and feet; if there's no one next to you, stretch out and prop your feet up across the seats.

10. Opt for Comfy and Practical Footwear

Ford recommends wearing slip-on shoes on travel days because “they can be removed easily and allow you to massage your feet or exercise your feet." A foot massage could help stimulate blood flow — just be conscious of your neighbors. (This might be one tip to save for a road trip rather than a crowded plane.)

How to Reduce Swelling in Feet After Travel

Once you’ve landed, you can use a lot of the same tools to reduce swelling after your travel: “Stay hydrated, move around, and wear compression socks,” says Wurster. “Also, be mindful of what you're eating and avoid foods too high in sodium because that can also add to further swelling.”

If you can’t move around, elevating your legs after traveling can also help, says Taylor. Use gravity to your advantage and prop your feet up to help your circulation move that blood around. For those who can manage it, the Cleveland Clinic recommends a yoga pose called Viparita Karani, where you lay with your back on the ground perpendicular to a wall and then press your legs up against the wall. (Steer clear of this pose if you’re living with uncontrolled high blood pressure, glaucoma , congestive heart failure , kidney failure, or liver failure, though.)

When Should You See a Doctor About Swollen Feet and Legs?

“Usually, the swelling isn't serious and will improve with activity after the flight lands,” says Wurster. “However, in long periods of travel and with people with certain risk factors, the swelling can be a sign of a blood clot in the calf, also known as a deep vein thrombosis . This can be very serious if not treated appropriately.”

Wurster and Taylor say any of these red flags would be a reason to go to the nearest emergency department for an evaluation:

  • Severe leg swelling
  • One leg bigger than the other
  • Swelling, pain, redness, and warmth to one of the calves
  • Shortness of breath

Wolters Kluwer

  • Find in topic

UpToDate

Please read the Disclaimer at the end of this page.

EDEMA OVERVIEW

Edema is the medical term for swelling caused by a collection of fluid in the spaces that surround the body's tissues and organs. Edema can occur nearly anywhere in the body. Some of the most common sites are:

● The lower legs or hands (also called peripheral edema)

● Abdomen (also called ascites)

● Chest (called pulmonary edema if in the lungs, and pleural effusion if in the space surrounding the lungs)

Ascites and peripheral edema can be uncomfortable and can be a sign of a more serious condition. Pulmonary edema, which makes it difficult to breathe and can be life threatening, is a symptom of heart failure and is discussed in more detail separately. (See "Patient education: Heart failure (Beyond the Basics)" .)

EDEMA SYMPTOMS

Symptoms of edema depend upon the cause but may include:

● Swelling or puffiness of the skin, causing it to appear stretched and shiny. This typically is worse in the areas of the body that are closest to the ground (because of gravity). Therefore, edema is generally the worst in the lower legs (called peripheral edema) after walking about, standing, sitting in a chair for a period of time, or at the end of the day. It accumulates in the lower back (called sacral edema) after being in bed for several hours. Pushing on the swollen area for a few seconds will leave a temporary dimple or dent in the skin ( figure 1 ).

● Increased size of the abdomen (with ascites).

● Difficulty breathing (with edema in the chest).

CONDITIONS ASSOCIATED WITH EDEMA

A number of different problems can cause edema.

Chronic venous disease  —  A common cause of edema in the lower legs is chronic venous disease, a condition in which the veins in the legs cannot pump enough blood back up to the heart because the valves in the veins are damaged. This can lead to fluid collecting in the lower legs, thinning of the skin, and, in some cases, development of skin sores (ulcers). (See "Patient education: Lower extremity chronic venous disease (Beyond the Basics)" .)

Edema can also develop as a result of a blood clot in the deep veins of the lower leg (called deep vein thrombosis [DVT]). In this case, the edema is mostly limited to the feet or ankles and usually affects only one side (the left or right); other conditions that cause edema usually cause swelling of both legs. (See "Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)" .)

Pregnancy  —  Pregnant women retain extra fluid. Swelling commonly develops in the hands, feet, and face, especially near the end of a normal pregnancy. Swelling without other symptoms and findings is common and is not usually a sign that a complication, such as preeclampsia (sometimes called toxemia), has developed. (See "Patient education: Preeclampsia (Beyond the Basics)" .)

Monthly menstrual periods  —  Edema in women that occurs in a cyclic pattern (usually once per month) can be the result of hormonal changes related to the menstrual cycle. This type of edema is common but does not require treatment, because it resolves on its own.

Drugs  —  Edema can be a side effect of a variety of medications, including some oral diabetes medications, high blood pressure medications, non-prescription pain relievers (such as ibuprofen), and estrogens.

Kidney disease  —  The edema of kidney disease can cause swelling in the lower legs and around the eyes. (See "Patient education: Chronic kidney disease (Beyond the Basics)" .)

Heart failure  —  Heart failure, also called congestive heart failure, is due to a weakened heart, which impairs its pumping action. Heart failure can cause swelling in the legs and abdomen, as well as other symptoms. Heart failure can also cause fluid to accumulate in the lungs (pulmonary edema), causing shortness of breath. This can be a very dangerous condition requiring emergency treatment. (See "Patient education: Heart failure (Beyond the Basics)" .)

Cirrhosis  —  Cirrhosis is scarring of the liver from various causes, which can obstruct blood flow through the liver. People with cirrhosis can develop pronounced swelling in the abdomen (ascites) or in the lower legs (peripheral edema). (See "Patient education: Cirrhosis (Beyond the Basics)" .)

Travel  —  Sitting for prolonged periods, such as during air travel, can cause swelling in the lower legs. This is common and is not usually a sign of a problem. The table provides tips to minimize leg swelling during travel ( table 1 ).

If your leg(s) remain swollen or you develop leg pain hours or days after the flight, contact your healthcare provider. Continued swelling and pain can be signs of a blood clot (DVT). (See "Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)" .)

Angioedema  —  Reactions to some medications and some inherited disorders can cause fluid to leak out of the blood vessels into surrounding tissues (angioedema). This can cause rapid swelling in the face, lips, tongue, mouth, throat, voice box, limbs, or genitals. Symptoms may include hoarse voice, throat tightness, and difficulty swallowing. Swelling of the throat can interfere with breathing and may be life threatening.

Sometimes, this type of swelling occurs in the bowel (the intestinal wall) and can result in abdominal pain.

Lymphedema  —  Surgical removal of lymph nodes for the treatment of cancer (most commonly breast cancer) can cause swelling of a limb or limbs with thickening of the skin on the side of the surgery. Swelling of both legs because of lymph problems can also be an inherited condition that becomes apparent in childhood or young adulthood. Lymphedema can also be caused by infection, trauma, or obesity.

DIAGNOSING THE CAUSE OF EDEMA

If you develop new swelling in one or both of your legs, hands, in your abdomen, or around your eyes, you should call your healthcare provider to determine if you need to be evaluated. (See "Clinical manifestations and evaluation of edema in adults" .)

If you develop a sudden onset of swelling in the lips, tongue, or mouth, especially if it affects your ability to talk or breathe, you should go to an emergency department immediately.

EDEMA TREATMENT

Treatment of edema includes several components: treatment of the underlying cause (if possible), reducing the amount of salt (sodium) in your diet, and, in many cases, use of a medication called a diuretic to eliminate excess fluid. Using compression stockings and elevating the legs may also be recommended. (See "General principles of the treatment of edema in adults" .)

Not all types of edema require treatment. Edema related to pregnancy or menstrual cycles is not usually treated. Peripheral edema and ascites are usually treated slowly to minimize the side effects of rapid fluid loss (such as low blood pressure).

Reduce salt (sodium) in your diet  —  Sodium, which is found in table salt and processed foods, can worsen edema. Reducing the amount of salt you consume can help to reduce edema, especially if you also take a diuretic. Guidelines on how to reduce sodium are available separately. (See "Patient education: Low-sodium diet (Beyond the Basics)" .)

Diuretics  —  Diuretics are a type of medication that causes the kidneys to excrete more water and sodium, which can reduce edema. Diuretics must be used with care because removing too much fluid too quickly can lower the blood pressure, cause lightheadedness or fainting, and impair kidney function.

You may have to empty your bladder more frequently after taking a diuretic. However, other side effects are uncommon when diuretics are taken at the recommended dose.

Compression stockings  —  Leg edema can be prevented and treated with the use of compression stockings. Stockings are available in several heights, including knee-high, thigh-high, and pantyhose. Knee-high stockings are sufficient for most patients. Some stockings can cause skin irritation or pain, although proper measurement and fitting of the stockings can reduce the risk of discomfort. More detailed compression stocking tips are available in the table ( table 2 and figure 2A-C ).

Effective compression stockings apply the greatest amount of pressure at the ankle and gradually decrease the pressure up the leg. These stockings are available with varying degrees of compression.

● Stockings with small amounts of compression can be purchased at pharmacies and surgical supply stores without a prescription.

● People with moderate to severe edema, those on their feet a lot, and those with ulcers usually require prescription stockings. A healthcare provider may take measurements for stockings or may write a prescription for stockings and then have a surgical supply or specialty store take the necessary measurements.

● The white "antiembolism" stockings commonly given in the hospital do not apply enough pressure at the ankle and are not adequate treatment for edema.

Body positioning  —  Leg, ankle, and foot edema can be improved by elevating the legs above heart level for 30 minutes three or four times per day. Elevating the legs may be sufficient to reduce or eliminate edema for people with mild venous disease, but more severe cases require other measures. In addition, it may not be practical for those who work to elevate their legs several times per day.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site ( www.uptodate.com/patients ). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information  —  UpToDate offers two types of patient education materials.

The Basics  —  The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Chronic kidney disease (The Basics) Patient education: Swelling (The Basics) Patient education: Preeclampsia (The Basics) Patient education: Glomerular disease (The Basics) Patient education: Growth hormone treatment in adults (The Basics) Patient education: Tricuspid regurgitation (The Basics) Patient education: Tricuspid stenosis (The Basics) Patient education: Heart failure with preserved ejection fraction (The Basics) Patient education: Heart failure with reduced ejection fraction (The Basics)

Beyond the Basics  —  Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Cirrhosis (Beyond the Basics) Patient education: Heart failure (Beyond the Basics) Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the Basics) Patient education: Lower extremity chronic venous disease (Beyond the Basics) Patient education: Deep vein thrombosis (DVT) (Beyond the Basics) Patient education: Preeclampsia (Beyond the Basics) Patient education: Chronic kidney disease (Beyond the Basics) Patient education: Low-sodium diet (Beyond the Basics)

Professional level information  —  Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Clinical manifestations and evaluation of edema in adults Idiopathic edema Clinical features and diagnosis of peripheral lymphedema Clinical staging and conservative management of peripheral lymphedema Pathophysiology and treatment of edema in adults with the nephrotic syndrome Mechanism of action of diuretics Neurogenic pulmonary edema Overview of heavy proteinuria and the nephrotic syndrome Pathophysiology and etiology of edema in adults Causes and treatment of refractory edema in adults General principles of the treatment of edema in adults

The following organizations also provide reliable health information.

● National Library of Medicine

     ( www.nlm.nih.gov/medlineplus/edema.html , available in Spanish)

● National Institute of Diabetes and Digestive and Kidney Diseases

     ( www.niddk.nih.gov )

● National Kidney Foundation

     ( www.kidney.org )

This image shows 2 photographs side-by-side of the same, swollen foot and ankle. In panel A, a doctor is grasping the foot and their thumb is pressed firmly against the top of the foot. In panel B, the doctor’s hand is gone, but the foot remains, and there is a depression where the thumb was pressing on the foot.

The heel-pocket-out method to put on compression stockings is as follows:

(A) Turn the leg part of the stocking inside-out down to the heel.

(B) Put your foot into the stocking, hold onto the folded edge, and pull the stocking onto your foot and over the heel.

(C) Gently work the stocking up your leg by turning it right-side out.

Image

Contributor Disclosures

Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.

Conflict of interest policy

Print Options

  • Português Br
  • Journalist Pass

Foot swelling during air travel: A concern?

Dana Sparks

Share this:

Share to facebook

Leg and foot swelling during air travel is common and typically harmless. The most likely culprit is inactivity during a flight.

Sitting with your feet on the floor for a long period causes blood to pool in your leg veins. The position of your legs when you are seated also increases pressure in your leg veins. This contributes to foot swelling by causing fluid to leave the blood and move into the surrounding soft tissues.

To relieve foot swelling during a flight:

  • Wear loosefitting clothing
  • Take a short walk every hour or so
  • Flex and extend your ankles and knees frequently while you're seated
  • Flex your calf muscles
  • Shift your position in your seat as much as possible, being careful to avoid crossing your legs
  • Drink plenty of fluids to prevent dehydration
  • Avoid alcohol and sedatives, which could make you too sleepy or unsteady to walk around the cabin

Foot swelling isn't a serious problem if it lasts only a short time. But excessive swelling that persists for several hours after you resume activity may be due to a more serious condition, such as a blood clot in the leg (deep vein thrombosis). If you have swelling in only one leg and also have leg pain, seek prompt medical care.

If you're at increased risk of blood clots — because you recently had major surgery or you take birth control pills, for example — talk with your doctor before flying. He or she may recommend wearing compression stockings during your flight. In some cases, your doctor may prescribe a blood-thinning medication to be taken before departure.

This article is written by Dr. Sheldon G. Sheps and  Mayo Clinic staff . Find more health and medical information on  mayoclinic.org .

  • Helping Others Heal: Encouraging whole person care blossoms into a center for women’s health Home Remedies: High blood pressure and cold remedies

Related Articles

travel related edema

  • Search Menu
  • Advance articles
  • Collections
  • Editor's Choice
  • Supplements
  • Author Guidelines
  • Submission Site
  • Open Access
  • About Journal of Travel Medicine
  • About the International Society of Travel Medicine
  • Editorial Board
  • Advertising and Corporate Services
  • Journals Career Network
  • Self-Archiving Policy
  • Journals on Oxford Academic
  • Books on Oxford Academic

International Society of Travel Medicine

Article Contents

Epidemiologic data, common localized skin infections and infestations, common systemic febrile illnesses with skin involvement, declaration of interests.

  • < Previous

Common Skin Infections in Travelers

  • Article contents
  • Figures & tables
  • Supplementary Data

Patrick Hochedez, Eric Caumes, Common Skin Infections in Travelers, Journal of Travel Medicine , Volume 15, Issue 4, 1 July 2008, Pages 252–262, https://doi.org/10.1111/j.1708-8305.2008.00206.x

  • Permissions Icon Permissions

Dermatoses are a leading cause of health problems in travelers. They cover a large spectrum of diseases, which includes infectious skin diseases of exotic or cosmopolitan origin as well as environmental skin diseases. The purposes of this review were to identify the most common travel‐related skin infections and to familiarize health providers with their epidemiology, clinical features, prevention, diagnosis, and treatment.

During travel, dermatoses have been reported by 8% of 784 American travelers worldwide in a questionnaire‐based survey published in 2000. Of the 63 dermatoses reported in this cohort, 14 were related to insect bites or stings, 10 to sun exposure, 7 to dermatophytes, 7 to contact allergy, 5 to infectious cellulites, 4 to miscellaneous causes, and 16 were from unknown causes. 1

Similarly, on‐site studies of health impairment described dermatoses as being one of the three main reasons for consultation in travelers abroad. In Nepal, three studies showed that dermatoses were the third to the fourth most frequent presenting illness among tourists: skin diseases accounted for 12% of health impairments among 838 French tourists in 1984, 8.7% of consultations among 276 French tourists in 2001, and 10% of 19,616 presentations of patients of all nationalities at a private clinic in the 1980s. 2,3 In two of these three Nepalese studies, bacterial and fungal skin infections as well as scabies infestation were the most common travel‐associated dermatoses reported. 2 Considering a different environment in the Maldives and Fiji, dermatoses were the most frequent presenting illnesses in tourists, with sunburns, superficial injuries (including those due to contact with marine creatures), and skin infections documented most often. 4,5 In Burkina Faso, among 100 Westerners with 106 dermatoses diagnosed through teledermatology, the most frequently observed skin diseases were bacterial (21%), viral (12%), and fungal (17%) infections; arthropod‐induced dermatitis (8%); and dermatoses of another origin (29%). Fungal diseases were only observed in expatriates but not in tourists. 6 Taken together, these six on‐site studies from different regions of the world illustrate that the leading dermatoses observed during travel are skin infections and environmental skin diseases (arthropod‐induced pruritic dermatitis, sunburns, marine‐associated dermatitis, and superficial injuries).

In an international study concerning 17,353 returning travelers, dermatologic disorders were the third most common cause of health problems after systemic febrile illness and acute diarrhea. The most common causes of dermatologic problems were insect bites (with or without secondary infection), cutaneous larva migrans, allergic reactions, and skin abscesses. 7 In a prospective study of 269 short‐term travelers (tourists and business) who presented to a tropical disease clinic in Paris with dermatoses, similar skin diseases were diagnosed ( Table 1 ). Of the 269 cases, 137 (53%) involved an imported tropical disease. 8 In a prospective study made 10 years later in the same hospital unit among a broader spectrum of travelers (immigrants returning from visiting their home countries, expatriates, business travelers, and tourists), the part of imported dermatoses declined to 33.9% ( Table 1 ). 9

The top 10 leading dermatoses in three series of returning travelers

HrCLM = hookworm‐related cutaneous larva migrans.

Bacterial skin infections

Bacterial skin infections are one of the most common dermatoses in travelers. The clinical spectrum ranges from impetigo and ecthyma to erysipelas, abscess, and necrotizing cellulitis. Lesions usually appear while the patient is still abroad but are also a leading cause of consultation in returning travelers. 7–9 Pyodermas were the second cause (18%) of dermatoses after cutaneous larva migrans (25%) in a prospective study of travel‐associated dermatoses conducted in Paris. 8 Among the 48 patients with bacterial cutaneous infections, 75% were diagnosed as impetigo, erysipelas, or ecthyma. Among the 19 patients with impetigo, Staphylococcus aureus and Streptococcus sp. were identified in 80% of the 15 available swab samples, and 63% were secondary to an insect bite. Fifteen years later in the same center, bacterial skin infections were the leading cause of dermatoses in 165 returning travelers (21%) and were secondary to insect bites in 6 (28.6%) of the 21 cases of cellulitis. 9 Insect bite, with or without superinfection, was also the first etiologic diagnosis in 2,947 travelers with dermatologic disorder within wide clinician‐based surveillance data for 17,353 ill‐returned travelers. 7 Therefore, insect bites probably act as a frequent portal of entry of bacterial skin infections in travelers. Beyond the area of travel‐related dermatosis, the association between impetigo and insect bites has been suggested in a community‐based study conducted in England and Wales. 10

Bacterial analysis and susceptibility testing should be widely recommended considering the risk of antibiotic resistance and the possibility of highly pathogenic S aureus strains exhibiting Panton–Valentine leukocidin. 11 Otherwise, these cutaneous infections are mainly due to S aureus and Streptococcus pyogenes and therefore should be initially treated according to published guidelines after systematic bacterial skin sample, without taking into consideration the area visited. 12 Nonetheless, in case of a marine portal of entry, the spectrum of culprit agents must also include Gram‐negative bacilli such as Vibrio vulnificus . Finally, the antibiotics recommended in this setting should cover S aureus and Streptococcus sp. and thus include penicillinase‐resistant penicillins, first‐generation cephalosporins, clindamycin, or vancomycin for patients with life‐threatening penicillin allergies. 12

Considering that rupture of the cutaneous barrier, whatever is its cause, has been shown to be a common factor associated with cellulitis, 13 travelers should avoid skin injuries and should increase their self‐protection against insect bites.

Hookworm‐related cutaneous larva migrans

Hookworm‐related cutaneous larva migrans (HrCLM) is the most frequent travel‐associated skin disease of tropical origin and has been recently reviewed in the Journal. 7,8,14

HrCLM is caused by the penetration of the skin by cat or dog nematode larvae usually while landing or walking on contaminated lake and ocean beaches or soils of tropical and subtropical countries worldwide.

The incubation period of HrCLM is usually a few days and rarely goes beyond 1 month. In three series, cutaneous lesions appeared after return in 51% to 55% of the travelers, and the mean time of onset after return ranged from 5 to 16 days. 8,15,16 In a German study, the time of onset ranged from 16 weeks before return to 28 weeks after return (mean 1.5 d after return). 17 In two clusters of HrCLM, the median time from the start of the trip to the development of the eruption ranged from 10 to 15 days. 18,19 However, some extremely long incubation periods have been reported, up to 7 months. 14

The striking symptom of HrCLM is pruritus localized at the site of the eruption. It is reported in 98% to 100% of patients. 15,16 The most frequent and characteristic sign of HrCLM is “creeping dermatitis,” a clinical sign defined as an erythematous, linear, or serpiginous track that is approximately 3 mm wide and may be up to 15 to 20 mm in length, which may extend a few millimeters to a few centimeters daily 15 ( Figure 1 ). The mean number of lesions per person varies from one to three. 8,15,16 Two other major clinical signs are edema and vesiculobullous lesions along the course of the larva. Local swelling is reported in 6% to 17% and vesiculobullous lesions in 4% to 40% of patients, respectively. 8,15,19,20 Potentially, all unprotected parts of the skin in contact with contaminated soil may be involved. However, the most frequent anatomic locations of HrCLM lesions are the feet in more than 50%, followed by the buttocks and thighs. 8,15,17,19 Without any treatment, the eruption usually lasts between 2 and 8 weeks. 14 Hookworm folliculitis is a particular form of HrCLM, consisting of folliculitis‐like lesions associated with numerous relatively short tracks, generally arising from follicular lesions. 21

Creeping eruption due to hookworm‐related cutaneous larva migrans.

Creeping eruption due to hookworm‐related cutaneous larva migrans.

Local complications of HrCLM are led by secondary bacterial infection of the involved skin area, which may occur in up to 8% of cases. 16 Systemic complications have been rarely reported. 14

HrCLM is usually a clinical diagnosis based on the typical clinical presentation in the context of recent travel to a tropical country and beach exposure. The differential diagnoses include the other dermatoses that give rise to creeping dermatitis 22 ( Table 2 ).

Causes of creeping eruption in travelers *

Adapted from Caumes. 22

Oral ivermectin and albendazole are the first‐line treatments. Taken in a single dose, ivermectin is well tolerated and highly efficacious with cure rates of 94% to 100% in all but one of the largest series. 14 In the case of hookworm folliculitis, treatment may necessitate repeated courses of oral anthelmintic agents. 21 When oral ivermectin and albendazole are contraindicated (eg, very young children), then the application of a 10% albendazole ointment, twice a day for 10 days, is a safe and effective alternative treatment. 14 Where available, thiabendazole ointment remains the first‐choice treatment. 14

Localized cutaneous leishmaniasis

Localized cutaneous leishmaniasis (LCL) occurs in tropical and warm temperate countries and is transmitted by sandflies. Old World LCL (caused primarily by Leishmania major and Leishmania tropica ) mainly occurs in travelers to the sub‐Saharan and North Africa, the Mediterranean basin, and the Middle East. New World LCL (caused primarily by the species of Leishmania braziliensis and Leishmania mexicana complexes) mainly occurs in travelers to the Amazon Forest of South America.

The main clinical form of cutaneous leishmaniasis among travelers is LCL. Of the 59 cases of cutaneous leishmaniasis reported to the National Institutes of Health from 1973 to 1991, there were 42 cases of LCL (23 Old World and 19 New World), 4 cases of recurrent cutaneous leishmaniasis, 2 cases of mucosal leishmaniasis, and 10 cases of diffuse cutaneous leishmaniasis. 23 Similarly, in Germany, 23 cases of LCL and 3 cases of mucocutaneous forms of imported leishmaniasis were reported to the German surveillance network for imported infectious diseases from January 2001 to June 2004. The median time to a definitive diagnosis was 61 days in cases of cutaneous/mucocutaneous leishmaniasis, reflecting the unfamiliarity of physicians working in industrialized countries with leishmanial infections. 24 This is also illustrated by a study of cutaneous leishmaniasis in the United States where the median time interval from when the lesions were first noticed to when treatment was instituted was 112 days (range 0–1,032 d). 25

The incubation period varies from a few days to a few months. The median time interval between return from the tropics and the onset of cutaneous lesions has been estimated to be 15 (range 7–30 d) to 22 days (range 1–150 d). 23,26 The clinical forms of LCL include papule, nodule, ulcer, and nodular lymphangitis ( Figure 2 ). The average number of cutaneous lesions varies from 1 to 3 and rarely exceeds 10 per patient. Usual features of LCL include the anatomic location on exposed skin (face, arms, and legs), absence of pain, chronicity (more than 15 d duration), and failure of antibiotics (which are often prescribed, given that it often looks like pyoderma). Old World LCL is often benign and self‐limiting cutaneous disease. 27 Meanwhile, in travelers returning from South America, the clinical spectrum is larger, ranging from ulcerative skin lesions to destructive mucosal inflammation, the latter usually being a rarely described complication of L (Viannia) braziliensis infection in travelers. 28

Ulcer due to Old World localized cutaneous leishmaniasis.

Ulcer due to Old World localized cutaneous leishmaniasis.

The differential diagnosis of LCL includes all diseases that give rise to localized macular, papular, nodular lesion or cutaneous ulcer ( Table 3 ). New World LCL may present with sporotrichoid lesions mimicking sporotrichosis ( Table 4 ). 29

Causes of localized skin diseases in travelers according to the primary cutaneous lesion

Causes of nodular lymphangitis in travelers *

Nodular lymphangitis: nodular and/or ulcerative lesions along the line of lymphatic drainage distributed as in a sporotrichosis.

Adapted from Kostman and colleagues. 29

Diagnosis is based on direct examination of a slit‐skin smear of the cutaneous lesion stained with Giemsa under light microscopy and/or culture with identification of subsequent subspecies. 30 Skin biopsy from the edge of the ulcer may reveal the characteristic amastigotes within macrophages but is less sensitive than culture. The recently developed polymerase chain reaction (PCR) technology allows a rapid and high‐sensitivity diagnosis with determination of most species. 28

The response to treatment varies according to the species. Therefore, identification techniques that, like PCR, allow a species‐orientated treatment are particularly useful. 28 In cases of Old World LCL, absence of treatment may be considered, given that the cutaneous lesions heal spontaneously in nearly all the patients within 1 year. Topical treatment with paromomycin ointment could also be an attractive alternative. 31 Otherwise, the mainstay of treatment is pentavalent antimonial agents given intralesionally. Fluconazole is more questionable even in those with L major infections. 32 In contrast, treatment is strongly recommended for New World leishmaniasis, at least because it is supposed to prevent mucosal invasion. If pentavalent antimonial drugs are still the drug of choice for New World leishmaniasis, liposomal amphotericin B, pentamidine isethionate, and miltefosine could be attractive alternatives according to the culprit species. 28

Myiasis is defined as the infestation of human tissues by larvae or maggots of flies (Diptera). The most common form of human myiasis reported in travelers is furuncular myiasis, which is often caused by Cordylobia anthropophaga (tumbu fly) in sub‐Saharan Africa and Dermatobia hominis (human botfly) in Central and South America. 33 However, according to the results of series of imported cases in Western countries, a wide variety of clinical presentations of myiasis are observed in travelers. 8,34,35 In a series of 25 imported cases seen in France, 20 were due to C anthropophaga , 4 to D hominis , and 1 to Cochliomyia hominivorax . 8 In a series of 18 cases imported in England, 9 were due to C anthropophaga , 4 to D hominis , 2 to Oestrus ovis (sheep nasal botfly), 1 to Cordylobia rodhaini , 1 to C hominivorax , and 1 to unidentified Oestrid larva . 34 The genus Cordylobia also contains two less common species, Cordylobia ruandae and Cordylobia rodhani . The usual hosts of C rodhani are mainly mammals like rodents, but travelers can be accidentally infested as reported in two Israeli travelers returning from Ghana. 36 The most common form of myiasis after travel to Central and South America is due to D hominis . It was reported in a series of 14 Israeli travelers returning from South America. 37

Depending on which fly is involved, the presentation of myiasis differs by the method of infestation, place of acquisition, duration of maturation, number of cutaneous lesions, anatomic location, and the ability to manually extract the larvae. Cordylobia anthropophaga larvae penetrate the skin after hatching from eggs deposited on moist soil or clothing and bed linens hung to dry outdoors and that have not been ironed. The infestation by D hominis larvae develops from fly eggs carried to the human by a biting mosquito. 33,38 In both cases, the larvae develop by successive molts. The incubation period varies from 7 days to 3 weeks (7–10 d for the tumbu fly and 15–45 d for the botfly). 8 The mean time from exposure to diagnosis was 1.5 months in 12 Israeli travelers with D hominis myiasis after return from the Amazon River basin of Bolivia. 39

The cutaneous lesion is a 1 to 2 cm furuncle‐like lesion with a central punctum through which serosanguineous or purulent fluid discharges. Importantly, the patient complains of a crawling sensation within the lesion, and movements of the larvae may be seen within the central punctum. Cordylobia anthropophaga lesions are more commonly multiple, whereas D hominis lesions usually number from one to three. 35 , Cordylobia anthropophaga lesions are usually located on areas of the body covered by clothing (such as the trunk), whereas D hominis lesions are commonly located on exposed areas of the body (such as the scalp, face, forearms, and legs). The largest number of lesions ever reported was 94 in a child from Ghana infected by C anthropophaga . 40

The diagnosis of myiasis is made by the identification of the larva from the lesion. The treatment is the removal of the larvae. No oral antiparasitic medication is usually recommended for myiasis, but ivermectin has been showed to be efficient. It is important to avoid breaking the larvae in that incomplete removal may result in a hypersensitivity or foreign body reaction to the larvae. In the case of C anthropophaga , manual pressure to the lateral aspects of the lesion easily allows the expression of the maggot. With D hominis , extraction is facilitated by placing an occlusive agent (eg, paraffin, petrolatum, pork fat, toothpaste cap) onto the lesion that may cause the larva to migrate to the skin surface. 41 Unsuccessful occlusive therapy may necessitate sterile surgical extraction and debridement. 33 Although rarely reported, bacterial superinfection is the main complication. Myiasis wounds should be disinfected in addition to the provision of tetanus prophylaxis and antibiotic treatment for secondary bacterial infections. 33 In Brazil and Colombia, oral use of ivermectin has been reported as a useful surgery‐associated treatment in case of severe orbital myiasis due to C hominivorax . 42

Tungiasis is caused by penetration of the gravid female sand flea Tunga penetrans that burrows into the skin of its host, usually on the feet to feed on blood while producing and extruding eggs. 33 The infection is usually acquired via direct contact (eg, bare feet) with infested soil or beaches where adult fleas live. Tungiasis (also called chigoe flea, jigger flea) is widely distributed throughout Latin America, the Caribbean, Africa, and Asia up to the west coast of India. 33,43 Humans and animals (eg, dogs, pigs) can be affected. In the largest study of 17 imported cases, tungiasis manifested after return in eight cases (47%), and the median lag time between return and onset was 5 days (range 2–10 d). For all 17 cases, the median lag time between return and presentation was 12 days (range 5–40 d), and all lesions were located at the extremity of a toe. 8

The acute cutaneous lesion is a papule with a central black dot at the site of penetration that develops into a wart‐like nodule through which eggs of the flea are expelled. There is a limited number of nodules (most commonly one), which are usually located on the feet (subungual, soles, tips or toes, and web spaces) and lower extremities. 8,43

The diagnosis relies on clinical findings and is confirmed by the morphology of the flea after its extraction. The differential diagnosis includes myiasis, pyoderma, and foreign body reaction.

Treatment consists of complete sterile excision of all embedded fleas with needles or curettes, administration of tetanus prophylaxis, and oral antibiotherapy if there are signs of secondary bacterial infection. 33

Scabies is the commonest cause of diffuse pruritic skin disease diagnosed in travelers returning from the tropics. 7,9 Scabies is an infestation by the mite Sarcoptes scabiei and is acquired by skin‐to‐skin contact. Clinically, a patient complains of generalized and intense itching, worsening at night, usually sparing the face and head. Pruritus occurs within 3 weeks of contact in case of primary exposure and within a few days in patients with a history of previous scabies exposure. The most specific skin findings include 5 to 10 mm burrows and papulonodular genital lesions. The classic distributions of lesions are the interdigital web spaces, flexor surfaces of the wrists, the elbows, the axillae, the buttocks and genitalia, and on the breasts of women. Other skin changes are secondary to pruritus and include excoriation, lichenification, and impetiginization.

A family history of pruritus is a classical clue to the diagnosis. Diagnosis is confirmed by the microscopic identification of the female mite, eggs, or fecal pellets on skin scrapings of a cutaneous lesion. Treatment includes permethrin cream 5%, lindane 1% (gamma‐benzene hexachloride), benzyl benzoate (in Europe), and ivermectin. For oral ivermectin, which is a simple and well‐tolerated alternative, a second dose 2 weeks later should be recommended. 44 Bedding and clothing must be laundered or removed from contact for at least 3 days. Personal and household contacts must also be treated.

Arboviral infections

The most frequent arboviral infections that give rise to a cutaneous eruption in travelers are caused by dengue and chikungunya viruses. Both infections are transmitted to humans by arthropods, and both are responsible for febrile exanthema ( Table 5 ). Dengue is the most common cause of arboviral disease in the world, one of the most frequent specific causes of systemic febrile illness among travelers and the most frequent arbovirus reported after travel to tropical and subtropical countries. 7,45 Dengue virus belongs to the family Flaviviridae and is transmitted by mosquitoes Aedes aegypti and Aedes albopictus . Dengue is widely reported in tropical and subtropical countries, and dengue hemorrhagic fever is reported in travelers returning from Southeast Asia, South Pacific Islands, Caribbean, and Latin America.

Causes of febrile rash in travelers

Typical presentation of classic dengue fever includes the sudden onset of fever, headache, retroorbital pain, fatigue, musculoskeletal symptoms (arthralgia and myalgia), and a exanthema that usually appears when the fever decreases. The exanthema is typically macular or maculopapular, confluent with the sparing of small islands of normal skin. Other dermatologic signs include pruritus, flushed facies, and hemorrhagic manifestations such as petechiae and purpura. 46 Most patients present with classic dengue fever and have benign febrile illness, but dengue hemorrhagic fever and dengue shock syndrome must be systematically evaluated.

Typical lab abnormalities include thrombocytopenia, leukopenia, lymphopenia, and elevations of hepatic aminotransferases. A usual fall in the platelet count and a rise in hematocrit must be monitored to promptly diagnose dengue hemorrhagic fever. Diagnosis of dengue virus infection is often based on serology or PCR. Diagnosis of dengue hemorrhagic fever is made on the basis of the association of hemorrhagic manifestations, a platelet count of less than 100,000/μL, and objective evidence of plasma leakage (eg, pleural effusion, ascites, or hypoproteinemia). 45

Chikungunya virus was first isolated in Tanzania in 1953; since then, chikungunya outbreaks have been reported in Africa and Asia and more recently in the Indian Ocean. Transmission to humans occurs through bites of Aedes (mainly A aegypti and A albopictus ) mosquitoes. Since 2005, chikungunya has emerged in the islands of the southwestern Indian Ocean (Comoros, Mauritius, Seychelles, and Reunion) and has later reemerged in India. Since 2005, chikungunya cases have been reported in travelers returning from known outbreak areas to Europe (especially in France), Canada, and the United States. 47–49

Skin manifestations of chikungunya infection in travelers seem to be very similar to those described for classic dengue fever infection, with a pruritic, macular, or a maculopapular exanthema in which small islands of normal skin are spared 48 ( Figure 3 ). Diagnosis confirmation is based on serology or PCR, and treatment of the acute phase is only symptomatic (eg, antipyretic agents such as paracetamol and bed rest). Chikungunya and dengue skin manifestations are difficult to differentiate. 50 Moreover, the viruses are transmitted by the same mosquito species, and disease‐endemic areas are nearly the same in Asia, Africa, and the Indian Ocean. Finally, it is important to differentiate between the two illnesses because shock and gastrointestinal hemorrhages are complications associated with dengue fever, 50 whereas long‐lasting arthralgia is a complication specifically associated with chikungunya. 49

Exanthema attributed to chikungunya infection.

Exanthema attributed to chikungunya infection.

Other arboviruses presenting with fever and rash should be considered: West Nile virus in North America, Africa, and southern Europe; the Ross River and Barmah Forest viruses in the South Pacific; O’nyong‐nyong and Sindbis viruses in tropical Africa; and Mayaro virus in South America. 51

Rickettsioses and scrub typhus

Rickettsioses are zoonotic bacterial infections transmitted to humans by arthropods and are considered as emerging diseases in travelers. Regardless of the causative agent, most patients usually present with a benign febrile illness accompanied by headache, myalgia, and cutaneous eruptions (diffuse skin rash and sometimes a cutaneous eschar, the portal of entry). Severe complications such as multiorgan failure and fatalities are occasionally seen. 52

African tick bite fever (ATBF) is currently the leading rickettsiosis reported in travelers. 52 It is caused by Rickettsia africae and transmitted by cattle ticks of the Amblyomma genus. ATBF is endemic in large parts of rural sub‐Saharan Africa and the eastern Caribbean. ATBF frequently occurs in clusters of travelers exposed to Amblyomma ticks during game hunting, safaris, adventure races, and military exercises. 53

ATBF is usually a mild disease, and typical clinical presentation usually includes one or several inoculation eschars with a maculopapular or vesicular cutaneous rash accompanied by fever, headache, and neck myalgia ( Figure 4 ). 52 In 38 travelers with confirmed ATBF returning from rural sub‐Equatorial Africa, more than 80% of patients had fever, headache, and/or myalgia, whereas less than 50% of patients had inoculation eschars, lymphadenitis, cutaneous rash, and aphthous stomatitis. 54 In this study, risk factors included game hunting, travel to southern Africa, and seasonal travel from November to April. 54 Long‐lasting subacute neuropathy has been reported following ATBF contracted during safari trips to southern Africa. 55

African tick bite fever: eschar associated with a few cutaneous lesions.

African tick bite fever: eschar associated with a few cutaneous lesions.

Other rickettsioses reported in the travelers include:

Mediterranean spotted fever, caused by Rickettsia conorii , transmitted by dog ticks and endemic in Mediterranean Europe, Africa, and Asia.

Murine typhus, a flea‐borne infection, caused by Rickettsia typhi , and widely distributed in tropical and subtropical regions.

Rocky Mountain spotted fever, caused by Rickettsia rickettsii , transmitted by dog ticks and endemic in the Americas.

Scrub typhus, caused by Orientia tsutsugamushi , transmitted by the bite of larval trombiculid mites (chiggers) and endemic in rural south and southeastern Asia and the western Pacific. 52

Diagnosis of rickettsiosis is often made on clinical grounds. Serological analysis mainly provides a retrospective confirmation of the clinical diagnosis. However, an early diagnosis may be possible using PCR testing of skin biopsies performed on the eschar. Presumptive therapy with doxycycline is recommended whenever a case of rickettsiosis is suspected allowing for rapid recovery and prevention of complications. 52 The usual dosage of doxycycline is 200 mg/d, and the antibiotic is contraindicated for children. Symptoms usually resolve within 24 to 48 hours after the onset of treatment, which may also help with the diagnosis of rickettsiosis.

There are many other travel‐related skin infections beyond the scope of this review. Tables 2 to 8 are provided to help clinicians considering morphologic characteristics of cutaneous lesions.

Causes of pruritus in travelers

Causes of urticaria in travelers

Causes of localized edema in travelers

Skin diseases as a whole are a common cause of morbitidy among international travelers and are a reason for presenting to a doctor after travel. It is important for travel medicine providers to understand the epidemiology, clinical features, preventive measures, diagnostic testing, and treatment options for their patients. The pretravel consultation provides an opportunity to review some of these commonly encountered skin infections and provide travelers with strategies to prevent or self‐treat them as they may arise during their travels. When seeing a patient following travel, it is important to recognize important conditions that may require prompt therapy and/or further evaluation with an infectious disease specialist or dermatologist.

The authors state that they have no conflicts of interest.

Hill DR . Health problems in a large cohort of Americans traveling to developing countries . J Travel Med 2000 ; 7 : 259 – 266 .

Google Scholar

Hochedez P Vinsentini P Ansart S Caumes E . Changes in the pattern of health disorders diagnosed among two cohorts of French travelers to Nepal, 17 years apart . J Travel Med 2004 ; 11 : 341 – 346 .

Shlim D . Learning from experience: travel medicine in Kathmandu . In: Travel medicine 2. Proceedings of the Second Conference on International Travel Medicine . Atlanta, GA: International Society of Travel Medicine , 1992 : 40 – 48 .

Raju R Smal N Sorokin M . Incidence of minor and major disorders among visitors to Fiji . In: Travel medicine 2. Proceedings of the Second Conference on International Travel Medicine . Atlanta, GA: International Society of Travel Medicine , 1992 : 62 .

Plentz K . Nontropical and noninfectious diseases among travelers in a tropical area during five year period (1986‐1990) . In: Travel medicine 2. Proceedings of the Second Conference on International Travel Medicine . Atlanta, GA: International Society of Travel Medicine , 1992 : 77.

Caumes E Le Bris V Couzigou C , et al . Dermatoses associated with travel to Burkina Faso and diagnosed by means of teledermatology . Br J Dermatol 2004 ; 150 : 312 – 316 .

Freedman DO Weld LH Kozarsky PE , et al . Spectrum of disease and relation to place of exposure among ill returned travelers . N Engl J Med 2006 ; 354 : 119 – 130 .

Caumes E Carriere J Guermonprez G , et al . Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit . Clin Infect Dis 1995 ; 20 : 542 – 548 .

Ansart S Perez L Jaureguiberry S , et al . Spectrum of dermatoses in 165 travelers returning from the tropics with skin diseases . Am J Trop Med Hyg 2007 ; 76 : 184 – 186 .

Elliot AJ Cross KW Smith GE , et al . The association between impetigo, insect bites and air temperature: a retrospective 5‐year study (1999‐2003) using morbidity data collected from a sentinel general practice network database . Fam Pract 2006 ; 23 : 490 – 496 .

Denis O Deplano A De Beenhouwer H , et al . Polyclonal emergence and importation of community‐acquired methicillin‐resistant Staphylococcus aureus strains harbouring Panton‐Valentine leucocidin genes in Belgium . J Antimicrob Chemother 2005 ; 56 : 1103 – 1106 .

Stevens DL Bisno AL Chambers HF , et al . Practice guidelines for the diagnosis and management of skin and soft‐tissue infections . Clin Infect Dis 2005 ; 41 : 1373 – 1406 .

Roujeau JC Sigurgeirsson B Korting HC , et al . Chronic dermatomycoses of the foot as risk factors for acute bacterial cellulitis of the leg: a case‐control study . Dermatology 2004 ; 209 : 301 – 307 .

Hochedez P Caumes E . Hookworm‐related cutaneous larva migrans . J Travel Med 2007 ; 14 : 339 – 346 .

Davies HD Sakuls P Keystone JS . Creeping eruption. A review of clinical presentation and management of 60 cases presenting to a tropical disease unit . Arch Dermatol 1993 ; 129 : 588 – 591 .

Bouchaud O Houze S Schiemann R , et al . Cutaneous larva migrans in travelers: a prospective study, with assessment of therapy with ivermectin . Clin Infect Dis 2000 ; 31 : 493 – 498 .

Jelinek T Maiwald H Nothdurft HD Loscher T . Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients . Clin Infect Dis 1994 ; 19 : 1062 – 1066 .

Green AD Mason C Spragg PM . Outbreak of cutaneous larva migrans among British military personnel in Belize . J Travel Med 2001 ; 8 : 267 – 269 .

Tremblay A MacLean JD Gyorkos T Macpherson DW . Outbreak of cutaneous larva migrans in a group of travellers . Trop Med Int Health 2000 ; 5 : 330 – 334 .

Blackwell V Vega‐Lopez F . Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller . Br J Dermatol 2001 ; 145 : 434 – 437 .

Caumes E Ly F Bricaire F . Cutaneous larva migrans with folliculitis: report of seven cases and review of the literature . Br J Dermatol 2002 ; 146 : 314 – 316 .

Caumes E . It’s time to distinguish the sign ‘creeping eruption’ from the syndrome ‘cutaneous larva migrans’ . Dermatology 2006 ; 213 : 179 – 181 .

Melby PC Kreutzer RD McMahon‐Pratt D , et al . Cutaneous leishmaniasis: review of 59 cases seen at the National Institutes of Health . Clin Infect Dis 1992 ; 15 : 924 – 937 .

Weitzel T Muhlberger N Jelinek T , et al . Imported leishmaniasis in Germany 2001‐2004: data of the SIMPID surveillance network . Eur J Clin Microbiol Infect Dis 2005 ; 24 : 471 – 476 .

Herwaldt BL Stokes SL Juranek DD . American cutaneous leishmaniasis in U.S. travelers . Ann Intern Med 1993 ; 118 : 779 – 784 .

El Hajj L Thellier M Carriere J , et al . Localized cutaneous leishmaniasis imported into Paris: a review of 39 cases . Int J Dermatol 2004 ; 43 : 120 – 125 .

Blum J Desjeux P Schwartz E , et al . Treatment of cutaneous leishmaniasis among travellers . J Antimicrob Chemother 2004 ; 53 : 158 – 166 .

Schwartz E Hatz C Blum J . New world cutaneous leishmaniasis in travellers . Lancet Infect Dis 2006 ; 6 : 342 – 349 .

Kostman JR DiNubile MJ . Nodular lymphangitis: a distinctive but often unrecognized syndrome . Ann Intern Med 1993 ; 118 : 883 – 888 .

Herwaldt BL . Leishmaniasis . Lancet 1999 ; 354 : 1191 – 1199 .

Shazad B Abbaszadeh B Khamesipour A . Comparison of topical paromomycin sulfate (twice/day) with intralesional meglumine antimoniate for the treatment of cutaneous leishmaniasis caused by L. major . Eur J Dermatol 2005 ; 15 : 85 – 87 .

Morizot G Delgiudice P Caumes E , et al . Healing of Old World cutaneous leishmaniasis in travelers treated with fluconazole: drug effect or spontaneous evolution? Am J Trop Med Hyg 2007 ; 76 : 48 – 52 .

Diaz JH . The epidemiology, diagnosis, management, and prevention of ectoparasitic diseases in travelers . J Travel Med 2006 ; 13 : 100 – 111 .

McGarry JW McCall PJ Welby S . Arthropod dermatoses acquired in the UK and overseas . Lancet 2001 ; 357 : 2105 – 2106 .

Jelinek T Nothdurft HD Rieder N Loscher T . Cutaneous myiasis: review of 13 cases in travelers returning from tropical countries . Int J Dermatol 1995 ; 34 : 624 – 626 .

Tamir J Haik J Schwartz E . Myiasis with Lund’s fly (Cordylobia rodhaini) in travelers . J Travel Med 2003 ; 10 : 293 – 295 .

Tamir J Haik J Orenstein A Schwartz E . Dermatobia hominis myiasis among travelers returning from South America . J Am Acad Dermatol 2003 ; 48 : 630 – 632 .

Maier H Honigsmann H . Furuncular myiasis caused by Dermatobia hominis, the human botfly . J Am Acad Dermatol 2004 ; 50 : S26 – S30 .

Schwartz E Gur H . Dermatobia hominis myiasis: an emerging disease among travelers to the Amazon basin of Bolivia . J Travel Med 2002 ; 9 : 97 – 99 .

Biggar RJ Morrow H Morrow RH . Extensive myiasis from tumbu fly larvae in Ghana, West Africa . Clin Pediatr (Phila) 1980 ; 19 : 231 – 232 .

Brewer TF Wilson ME Gonzalez E Felsenstein D . Bacon therapy and furuncular myiasis . JAMA 1993 ; 270 : 2087 – 2088 .

De Tarso P Pierre‐Filho P Minguini N , et al . Use of ivermectin in the treatment of orbital myiasis caused by Cochliomyia hominivorax . Scand J Infect Dis 2004 ; 36 : 503 – 505 .

Sanusi ID Brown EB Shepard TG Grafton WD . Tungiasis: report of one case and review of the 14 reported cases in the United States . J Am Acad Dermatol 1989 ; 20 : 941 – 944 .

Chosidow O . Clinical practices. Scabies . N Engl J Med 2006 ; 354 : 1718 – 1727 .

Wilder‐Smith A Schwartz E . Dengue in travelers . N Engl J Med 2005 ; 353 : 924 – 932 .

Jelinek T Muhlberger N Harms G , et al . Epidemiology and clinical features of imported dengue fever in Europe: sentinel surveillance data from TropNetEurop . Clin Infect Dis 2002 ; 35 : 1047 – 1052 .

Chikungunya fever diagnosed among international travelers—United States, 2005‐2006 . MMWR Morb Mortal Wkly Rep 2006 ; 55 : 1040 – 1042 .

Hochedez P Jaureguiberry S Debruyne M , et al . Chikungunya infection in travelers . Emerg Infect Dis 2006 ; 12 : 1565 – 1567 .

Simon F Parola P Grandadam M , et al . Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases . Medicine (Baltimore) 2007 ; 86 : 123 – 137 .

Nimmannitya S Halstead SB Cohen SN Margiotta MR . Dengue and chikungunya virus infection in man in Thailand, 1962‐1964. I. Observations on hospitalized patients with hemorrhagic fever . Am J Trop Med Hyg 1969 ; 18 : 954 – 971 .

McGill PE . Viral infections: alpha‐viral arthropathy . Baillieres Clin Rheumatol 1995 ; 9 : 145 – 150 .

Jensenius M Fournier PE Raoult D . Rickettsioses and the international traveler . Clin Infect Dis 2004 ; 39 : 1493 – 1499 .

Fournier PE Roux V Caumes E , et al . Outbreak of Rickettsia africae infections in participants of an adventure race in South Africa . Clin Infect Dis 1998 ; 27 : 316 – 323 .

Jensenius M Fournier PE Vene S , et al . African tick bite fever in travelers to rural sub‐Equatorial Africa . Clin Infect Dis 2003 ; 36 : 1411 – 1417 .

Jensenius M Fournier PE Fladby T , et al . Sub‐acute neuropathy in patients with African tick bite fever . Scand J Infect Dis 2006 ; 38 : 114 – 118 .

  • skin diseases, infectious

Email alerts

More on this topic, related articles in pubmed, citing articles via.

  • Recommend to your Library

Affiliations

  • Online ISSN 1708-8305
  • Copyright © 2024 International Society of Travel Medicine
  • About Oxford Academic
  • Publish journals with us
  • University press partners
  • What we publish
  • New features  
  • Open access
  • Institutional account management
  • Rights and permissions
  • Get help with access
  • Accessibility
  • Advertising
  • Media enquiries
  • Oxford University Press
  • Oxford Languages
  • University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

  • Copyright © 2024 Oxford University Press
  • Cookie settings
  • Cookie policy
  • Privacy policy
  • Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

  • Couch to 5K
  • Half Marathon
  • See All ...
  • Olympic/International
  • IRONMAN 70.3
  • Road Cycling
  • Century Rides
  • Mountain Biking
  • Martial Arts
  • Winter Sports

ACTIVE Kids

Sports camps, browse all activites, race results, calculators, calculators.

  • Running Pace
  • Body Fat Percentage
  • Body Mass Index (BMI)
  • Ideal Weight
  • Caloric Needs
  • Nutritional Needs
  • Basal Metabolic Rate (BMR)
  • Kids' Body Mass Index (BMI)

Running Events

  • Half Marthon

Running Articles

  • Distance Running
  • Trail Running
  • Mud Running
  • Training Plans
  • Product Reviews

Triathlon Events

  • Super Sprint

Cycling Events

Triathlon articles, cycling articles.

  • Cyclo-Cross

Fitness Events

  • Strength Training
  • Weight Lifting

Fitness Articles

  • Weight Loss

Sports Events

Outdoor events.

  • Book Campground

Sports Articles

  • Water Sports
  • Snowshoeing

Nutrition Articles

  • Supplements

Health & Injury Articles

  • Health & Injury
  • Physical Health
  • Mental Health
  • Injury Prevention

Kids & Family

  • Infants (0-1)
  • Toddlers (2-4)
  • Big Kids (5-8)
  • Tweens (9-12)
  • Teens (13-18)
  • Cheerleading
  • Arts & Crafts
  • Kids Fitness

ACTIVE Kids Articles

Active works®.

From marketing exposure to actionable data insights, ACTIVE Works® is the race management software for managing & marketing your events.

travel related edema

Travel and Lower Leg Swelling

  • By Gale Bernhardt Updated On October 25, 2017
  • For Active.com

travel related edema

The fall of 2003 was an extremely busy travel period for me. The travel schtick began with doing contract work for the Active Network at the expo of the Hawaiian Ironman race. I stayed for the race, and the day after the race I boarded a plane back to Colorado.

After a short six-hour layover in Denver and a bag exchange coordinated with my husband Del, it was back on a plane to the Washington Dulles Airport for another layover. Then off I went to Frankfurt, Germany, Athens and finally to Vouligmeni, Greece. I traveled to Greece for the World Cup race that was the test event prior to the 2004 Olympic Games. By the time I arrived in Vouligmeni I had monster jet lag and cankles.

The urban-slang term "cankle" is loosely defined as an unfortunate condition where there is no discernable change in the diameter of the lower leg between the knee and the foot. The calf and ankle seem to blend together. There are various causes for cankles; my condition was caused by travel.

I was a little worried because I had never seen my legs look that way. They not only looked bad, they felt bad. Walking in my regular shoes felt strange and running was really uncomfortable. In fact, I couldn't run much at all.

My skin felt like the surface of a water balloon, and it took several days for my ankle bones to reappear. Randy Wilber, the U.S. Olympic Committee exercise physiologist that was doing work at the race site, told me that lower-leg swelling is common after long flights--even for athletes.

One of the recommendations that would be made for American athletes traveling to the Olympic Games would be to consider wearing compression stockings. He said the stockings really work to help eliminate lower-leg swelling. After talking to Randy, I decided I would not leave Greece without wearing a pair of compression stockings for the flights back to the U.S.A.

That experience made me curious about lower-extremity swelling and travel. I investigated and found that leg and foot swelling is quite common during air travel. Some people experience problems on shorter flights, while others do not experience problems unless flight time is four hours or longer.

Contributors to the swelling include inactivity, the position of your legs while seated, low cabin pressure, low humidity, dehydration and certain medications. A small amount of lower-leg and foot swelling that goes away quickly isn't a major problem, but there is a condition called deep vein thrombosis (DVT) that is a major problem.

DVT is a condition where blood clots form in the body's deep veins, particularly the legs. Sometimes a clot can break off and travel elsewhere in the body where it can cause major problems, such as obstructing a vessel in the lungs causing pulmonary embolism.

Airhealth.org says, "About 85 percent of air travel thrombosis victims are athletic, usually endurance-type athletes like marathoners. People with slower resting blood flow are at greater risk of stasis, stagnant blood subject to clotting. Also, they are more likely to have bruises and sore muscles that can trigger clotting."

I don't know that endurance athletes need to be paranoid about DVT, but it is good to be aware of the condition. To learn more about DVT, consult the reference list at the end of the column.

After my experience in 2003, I wear compression stockings for long bouts of air travel. I also use the compression stockings for long bouts of car travel where there will be minimal stops. The biggest reason I wear the stockings and take a few extra precautions during travel is that my legs feel much better when I arrive at my destination. If my legs feel good, my workout quality is improved and my overall attitude is much better.

Whether you're traveling for races or to holiday gatherings, this is a gentle reminder to be sure to take good care of legs when you're in the air or on the road.

Tips to Reduce Lower-leg Swelling During Travel

  • Avoid wearing tight clothing, particularly around your waist.
  • Drink enough fluid to keep your urine light in color.
  • Include an isotonic drink.
  • Try to move your legs and stretch your ankles once per hour. Take a short walk if possible. When you walk, the muscles in your legs contract and compress your veins which helps move blood back to your heart.
  • Elevate your feet and legs when possible.
  • Draw circles with your toes to rotate your ankles if you are stuck in one position and cannot walk.
  • Avoid alcohol and sedatives because they both promote inactivity.
  • Consider wearing compression stockings. Do not confuse compression stockings with support stockings. Compression stockings are graduated with much more pressure at the ankle and less pressure toward the knee. It is best to purchase stockings that require a lower leg measurement to be sure you get the appropriate size.
  • www.Mayoclinic.com
  • www.Airhealth.org  
  • www.AmericanHeart.org  

Related Items

Share this article, discuss this article, latest in travel, connect with us, add a family member, edit family member.

Are you sure you want to delete this family member?

Activities near you will have this indicator

Within 2 miles.

To save your home and search preferences

Join Active or Sign In

Mobile Apps

  • Couch to 5K® View All Mobile Apps

Follow ACTIVE

© 2024 Active Network, LLC and/or its affiliates and licensors. All rights reserved.

Sitemap Terms of Use Copyright Policy Privacy Policy Do Not Sell My Personal Information Cookie Policy Privacy Settings Careers Support & Feedback Cookie Settings

  • Get Your 3rd Race FREE
  • Up to $10 off Event Fees
  • Get $50 off New Running Shoes
  • FREE pair of Pro Compression Socks
  • Up to 15% off GearUp
  • VIP Travel Discounts

...and more!

Google Maps

Schedule An Appointment Enjoy a Pain Free Life! Advanced Pain Management Medicine in Lakeland, Florida & Surrounding Area 863.583.4445

Causes, symptoms, treatments, and prevention of edema (swelling).

Causes, treatments, and prevention of Edema in Lakeland, Florida

What Is Edema?

Edema is an abnormal accumulation of fluid in the tissues of the body leading to swelling which can create pain. It is a common problem that can affect any part of the body, but most commonly affects the feet, ankles, legs, hands, and arms. Edema can be a sign of a serious condition. Although it is most often confined to a small area, edema can affect the entire body.

Pregnant women and older adults more commonly suffer from edema than others; however, it can happen to anyone. Medications, infections, and many other medical conditions can cause edema, in addition to pregnancy.

Causes of Edema

Edema is not contagious, nor is it genetic. It occurs when small blood vessels leak fluid into nearby tissues. When the extra fluid builds up, it causes the surrounding tissues to swell. The swelling can be the result of a twisted ankle, a bee sting, or a skin infection. In some cases, like an infection, edema helps the body heal by bringing more infection-fighting white blood cells to the swollen area.

In some cases, however, edema may be a sign of a more serious underlying medical condition. Edema can be the result of an imbalance of substances in the blood. Other causes include:

  • Allergic reactions. In response to an allergen, nearby blood vessels leak fluid into the affected area. Edema is a part of most allergic reactions.
  • Blood clots. Any blockage that prevents blood from flowing, such as a clot in a vein, can cause edema.
  • A cyst, growth, or tumor. Any abnormal lump in the body can cause edema should it press against a lymph duct or a vein. As pressure builds up, fluids can leak into the surrounding tissue.
  • Head trauma. A build-up of fluid in the cavities (ventricles) deep within the brain (hydrocephalus) can cause cerebral edema.
  • Heart failure.
  • Kidney disease.
  • Cirrhosis of the liver, or other liver conditions.
  • Thyroid disorders.
  • Blood clots.
  • Infections.
  • Severe allergic reactions.
  • Prolonged immobility. People who are immobilized for a long time can develop edema. This type of edema can be due both to fluid pooling in gravity-dependent areas and the release of antidiuretic hormone from the pituitary.
  • Varicose veins . Varicose veins are enlarged, knobby rough and twisted veins that bulge as the result of damaged valves in the vein. The increased pressure in the vein increases the risk of fluids leaking into the surrounding tissue.

Some high blood pressure and diabetic medications can cause edema. Other medications that can cause edema include:

  • Calcium channel blockers.
  • Corticosteroids (like prednisone and methylprednisolone).
  • NSAIDs (such as ibuprofen and naproxen).

Symptoms of Edema

The symptoms of edema depend on the location in the body and the amount of swelling. Swelling in the legs, ankles, or feet that is not injury-related could be edema. The swelling, or “puffiness,” can cause an uncomfortable feeling. In severe cases, the swelling can restrict the range of motion in the ankles and wrists.

In addition to swelling, a person with edema may notice:

  • Stretched and shiny skin.
  • Aching body parts and stiff joints.
  • Higher pulse rate and blood pressure.

Individual symptoms depend on the underlying cause, the type of edema, and where the edema is located.

Edema Treatments

The only treatment for edema is to treat the underlying condition. Temporary edema can often be improved by reducing the amount of salt in the patient’s diet. The doctor may prescribe a diuretic (water pill) to help flush extra fluid out of the body by increasing the rate of urine production. However, diuretics do not work when edema is the result of medications.

Mild edema usually goes away on its own, especially if the patient helps the body eliminate the fluid by raising the affected limb higher than the heart.

Edema Self-Care Techniques

Some self-care techniques that can help prevent or reduce edema include:

  • Avoid tobacco and alcohol .
  • Compression . The doctor may recommend the patient wear compression (support) stockings, sleeves, or gloves, usually after the swelling has gone down, to prevent further swelling.
  • Healthy eating. Avoid packaged and processed foods with a high salt content.
  • Elevation . Elevating the swollen body part above the level of the heart, several times a day, helps improve circulation. In some cases, elevating the affected body part while you sleep may be helpful.
  • Maintain a healthy weight , if appropriate.
  • Movement/Exercise. Moving and using the muscles in the affected body part, especially the legs, may help pump the excess fluid back toward the heart. Avoid sitting or standing still for extended periods. Get up and walk when traveling, especially during air travel.

Minimally Invasive Edema Treatments

Edema can be an external sign of venous insufficiency (a vein problem). Patients with vein-related symptoms can experience chronic pain and discomfort as well as, leg heaviness, leg fatigue, leg swelling, itching, or leg cramping.

Endovenous ablation (also called Endovenous Thermal Ablation or Venus Ablation) is a frequently used method for treating varicose veins which can also help treat edema. There are three types of endovenous ablation treatments for varicose veins that can be performed with local anesthesia in an outpatient setting at the pain clinic in Lakeland, Florida :

  • Laser Ablation . An advantage of laser ablation is the ability to control the amount of energy delivered inside the vein
  • Radiofrequency . Similar to laser ablation, radiofrequency uses small electrodes in direct contact with the vein wall emitting high radiofrequency energy to heat, cauterize, and close the vein.
  • Steam Ablation . The newest method of thermal vein ablation. A very small volume of sterile water is used with a steam catheter to cauterize and close varicose veins.

Is Edema Preventable?

The prevention of edema may not be possible, depending on the cause. If edema is the result of health problems, such as congestive heart failure, liver disease, or kidney disease, the swelling can only be managed.

To help prevent edema, your doctor may recommend staying as physically active as possible and avoiding excess sodium in your diet. In addition:

  • Elevate the legs when seated or lying down.
  • Wear support stockings if you have edema of the legs.
  • Keep moving, as much as possible. Avoid sitting or standing for long periods without moving around.
  • Limit the amount of salt in your diet.

Any underlying disease or condition needs treatment to prevent it from becoming more serious.

Novus Spine & Pain Center

The Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating edema (swelling). By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.

Our Mission Statement: To provide the best quality of life to people suffering from pain, by providing state of the art treatments, knowledge and skill, compassion, and respect for all.

For your convenience, you may schedule an appointment online ,  request a call back , or call our office at  863-583-4445 .

Edema Resources

What is Edema? (WebMD) Edema – Symptoms & Causes (Mayo Clinic) Edema – Diagnosis & Treatment (Mayo Clinic) Leg Swelling (Mayo Clinic) Hydrocephalus (Mayo Clinic) Edema (MedicineNet) Everything You Need To Know About Edema (Medical News Today) Edema (Wikipedia) What Causes Edema? (Healthline) Edema (Family Doctor) C3: Edema (American Vein and Lymphatic Society)

Updated: April 18, 2022

  • Type 2 Diabetes
  • Heart Disease
  • Digestive Health
  • Multiple Sclerosis
  • COVID-19 Vaccines
  • Occupational Therapy
  • Healthy Aging
  • Health Insurance
  • Public Health
  • Patient Rights
  • Caregivers & Loved Ones
  • End of Life Concerns
  • Health News
  • Thyroid Test Analyzer
  • Doctor Discussion Guides
  • Hemoglobin A1c Test Analyzer
  • Lipid Test Analyzer
  • Complete Blood Count (CBC) Analyzer
  • What to Buy
  • Editorial Process
  • Meet Our Medical Expert Board

What Is Pitting Edema?

Risk factors.

  • Diagnosis and Grading Scale

Pitting edema occurs because of a buildup of fluids that causes swelling, usually in the lower body. Edema is called "pitting" when there's enough swelling to cause a “pit" when pressing on the affected area. Non-pitting edema doesn’t leave a mark and is usually caused by fluids with relatively higher protein and salt content.

The severity of pitting edema is clinically assessed on a scale, based on how deep the pit is and how long it takes to go away. Treatment for edema involves addressing the underlying factors causing the issue, based on the diagnosis and assessment of pitting edema.  

This article explains the underlying causes of pitting edema, as well as its symptoms. It presents lifestyle changes and other interventions used to treat pitting edema.

Verywell / Zoe Hansen

The symptoms of pitting edema arise due to fluid and blood buildup, ranging in severity depending on the cause. The edema can be localized (confined to a specific area) or generalized (present throughout the body). Symptoms can include:

  • Swelling, usually in the legs, feet, or ankles
  • Pressing on affected areas that leaves an indentation that gradually fills in
  • Pain and tenderness
  • Warmth, discoloration, and changes in the texture of affected areas

Pitting Edema Complications

If untreated, pitting edema can lead to cracking, peeling skin, while raising the risk of infection.

Whereas non-pitting edema typically develops due to disorders of the lymph nodes ( lymphedema ) or thyroid ( myxedema ), pitting edema is seen in a broader range of cases with varying degrees of severity.

For example, some cases are due to gravity when you stand for long periods and will stop when you change position. Lifestyle factors, like high salt intake, can lead to fluid retention and can be modified through diet. Other causes, though, include serious illness, such as chronic obstructive pulmonary disease (COPD).

Pitting edema can be a side effect of several types of medications and can also be a sign of an allergic reaction. These medications include:

  • Corticosteroids (prednisone, prednisolone, triamcinolone , and others)
  • Nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen)
  • Heart disease drugs (acebutolol, betaxolol, bisoprolol)
  • High blood pressure medications (diuretics, beta-blockers, ACE inhibitors )
  • Certain diabetes medications ( thiazolidinediones )

Deep Vein Thrombosis

Deep vein thrombosis (DVT, a clotting of veins deep in the body) typically affects older adults but it can be seen in young people, including children. The clotting, usually located in the calf of the lower leg, can cause edema and pain, and it requires immediate treatment with anticoagulants  or other medication.

While DVTs can be treated, they also can lead to complications such as post-thrombotic syndrome (PTS). People with PTS also may experience edema at the affected site, which may call for the use of elastic compression stockings and other longer-term interventions.

Weakening in the walls of veins in the legs ( venous insufficiency ) also leads to swelling in the lower limbs or elsewhere. This leads to the formation of varicose veins.

Congestive Heart Failure

Congestive heart failure (CHF) occurs when the heart muscle is no longer able to pump well enough to meet the body's need for oxygen in the blood. It can be caused by left-sided or right-sided failure, based on which of the heart's four chambers are involved. Or, both sides may fail in CHF.

It's usually right-sided failure that leads to an accumulation of fluid in the lower legs (peripheral edema) or lower back (sacral edema). The edema also can affect the lungs. Treatment is focused on the underlying cause of the CHF, which is usually a heart condition but may be related to infection, cancer treatment, or another cause.

Kidney Disease

Kidney diseases (nephrotic syndrome, acute glomerulonephritis ) can lead to edema because the body's ability to remove fluids through urination is compromised. The swelling can affect the hands, feet, and ankles, but also may appear in the face.

Over time, kidney disease also affects other body systems and causes complications such as high levels of electrolytes, the key minerals that include potassium and calcium. With renal hypertension, the pulmonary edema can affect the lungs.

Liver cirrhosis is a severe scarring of liver tissue that causes fibrosis and typically leads to a progressive loss of liver function. Symptoms in the later stages of the disease include edema in the feet, ankles, and legs due to a buildup of fluid. Often, fluid will build up in the abdomen, too.

Hepatitis of the liver can lead to edema. Hepatitis related to alcohol use also can lead to swelling in the body due to a condition called portal hypertension , which stops blood from returning to the liver from the digestive system.

Pregnancy  and related hormonal changes can lead to edema because they cause fluid retention. Pregnant people also have more blood volume in their bodies. It's quite common but if you experience sudden swelling, get it checked out. It may be a sign of preeclampsia , a serious condition that needs medical attention right away.

Hormonal changes due to menstruation also can cause swelling in the feet, ankles, and other parts of your lower limbs.

Hot Weather

Heat edema is not uncommon, and is a mild form of heat-related illness. These illnesses also include muscle cramps, heat exhaustion, and potentially fatal heat stroke.

The swelling of the extremities, sometimes with facial flushing, usually resolves once a person is removed from the heat and kept with their legs resting up to help the swelling go down.

People with certain underlying medical conditions, like obesity , are at a higher risk of edema, even if the edema is caused by an environmental factor like heat or a temporary condition like pregnancy.

Lifestyle factors also can contribute to the development of edema. They include:

  • Smoking, which can lead to vascular damage in the lower extremities
  • Diets high in sodium (salt) intake
  • The use of certain medications

Alcohol use disorders that lead to cirrhosis and other conditions also may lead to pitting edema.

Grading Scale and Diagnosis

Accurate diagnosis and assessment is essential for proper treatment of pitting edema. The pitting edema scale, used to assess the grade and scope of the swelling, is central to this process. Doctors categorize cases into four grades, from 1+, the least severe, to 4+, the most severe.

In this examination, the doctor presses on an affected area—usually the top of the foot, outer ankle, or lower calf—for two seconds. The severity of the case is based on the size of the remaining impression, and the amount of time it takes to rebound, or disappear.

In addition to grading, doctors will also perform exams and tests to isolate what’s causing the pitting edema. Specific tests vary based on the suspected underlying cause and can include:  

  • Physical examination : Alongside grading, this involves checking pulse, heart rate , and other vitals. Medical history and medications are also assessed.
  • Blood tests : Doctors test albumin levels in the blood, a protein derived in the liver, as these are directly related to edema and can signal liver or kidney problems.
  • Urinalysis : Chemical and microscopic analysis of urine is performed to assess kidney and liver health.
  • Cardiac testing : Echocardiograms (also known as ECGs or EKGs) or echocardiographs, among other tests, are used to assess the heart’s electrical patterns to evaluate cardiac health.
  • Imaging : X-ray or other forms of imaging may be used to assess any clots or blockages of veins thought to be causing the swelling.

Treatment depends on the severity of pitting edema as well as whether or not the patient has any other underlying causes. The type of therapy and medical intervention can be closely tied to the grade of the case, and it can vary a great deal. Common approaches include:

  • Leg elevation : Keeping affected feet or legs elevated can help resolve milder cases of edema.
  • Support garments : Wearing special compression stockings may be recommended to improve blood circulation in the legs.
  • Dietary interventions : Cutting salt intake and stopping alcohol consumption, among other interventions, may be recommended.
  • Medications : If medications are causing the edema, your doctor may tell you to stop taking them. In some cases, diuretics (water pills) are prescribed to get rid of excess fluid buildup.

Additionally, pitting edema resolves when the liver, kidney, or heart problems causing it have resolved. As such, surgery , other medications, and lifestyle changes, among other therapies, may be employed as well.

Pitting edema is a type of swelling, often in the lower extremities, that causes enough fluid retention to leave a pit (or indentation) when you press on the affected area. How serious the edema is will depend on how deep the pitting is and how long it takes for it to disappear on your skin after pressing. The pitting edema scale is used to measure it.

A wide variety of conditions can cause pitting edema and some of them, like congestive heart failure can be serious. It’s essential to see a healthcare provider if you think you’re experiencing it. The presence of any kind of swelling is a cause for concern, especially if it’s related to a more serious health issue.

Treatment will vary based on the underlying cause of the edema, so it's important to get an accurate diagnosis as early as possible. Your healthcare provider can then discuss the prognosis, or possible outcomes, for your condition.

Frequently Asked Questions

Edema is graded by pressing the thumb into an affected area—usually the top of the foot, the outer ankle, or the lower calf—for two seconds. The grade is determined by measuring the size of the indentation (or “pit”) as well as the amount of time it takes for it to disappear (or “rebound”).

Since each grade of edema is defined as a range, rather than a single point, scores can’t fall between grades. For instance, grade 4 edema, the most severe type, is defined as having a pit anywhere over 6 mm in depth, taking over 30 seconds to rebound. How to treat a borderline case will depend on other factors.  

When seeing your doctor about your edema, you’ll want to be able to provide the size and location of swollen areas, and if you experience pain with it. You'll also want to review medical history, the medications you've been taking, and lifestyle factors like salt intake.

Singh, A. Pitting edema .

Gasparis AP, Kim PS, Dean SM, Khilnani NM, Labropoulos N. Diagnostic approach to lower limb edema . Phlebology . 2020 Oct;35(9):650-655. doi:10.1177/0268355520938283.

National Institutes of Health. Swelling .

Avila ML, Feldman BM, Williams S, Ward LC, Montoya MI, Stinson J, et al . Assessment of limb edema in pediatric post-thrombotic syndrome . Res Pract Thromb Haemost . 2018 Apr 17;2(3):591-595. doi:10.1002/rth2.12082.

Kahn SR. The post-thrombotic syndrome . Hematology Am Soc Hematol Educ Program . 2016 Dec 2;2016(1):413-418. doi:10.1182/asheducation-2016.

Inamdar AA, Inamdar AC.  Heart failure: diagnosis, management and utilization .  J Clin Med . 2016;5(7). doi:10.3390/jcm5070062

National Institute of Diabetes and Digestive and Kidney Diseases.  What is Kidney Failure?

National Institute of Diabetes and Digestive and Kidney Diseases.  Symptoms & Causes of Cirrhosis .

MedlinePlus.  Swelling . 

Gauer R, Meyers BK. Heat-Related Illnesses . Am Fam Physician. 2019 Apr 15;99(8):482-489. PMID:30990296.

Yao P, Mukhdomi T. Varicose Vein Endovenous Laser Therapy . 2022 Dec 11. StatPearls Publishing; 2023 Jan–. PMID: 32491651.

Kehrenberg MCA, Bachmann HS. Diuretics: a contemporary pharmacological classification? Naunyn Schmiedebergs Arch Pharmacol . 2022 Jun;395(6):619-627. doi:10.1007/s00210-022-02228-0.

Physiopedia contributors. Edema assessment .

By Mark Gurarie Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.  

Appointments at Mayo Clinic

  • Leg swelling
  • When to see a doctor

Many factors — varying greatly in severity — can cause leg swelling.

Leg swelling related to fluid buildup

Leg swelling caused by the retention of fluid in leg tissues is known as peripheral edema. It can be caused by a problem with the venous circulation system, the lymphatic system or the kidneys.

Leg swelling isn't always a sign of a heart or circulation problem. You can have swelling due to fluid buildup simply from being overweight, being inactive, sitting or standing for a long time, or wearing tight stockings or jeans.

Factors related to fluid buildup include:

  • Acute kidney failure
  • Cardiomyopathy (problem with the heart muscle)
  • Chemotherapy
  • Chronic kidney disease
  • Cirrhosis (scarring of the liver)
  • Deep vein thrombosis (DVT)
  • Heart failure
  • Hormone therapy
  • Lymphedema (blockage in the lymph system)
  • Nephrotic syndrome (damage to small filtering blood vessels in the kidneys)
  • Pain relievers, such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve)
  • Pericarditis (inflammation of the tissue around the heart)
  • Prescription medications, including some used for diabetes and high blood pressure
  • Pulmonary hypertension
  • Sitting for a long time, such as during airline flights
  • Standing for a long time
  • Thrombophlebitis (a blood clot that usually occurs in the leg)
  • Venous insufficiency, chronic (leg veins with a problem returning blood to the heart)

Leg swelling related to inflammation

Leg swelling can also be caused by inflammation in leg joints or tissues — either a normal response to injury or disease or due to rheumatoid arthritis or another inflammatory disorder. You'll usually feel pain with inflammatory disorders.

Conditions that can contribute to inflammation in the leg include:

  • Achilles tendon rupture
  • ACL injury (tearing of the anterior cruciate ligament in your knee)
  • Broken ankle
  • Broken foot
  • Cellulitis (a skin infection)
  • Knee bursitis (inflammation of fluid-filled sacs in the knee joint)
  • Osteoarthritis (The most common type of arthritis.)
  • Rheumatoid arthritis
  • Sprained ankle

Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Error Email field is required

Error Include a valid email address

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

  • Sterns RH. Pathophysiology and etiology of edema in adults. https://www.uptodate.com/contents/search. Accessed Jan. 30, 2020.
  • Edema. Merck Manual Professional Version. https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/edema?query=edema#. Accessed Jan. 30, 2020.
  • Papadakis MA, et al., eds. Lower extremity edema. In: Current Medical Diagnosis & Treatment 2020. 59th ed. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed Jan. 30, 2020.
  • Edema (swelling) and cancer treatment. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/edema. Accessed Jan. 30, 2020.
  • Smith CC. Clinical manifestations and evaluation of edema in adults. https://www.uptodate.com/contents/search. Accessed Jan. 30, 2020.
  • Seller RH, et al. Swelling of the legs. In: Differential Diagnosis of Common Complaints. 7th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Feb. 1, 2020.

Products and Services

  • Assortment of Health Products from Mayo Clinic Store
  • A Book: Mayo Clinic Book of Home Remedies
  • Anorexia nervosa
  • Arteriovenous fistula
  • Atrial septal defect (ASD)
  • Behcet's disease
  • Blood tests for heart disease
  • Blood thinners: Can I still get blood clots?
  • Jack Long — Live LONG - Beat STRONG to find a cure
  • Mayo Clinic offers congenital heart care: Marcus' story
  • Treating Pericarditis
  • Valve problems in children with heart disease: What patients and families should know
  • Can vitamins help prevent a heart attack?
  • Cardiomyopathy
  • Chelation therapy for heart disease: Does it work?
  • What is cirrhosis? A Mayo Clinic expert explains
  • Cirrhosis FAQs
  • What are congenital heart defects? An expert explains
  • Congenital heart defects in children
  • Congenital heart defects FAQs
  • Daily aspirin therapy
  • Ebstein anomaly
  • Fasting diet: Can it improve my heart health?
  • Flu shots and heart disease
  • Frequent sex: Does it protect against prostate cancer?
  • Grass-fed beef
  • Hamstring injury
  • Hashimoto's disease
  • Healthy Heart for Life!
  • Heart disease
  • Heart disease in women: Understand symptoms and risk factors
  • Heart-healthy diet: 8 steps to prevent heart disease
  • Membranous nephropathy
  • Menus for heart-healthy eating
  • Myocarditis
  • Neuroblastoma
  • Nuts and your heart: Eating nuts for heart health
  • Omega-3 in fish
  • Omega-6 fatty acids
  • Pericarditis
  • Polypill: Does it treat heart disease?
  • Posterior cruciate ligament injury
  • Prostate cancer
  • Prostate Cancer
  • Prostate cancer: Does PSA level affect prognosis?
  • What is prostate cancer? A Mayo Clinic expert explains
  • Prostate cancer metastasis: Where does prostate cancer spread?
  • Prostate cancer prevention
  • Prostate cancer FAQs
  • Pulmonary embolism
  • Red wine, antioxidants and resveratrol
  • Heart disease prevention
  • Swollen knee
  • Varicose veins
  • Ventricular septal defect (VSD)
  • Endovenous thermal ablation
  • Video: Heart and circulatory system
  • Warfarin side effects
  • Watch an interview with Fernando C Fervenza MD PhD
  • Wilson's disease

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

  • Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

  • Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
  • The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
  • Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
  • FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
  • Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Your gift holds great power – donate today!

Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine.

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Advanced Search
  • Journal List
  • Elsevier - PMC COVID-19 Collection

Logo of pheelsevier

Infections in Returning Travelers

Of the approximately 80 million people who travel from industrialized to developing countries each year, 22% to 64% of travelers report some illness. 1 , 2 The approach to the patient requires knowledge of world geography, the epidemiology of disease patterns in 230 or so countries, and the clinical presentation of a wide spectrum of disorders. 3 Most illnesses are mild, most are self-limited, and many are noninfectious. Up to 10% of travelers may consult a physician during or after a trip, and approximately 1 in 100,000 travelers will die.

The ill travelers that do come to the attention of infectious diseases clinicians are generally either the most seriously ill or are suspected of harboring infectious agents not familiar in their home country. Based on 42,173 ill returned travelers seen by the GeoSentinel Surveillance Network at 53 different clinical sites on six continents, in patients presenting to infectious or tropical diseases specialists after travel to the developing world, specific travel destinations are associated with the probability of the diagnosis of certain diseases. 4 Diagnostic approaches and empirical therapies can be guided by these destination-specific differences. Important region-specific disease occurrence data indicate that febrile illness is most important from Africa and Southeast Asia; malaria is one of the top three diagnoses from every region, yet over the past decade dengue has become the most common febrile illness from every region outside sub-Saharan Africa; in sub-Saharan Africa, rickettsial disease is second only to malaria as a cause of fever; respiratory disease is most important in Southeast Asia and sub-Saharan Africa; and acute diarrhea is disproportionately from South Central Asia. When individual diagnoses are collected into syndrome groups and examined for all regions together, 233 of every 1000 ill returned travelers have a systemic febrile illness, 334 have acute or chronic gastrointestinal infection, 195 have a dermatologic disorder, and 209 have a respiratory disorder.

Travelers who become ill during, or any time up to several months after, a foreign trip will frequently associate that illness with a possible travel-specific cause. This may be the case, but often it is not. Routine disorders are common, and common disorders are common whether actually acquired during travel or at some time after the trip. Thus fever, sore throat, and cervical adenopathy in a college student who returned 2 weeks earlier from a developing country is still more likely to be streptococcal pharyngitis or infectious mononucleosis than diphtheria. Presented with an ill patient with a history of travel, the physician must maintain discipline in making two separate lists of differential diagnoses, the first with the travel history factored in and the second considering the same presenting symptoms and signs as if in any other patient. The approach and workup must then proceed in parallel, with appropriate priority given to the most urgent or the most treatable diagnoses at the top of each list.

In this chapter, travelers are considered to be those returning from short visits to developing countries, and the term does not include immigrants, refugees, and very long-term residents arriving from those countries. Constellations of exposures and clinical presentations highly suggestive of particular diagnoses in returned travelers are shown in Table 324-1 . Highly exotic endemic diseases rarely acquired by travelers are not discussed. Low-frequency illnesses (<20 cases of the 42,173 listed in the “GeoSentinel Surveillance of Illness in Returned Travelers, 2007-2011” 4 ), some potentially serious, were reported, including visceral leishmaniasis, east African trypanosomiasis, scrub typhus, relapsing fever, angiostrongyliasis, botulism, melioidosis, tularemia, hantavirus infection, and infection with Plasmodium knowlesi. No cases of yellow fever, Ebola virus, Lassa fever, Marburg virus, tetanus, polio, anthrax, or plague were reported in this 5-year cohort, thus attesting to their rarity.

TABLE 324-1

Constellations of Exposures and Clinical Presentations Suggestive of Particular Diagnoses in Returned Travelers *

The focus is on the identification of infectious causes of the presenting illness, on travel-associated risk factors, and on manifestations of those diseases that are particular to travelers. Detailed discussions of pathophysiology, spectrum of clinical manifestations, and therapy for each infectious agent are found in the disease-specific chapters of this book. Fever, traveler's diarrhea, and skin problems are the most common presenting illnesses in returned travelers. Eosinophilia is less common but is a frequent source of referral to the infectious diseases specialist.

Epidemiology

Fever occurs in 2% to 3% 5 , 6 , 7 of European or American travelers to the developing world. The proportion of ill returned travelers who present to specialists with a febrile illness is 24%, with variation by region of travel: Americas, 14%; South-Central Asia (includes India), 13%; Southeast Asia, 18%; and sub-Saharan Africa, 43%.

Several large case series from busy tropical disease units indicate malaria to be the cause of the fever in 27% to 42%. 5 , 6 , 7 The other most common tropical diseases specific to returning travelers are dengue, rickettsial disease, typhoid fever, and those caused by enteric pathogens. Less common but important considerations are leptospirosis, chikungunya, acute schistosomiasis, and amebic liver abscess. All of these diseases have widespread distribution in the tropics and need to be considered initially in all febrile travelers. Some may be ruled out quickly based on a detailed travel and exposure history and consultation with relevant information sources on disease distribution. Upper and lower respiratory tract infection, including streptococcal pharyngitis and influenza, as well as urinary tract infections, are cosmopolitan, nontropical febrile disorders that are remarkably common in travelers and should always be considered. In every series from sophisticated referral centers, up to 22% to 25% of those presenting with fever have self-limited illnesses that never have an etiologic diagnosis confirmed. 7 These are mostly viral syndromes caused by one of hundreds of viral agents that exist outside developed countries for which diagnostic tests may not be available anywhere. In many cases, the time and expense of a large panel of viral isolation and serologic assays is not warranted outside the research setting. Fever due to deep venous thrombosis or pulmonary embolism may be related to travel, especially in those with preexisting conditions or underlying coagulopathy. Thromboembolic disease always needs to be considered from the outset but is not discussed further here. 8 , 9

A good patient history is always important in clinical medicine, but nowhere is it as important as in the returning traveler. The cumulative list of infectious agents in 230 separate countries is daunting. A day-by-day travel itinerary, knowledge of risk factors and exposures for the common travel diseases, knowledge of usual incubation periods of those diseases, and knowledge of or access to the known geographic distribution of possible infectious diseases will lead to an appropriately focused workup. 8 , 9 , 10 Much time, expense, and patient discomfort due to sometimes invasive diagnostic tests can be avoided when diagnoses that are not epidemiologically or chronologically possible are eliminated based on the patient history.

The fever pattern and clinical findings by themselves are often nonspecific and overlap greatly between many of the most common tropical infectious diseases. The history should include the key elements detailed in the following sections.

Detailed Travel Itinerary

A travel itinerary should include every locale visited in every country visited, including transit stops. Some individuals are frequent travelers, so all travel for at least the previous 6 months must be considered initially. If the diagnosis remains elusive, a more remote travel history, especially that involving malarious areas, may be sought. The exact date of arrival back in the home country is often crucial to ascertain the last possible exposure date to an exotic pathogen. These details are most efficiently ascertained using a waiting room questionnaire. For example, it is insufficient to know simply that the patient visited Peru. Some parts of Peru are malarious and others are not, only some have risk of yellow fever, high-altitude destinations have little risk of vector-borne disease, and there is no risk of strongyloidiasis along the desert coastal strip.

Chronology of Travel and Illness

This should include the exact dates spent in each locale with respect to the onset of illness. Knowledge of typical incubation periods ( Table 324-2 ) of possible infectious causes is a key tool in narrowing the differential diagnosis. Many agents are simply not biologically possible outside their usual incubation period. Arboviral diseases such as dengue uniformly have short incubation periods. Onset of illness more than 2 weeks after the last possible exposure effectively rules out this class of viral illness. None of the known hemorrhagic fever viruses has a possible incubation longer than 21 days. Long-incubation infections like schistosomiasis cannot present less than several weeks after first possible exposure. Some diseases such as malaria or enteric fever have more variable incubation periods but nevertheless have a typical incubation period during which time the majority of the patients present. A number of diseases, especially those that are arthropod borne, have a strict seasonality whereby transmission stops during either cold or dry weather. Examples would include malaria in nontropical countries such as Korea, Tajikistan, or northern China, as well as Lyme borreliosis or tick-borne encephalitis, all of which completely cease transmission during winter months. GeoSentinel surveillance data indicate that dengue cases in travelers show marked region-specific peaks for Southeast Asia (June, September), South-Central Asia (October), South America (March), and the Caribbean (August, October). 11 , 12

TABLE 324-2

Incubation Periods of Common Travel-Related Infections *

HIV, human immunodeficiency virus.

A detailed dietary history is essential. Budget travel and associated high-risk eating habits predispose to a variety of common enteric pathogens. A history of specific foods associated with known pathogens also should be elicited. This includes unpasteurized dairy products (Brucella, Campylobacter, Salmonella, Mycobacterium tuberculosis), shellfish (vibrios, enteric viruses, viral hepatitis), uncooked beef such as carpaccio and steak tartare ( Toxoplasma, Campylobacter, Escherichia coli O157-H7), undercooked fish such as sushi and ceviche (vibrios, Anisakis, Gnathostoma ), and undercooked pork or game meat (trichinosis). Exposure to fresh water or surface water in recreational or other settings may be associated with schistosomiasis 13 , 14 , 15 or leptospirosis. 16 , 17 A history of exposure to mosquitoes and flies is generally unhelpful, but a history of tick bite (rickettsiae, relapsing fever, tick-borne encephalitis) or tsetse fly bite should be sought in the right setting. Exposures to new sexual partners, 18 , 19 , 20 needles, or blood should be ascertained. Rodent exposure is associated with Lassa fever, hantavirus infection, murine typhus, and rat-bite fever. A history of contact with other sick people is especially important in the post-travel setting. Travelers usually move in groups or with families or companions, all of whom will likely have shared the same exposures.

Immunization History

The immunization history should include exact dates of the last dose of each vaccine received and in some instances whether an adequate primary series was completed in the first place. Most vaccines, with the notable exception of typhoid vaccines, are highly efficacious. Thus, hepatitis A or B, yellow fever, measles, and diphtheria are unlikely diagnoses in those travelers with a substantiated history of adequate and current immunization.

Antimalarial Prophylaxis or Treatment

If malaria is a possibility, a complete pill-by-pill history of ingestion of antimalarial drugs, including the name and dose of all drugs taken for prophylaxis or treatment, must be obtained. Patients often misunderstand the dosing or timing instructions given at the pretravel visit, or they may have been prescribed an inappropriate drug for their destination. Patients may have been treated with appropriate or inappropriate drugs en route for febrile illnesses. Some very efficacious drugs are not available in the United States, and an international pharmacopeia such as Martindale's may need to be consulted by those unfamiliar with these drugs. A history of appropriate prophylaxis diminishes the possibility of malaria but does not eliminate the need for a malaria thick film, which may be preceded by a malaria rapid card test for any patient legitimately exposed to malaria.

Other Medications Ingested

Travelers who fall ill during travel often self-treat with antibiotics or see a local physician and are prescribed a broad-spectrum antibiotic. Again, an international pharmacopeia may need to be consulted. Recent ingestion of a 1-week course of a quinolone, tetracycline, or cephalosporin may alter the course of the illness or even affect the possibility of certain diagnoses. In particular, malaria may be suppressed by azithromycin, doxycycline, quinolones, or clindamycin.

Physical Examination

Common tropical infections often present as undifferentiated fever without focal findings. However, when a focal finding such as arthritis, meningitis, or pneumonia is present, the differential diagnosis can often be narrowed. Unfortunately, physical findings such as jaundice, hepatomegaly, splenomegaly, and lymphadenopathy occur at least a portion of the time in many of the most common travel-related infections and so are not specific enough to greatly narrow the differential diagnosis. 5 Most imported febrile rash illnesses engender the same differential diagnosis as for nontravelers. However, arbovirus infections, typhoid, rickettsial illness, leptospirosis, measles, early stages of viral hemorrhagic fevers, relapsing fever, and acute African trypanosomiasis should always be kept in mind.

Considerations for the Common Travel-Related Febrile Illnesses

Fever in a traveler returning from a malarious area is an emergency, and the instinctive performance of an immediate malaria smear will prevent unnecessary deaths. A malaria rapid diagnostic test is licensed in the United States for use in clinical laboratories and not at the point of care. The readout for this antigen detection test is Plasmodium falciparum, or non– P. falciparum, or mixed infection. Because it is highly specific, a positive test means immediate treatment is warranted.

The malaria rapid diagnostic test has excellent sensitivity for P. falciparum but may still miss low parasitemias so is not a definitive means to rule out malaria. The sensitivity is poor for non– P. falciparum malaria, which tends to have much lower parasitemias, but non– P. falciparum malaria is not usually life threatening. 21 Thus, a negative test does not rule out malaria and must always be followed by a blood film. Malaria due to P. falciparum is easily treatable if diagnosed early but even with optimum treatment has a mortality rate of 20% or more if treatment is begun only after end-organ complications arise. Smears need to be repeated at least every 12 to 24 hours a minimum of three times to rule out malaria. Rapid deterioration can occur over a period of hours. Patients who are unreliable to care for themselves and have smear-negative results but a high index of suspicion for P. falciparum malaria may need to be admitted for inpatient observation.

Because malaria is overwhelmingly an African disease, with about 80% of all P. falciparum imported into developed countries originating there, 22 , 23 , 24 , 25 suspicion of malaria is especially acute for Africa returnees. Beyond this, trends in the geographic origin of imported malaria cases do not always correlate well with regional transmission patterns because absolute numbers of cases from particular geographic areas may also mirror the intensity of travel to the affected region. Ethnic minority travelers returning home to visit friends and relatives in malarious areas have the highest risk for infection. Resources describing current country-specific malaria microepidemiology should be immediately accessible to those assessing tropical fevers. In general, malaria is a rural disease, but the cities of Africa and India are exceptions.

P. falciparum malaria in nonimmune travelers most commonly has an incubation period of 9 to 14 days, and 90% of cases occur within 1 month of last exposure. Non– P. falciparum malaria in travelers is only rarely life threatening but can present much later after arrival. Incubation periods are prolonged in those taking inadequate or incomplete chemoprophylaxis. Relapses of disease due to Plasmodium vivax or Plasmodium ovale may occur many months after travel in those whose initial attack was clinically silent because of suppressive chemoprophylaxis but in whom terminal prophylaxis with primaquine was not used (see Chapter 276).

The presenting signs and symptoms of imported malaria remain sufficiently protean so as to mimic a number of common tropical or nontropical conditions. 22 , 23 , 24 , 25 No constellation of symptoms or signs differentiates P. falciparum from non– P. falciparum malaria. Classic periodic malarial fever is not a usual manifestation of imported malaria, although when fever does occur in discrete, repeated 48- or 72-hour cycles, the diagnosis is almost certain. The simian malaria parasite P. knowlesi, 26 which is now known to commonly infect humans in Malaysia and throughout Southeast Asia, uniquely has a periodicity of 24 hours. Infected patients have high parasitemias (>1%) with a plasmodium that is morphologically almost identical to Plasmodium malariae . P. malariae typically has a parasitemia of less than 1%. Fever is absent at the exact time of the initial medical assessment in up to 40% of patients with malaria. Respiratory or gastrointestinal symptoms may be predominant. The presence of rash, lymphadenopathy, or leukocytosis indicates another diagnosis. Anemia is uncommon in travelers who present in the early days of their malarial illness. Thrombocytopenia occurs in over 50% and is a reliable if nonspecific indicator of malaria when present.

Many other serious infections are present in malarious areas. The search for malaria should not hamper the simultaneous workup for other pathogens in smear-negative patients. Similarly, semi-immune residents of endemic areas may be mildly parasitemic on a chronic basis with little ill effect, so a positive malaria smear in these patients should not hamper a search for any other clinically suspected infections.

Dengue, transmitted by the day-biting Aedes aegypti mosquito, is an important travel-related problem most notably in heavily visited areas of Southeast Asia, the South Pacific, and Central America and the Caribbean. 11 , 12 Travelers to Thailand seem particularly prone to infection, and dengue is relatively uncommon in Africa but has begun to emerge there. In contrast to many other tropical fevers, it is predominantly an urban infection so that it can even affect upscale business travelers in urban centers. The incubation period is usually 2 to 7 days after the mosquito bite, so many travelers initially become ill while still overseas. The clinical spectrum ranges widely from asymptomatic through a range of clinical manifestations up to the severe myalgia and arthralgia of “breakbone fever” (see Chapter 155). Malaria, other arbovirus diseases including chikungunya fever, leptospirosis, rickettsial disease, measles, or typhoid may present as similar initial findings. However, in cases in which one of several associated rashes manifests ( Fig. 324-1A ), dengue or chikungunya becomes more likely than the other possibilities.

An external file that holds a picture, illustration, etc.
Object name is f324-001a-9781455748013.jpg

Cutaneous manifestations of some common systemic or widely disseminated diseases.

A, Generalized macular rash of dengue; rash usually appears after 4 or 5 days, but an earlier, faint, flushlike rash also may be present. B, Viral hemorrhagic fever due to yellow fever infection; typical signs of viral hemorrhagic fevers include bleeding from orifices and intravenous sites as well as diffuse petechiae or ecchymoses, especially over pressure points. C, Sepsis due to Vibrio vulnificus infection after ingestion of contaminated shellfish; hemorrhagic bullae are seen in sepsis, envenomation, and autoimmune disease but not with viral hemorrhagic fevers. D, Migratory lesions of infection with Gnathostoma spinigerum after ingestion of uncooked freshwater fish; larvae often leave a mildly hemorrhagic track. E, Faint, papular, highly pruritic dermatitis due to Onchocerca volvulus infection after travel to Sierra Leone; travelers who may not present for a year or more after travel are usually lightly infected and have no ocular manifestation. F, Typical eschar of African tick typhus due to Rickettsia africae; widely disseminated petechial vasculitic lesions are often present as well. G, Verruga peruana due to chronic infection with Bartonella bacilliformis, present only if the patient is not treated for and survives the acute bacteremic phase. H, Painless lesions of cutaneous anthrax; surrounding edema is characteristic, and the base quickly evolves to become totally black and necrotic. I, Spider bite due to Loxosceles laeta; unlike anthrax, spider bites are painful and usually have very irregular borders without significant edema.

A positive tourniquet test is found in up to 50% of patients with classic dengue and in almost all patients with severe dengue with or without hemorrhage, but it is a nonspecific finding that may also be present in leptospirosis. The test is performed by inflating a blood pressure cuff halfway between systolic and diastolic for 5 minutes and, upon release, counting the number of petechiae in a 2.5 × 2.5-cm patch below the cuff. More than 20 petechiae is considered a positive finding.

Polymerase chain reaction testing for viremia is possible only during the first 5 days of illness during the viremic phase and is available at many commercial reference laboratories in the United States. Serologic confirmation must be sent to a reference laboratory. Immunoglobulin M (IgM) is not elevated until 5 or more days after illness onset, but most patients initially present earlier than this. If an IgM sample drawn more than 5 days into illness is negative, a third visit to test for fourfold elevations of immunoglobulin G (IgG) is required. Because most patients will be better by the time results of any confirmatory tests would be available and because treatment is supportive, many clinicians do not seek laboratory confirmation of late-presenting cases. A postviral fatigue lasting up to 6 months may occur.

Chikungunya Fever

Although chikungunya fever, 12 a mosquito-borne alphavirus (chikungunya virus) infection, was first isolated in the early 1950s when it caused epidemics in East Africa and is endemic in tropical Africa and Asia, it has been unknown to most clinicians in the Americas and Europe until reemerging in 2005. Since 2006, with introduction of serology into routine practice, chikungunya virus infection has been identified frequently in travelers after return home from the endemic areas in India, Southeast Asia, and East Africa. Chikungunya virus was introduced to the Caribbean during a large epidemic in 2013 and is now established there. The acute illness resembles dengue but with more prominent joint symptoms. Patients have fever, arthralgia, and sometimes acute arthritis. Rash, which occurs in about 50% of cases, may resemble that seen in dengue and is pruritic and macular or maculopapular. Although acute symptoms usually subside within a week, disabling joint symptoms may persist for months.

Typhoid and Paratyphoid Fever

Typhoid fever is often the most nondescript of the relatively common causes of travel-related fever. 27 , 28 , 29 The incubation period is most often a week but can be as long as 3 weeks. Risk is at least 10 times higher on the Indian subcontinent than anywhere else, but risk exists throughout the tropics in the setting of poor sanitation. In contrast to malaria, dengue, or rickettsial infection, onset is insidious and abnormal physical findings are usually absent. Abdominal discomfort and constipation are common, but diarrhea is frequent enough so as to not rule out the diagnosis. Patients often look and feel particularly unwell, with severe prostration and high, unremitting fever. Leukopenia and thrombocytopenia often occur. Blood cultures are not always positive, but bone marrow cultures increase the yield. Serologic assays, including agglutination and enzyme-linked immunosorbent assay (ELISA), have overall poor sensitivity, especially early in the course, and some lack of specificity in some settings and enjoy poor reputations. However, when present, an unequivocal high titer in a previously naïve traveler provides a more rapid diagnosis than will blood cultures. Up-to-date vaccination against typhoid provides only partial protection against Salmonella typhi and does not protect at all against Salmonella Paratyphi. 30 Because of resistance, fluoroquinolones are no longer an option for empirical treatment in the Indian subcontinent and Southeast Asia, and third-generation cephalosporins or a carbapenem should be used. 27 Increasing data support the use of high-dose oral azithromycin for quinolone-resistant S. typhi . 30

Viral Hepatitis

Incidence rates for travel-related viral hepatitis are likely to have begun a decline as more individuals who had routine childhood hepatitis B vaccine are moving into the traveling population and as more high-risk travelers are receiving long-term protection due to pretravel hepatitis A and B vaccination. 31 Current vaccines do not protect against hepatitis E, which is enterically acquired, 32 or against hepatitis C, which, like hepatitis B, may be acquired overseas after blood transfusion or contact with contaminated syringes, medical equipment, or tattoo and body-piercing implements. Viral hepatitis is a long-incubation infection so that acquisition may not always be readily linked by the patient or the physician to the travel.

Rickettsial Disease

Rickettsial disease is emerging in travelers. 4 , 33 Most of the long list of rickettsial species infecting humans are transmitted by ticks, mites, and fleas. Eschars are seen in most patients with African tick typhus due to Rickettsia africae (see Fig. 324-1F ), 34 Mediterranean spotted fever due to Rickettsia conorii or R. africae and scrub typhus due to Orientia tsutsugamushi infection are the most common travel-related rickettsioses. In a group of 940 travelers to South Africa, 4% of all travelers and 27% of all travelers with flulike symptoms had infection with R. africae. 35 R. africae is the second most common cause of fever in travelers to Africa after malaria and is most prevalent in South Africa itself. Although rickettsial diseases are present in most countries of the world, individual species have restricted geographic distributions (see Chapter 187), which helps in the diagnostic formulation. High fever, headache, leukopenia, and thrombocytopenia are common. Rickettsiae infect endothelial cells and often cause widespread vasculitic-looking lesions. Severe infections may present as disseminated intravascular coagulation and mimic a viral hemorrhagic fever. Because African tick-bite fever and scrub typhus both occur in malarious areas, a thick film is indicated even in febrile patients with pathognomonic skin lesions. Because response to tetracyclines is uniformly prompt and dramatic and the results of serologic tests are slow to return, clinical suspicion and clinical diagnosis are usually relied on. The diagnosis should be reconsidered in those who do not respond within 48 hours of initiation of therapy with doxycycline or tetracycline.

Leptospirosis

Leptospirosis is thought of as an occupational disease and a disease of urban slum dwellers with rodent exposure. In recent years, large leptospirosis outbreaks in adventure travelers and adventure racers such as whitewater rafters, triathletes, and participants in the 2000 Borneo Eco-Challenge race have occurred. 16 Doxycycline prophylaxis is now recommended for both civilians and military personnel who will hike, bike, swim, or raft in tropical environments. 17 The protean clinical manifestations, which include fever, headache, proximal lower extremity myalgia, and abdominal wall pain, are impossible to distinguish clinically from dengue but may also mimic a number of other common tropical infections. Conjunctival suffusion and jaundice occur in a subset and are more common than in the other undifferentiated febrile diseases, although both may occur in relapsing fever. A reliable, rapid IgM dipstick test for leptospirosis is widely available and used. Recognition of possible leptospirosis affects therapy because antibiotic treatment is generally undertaken when the diagnosis is suspected.

Respiratory Illness

Travelers spend long periods in confined spaces and tend to meet many different people during the course of their trip. Acute respiratory tract infections occur in 10% to 20% of all travelers, with rates as high as 1,261 per 100,000 travelers for a 1-month stay in a developing country. For all ill returning travelers seen at GeoSentinel Surveillance Network sites, 7.8% were diagnosed with respiratory tract infection, with almost half of these being lower respiratory tract infections such as pneumonia or atypical pneumonia. 36

Respiratory diseases are second only to gastrointestinal infections as a cause of morbidity in travelers. In outbreaks of infections on cruise ships, respiratory tract infections constitute the most common diagnosis. 37 Influenza is the most common vaccine-preventable disease of travelers, with an incidence rate of approximately 1%. One fourth or more of all cases of legionellosis are associated with travel in the previous 2 weeks, and rates appear to be increasing. Risk factors include stays at large air-conditioned resort hotels or spas and cruise ship travel. 38 Acute histoplasmosis can be seen after brief excursions into caves anywhere in the Americas, and travel-related coccidioidomycosis is reported. 39 Tuberculosis is a clear risk in those who spend longer periods in very high-risk countries and especially those who are doing medical or aid work. 40 , 41 Pulmonary infiltrates and symptoms may be seen during the migratory phases of helminthiases such as schistosomiasis, strongyloidosis, hookworm infestation, and ascariasis. Hemorrhagic pneumonitis may be seen with leptospirosis. Q fever should be sought in those with animal exposure. Workup should be guided by clinical and radiologic findings.

Initial Office Approach to the Febrile Patient

The first priority is assessment for dangerous or immediately life-threatening disease, such as when hemorrhagic manifestations are apparent. If the patient has the appropriate exposures for a viral hemorrhagic fever, he or she needs to be immediately isolated and public health authorities contacted. None of the isolatable hemorrhagic fever viruses have incubation periods exceeding 3 weeks. Arenavirus infection, whether from West Africa (Lassa virus) or South America (Junin, Machupo, Guanarito viruses), should be treated with ribavirin. Most also recommend treating Crimean-Congo hemorrhagic fever with ribavirin. 42 Other rare hemorrhagic fevers of travelers such as Rift Valley fever, yellow fever, dengue hemorrhagic fever, and Ebola hemorrhagic fever need to be supported with the best possible intensive care. 43 Meningococcemia and rickettsial infection present as purpuric lesions, and bacterial sepsis and severe malaria are serious but treatable causes of hemorrhage owing to disseminated intravascular coagulation. Any febrile patient with altered sensorium or any other evidence of end-organ damage consistent with malaria and in whom P. falciparum malaria is a possibility should receive empirical therapy for malaria regardless of the result of a blood film. The smear is often negative in advanced disease because of sequestration of parasites in capillary beds.

In the patient who is not severely ill but who has an undifferentiated fever without any localizing symptoms or signs, three blood films, if epidemiologically indicated, are the first priority. At the same time, other mandatory diagnostic tests in the workup of every tropical fever include blood cultures (for enteric fever), complete blood cell count with differential and platelets, liver function tests, urinalysis, and a chest radiograph. The blood film may also diagnose bartonellosis, acute trypanosomiasis, and relapsing fever. Leukopenia militates away from common bacterial infections and toward dengue, typhoid, brucellosis, rickettsial disease, or acute human immunodeficiency virus (HIV) infection. Thrombocytopenia is indicative of malaria, dengue, or brucellosis. Eosinophilia may indicate early migratory stages of a number of helminths (see later). Liver function test results will be consistently abnormal in viral hepatitis or toxin damage and variably abnormal in leptospirosis, rickettsial disease (including Q fever), relapsing fever, yellow fever, amebic abscess, brucellosis, typhoid, hemorrhagic fever, and dengue. An indirect benefit of chest radiography is the finding of an elevated right hemidiaphragm in many patients with amebic liver abscess.

The second wave of diagnostic testing is driven by any abnormalities that emerge from initial test results. In the absence of enlightening abnormalities, additional serologic studies may need to be obtained based on travel itinerary, incubation periods, and known exposures, as discussed previously. HIV infection and its complications, syphilis, and tuberculosis should be sought at this stage if there is any suggestive exposure at all. After ruling out potentially serious as well as potentially treatable infections by history, physical examination, and routine laboratory work, and especially if patient financial resources are limiting, the clinician must then decide whether to wait 48 to 72 hours before serology and sophisticated diagnostic studies are pursued. Because up to 25% of all febrile illnesses in returning travelers are self-limited viral syndromes, a patient who was highly febrile and quite toxic looking at initial assessment is quite often perfectly well 48 hours later with no intervention. Reasonable clinical and local laboratory experience and confidence are required for this approach, but from the patient standpoint it is the most desirable course. At a minimum, acute serum should be stored for possible later use. If the patient is stable, has no laboratory abnormalities and no clinical evidence of end-organ damage, and has a reliable companion, he or she may be followed as an outpatient during the clinical evolution and the appropriate workup pursued according to any ensuing clinical findings.

Oral ciprofloxacin is sometimes given as empirical therapy for the slightest chance of typhoid fever because of the ease of treatment and the difficulty making the diagnosis. However, quinolone-resistant typhoid and paratyphoid fever are now predominant in the Indian subcontinent and Southeast Asia, where much of the travel-related enteric fever originates. Thus, in this situation, if clinical suspicion is high, the patient may need to be admitted for parenteral therapy. Empirical therapy for malaria without a positive blood film is appropriate if clinical evidence of cerebral dysfunction or any other end-organ damage consistent with malaria is present. Otherwise, examination of these patients and of serial blood smears over several days by someone with appropriate experience will generally lead to the parasitologic diagnosis of malaria, when present. 44 Expertise is rarely so far away as to compromise patient care, although empirical therapy with co-artemether or atovaquone-proguanil is generally well tolerated. However, empirical treatment will necessarily eliminate any possibility of making a species diagnosis if the patient, in fact, does have malaria. After empirical treatment, the clinician is then probably obligated to a course of primaquine, a potentially toxic drug, to cover the possibility that the antecedent infection was due to relapsing ( P. vivax or P. ovale ) malaria.

Febrile patients who present initially with focal symptoms or signs should have a more directed workup that takes into consideration appropriate disease distribution, incubation period, and possible exposures. Altered mental status or other central nervous system deficits are present as nonspecific sequelae of many systemic infections. However, appropriate itinerary, exposure, and incubation periods for the following less common infections should be sought: Japanese encephalitis, rabies, West Nile virus, tick-borne encephalitis, African trypanosomiasis, angiostrongyliasis, gnathostomiasis, and, in recent Hajj pilgrims to Mecca, meningococcal infection. 45

Diarrhea in Travelers

Acute traveler's diarrhea.

Diarrhea is by far the most common cause of illness during travel, affecting up to 60% of travelers to some high-risk destinations. South Asia is by far the highest-risk region for traveler's diarrhea. 46 The most frequent cause of traveler's diarrhea is enterotoxigenic E. coli (6% to 70%). Other types of E. coli (especially enteroaggregative E. coli ), 47 , 48 Salmonella, Shigella, and Campylobacter each account for 5% to 15%. Vibrio parahaemolyticus is related to shellfish ingestion and is seen almost exclusively in Asia. Protozoa account for less than 5%; and in adults, norovirus or, rarely, rotavirus may be detected. 49 , 50 , 51 However, norovirus outbreaks aboard cruise ships are increasingly recognized. About 30% of diarrheal episodes remain unexplained, but many are likely due to enteroaggregative E. coli.

Bacterial diarrhea generally manifests as the abrupt onset of uncomfortable, crampy diarrhea. 52 , 53 Fever, nausea, or vomiting, if present, further increase the likelihood of a bacterial cause. In contrast, protozoal diarrhea (most often due to Giardia lamblia or Entamoeba histolytica ) begins gradually, with loose stools occurring in distinct episodes and gradually becoming more disabling over 1 to 2 weeks. In protozoal diarrhea, medical care usually is not sought immediately because of the low-grade nature of the symptoms. Because most traveler's diarrhea is bacterial, many travelers are instructed to self-treat with quinolone antibiotics and are told to seek medical assistance if diarrhea does not resolve after 3 to 5 days of treatment. 51 , 52 , 53 , 54

Classic traveler's diarrhea is defined as three or more unformed stools per day, although a syndrome of nonclassic traveler's diarrhea with fewer stools but with accompanying symptoms is defined by some. Travelers may vary in their own definition of what is an abnormal bowel pattern, and this needs to be established with the patient in a quantitative way at the outset. Returned travelers with acute diarrhea of a few days' duration who have not yet had a course of quinolone antibiotic can be prescribed an empirical course without any workup or stool culture. Toxic patients with bloody diarrhea should have a wet prep of stool and an immediate sigmoidoscopic examination to look for amebic trophozoites. Nonresponders at 36 to 48 hours should then have stool specimen sent for performance of bacterial culture, ova and parasite testing, acid-fast bacilli testing (to detect Cryptosporidium and Cyclospora ), Giardia enzyme-linked immunosorbent assay (ELISA) or immunofluorescence assay, Entamoeba ELISA, and Clostridium difficile toxin assay. Vibrio cultures usually require a special request. Quinolone-resistant Campylobacter is increasing worldwide and is prevalent in Southeast Asia, so an empirical course of azithromycin can be given while awaiting culture if the patient is still moderately ill. 53 Rifaximin has been approved for traveler's diarrhea due to E. coli. 54 Because of the difficulty in making the diagnosis of giardiasis, an empirical course of tinidazole is often given in practice to those with subacute symptoms and a negative workup. Reactive arthritis (formerly Reiter's syndrome) is an occasional sequela of enteritis due to Shigella or Campylobacter.

Persistent Diarrhea in the Traveler

Two percent of those with traveler's diarrhea go on to develop chronic diarrhea lasting a month or more. These patients' disorders can be extremely frustrating to deal with because diagnosis is most often elusive despite extensive diagnostic testing. 55 Clearly, some undiscovered enteric pathogens remain. A number of limited studies indicate that the incidence of postinfective irritable bowel syndrome at 6 months after an acute episode of traveler's diarrhea may range from 4% to 32%. The true incidence of this syndrome is not clear, and ancillary contributing factors and possible preemptive interventions are still being investigated. 56 Appropriate studies, in addition to those already listed, include HIV serology, 5-hydroxyindoleacetic acid (5-HIAA) levels, thyroid function tests, serum calcium, testing for malabsorption, anti– Saccharomyces cerevisiae antibody/antineutrophil cytoplasmic antibody serologic studies for inflammatory bowel disease, antigliadin/antiendomysial/antitransglutamase antibodies for celiac disease, and upper and lower endoscopy with all aspirates and biopsy samples examined carefully for a parasitic cause. G. lamblia, Strongyloides stercoralis, Cryptosporidium parvum, and Cyclospora cayetanensis are occasional infectious causes of persistent diarrhea and may be discovered only after invasive workup. Serology for S. stercoralis, Schistosoma mansoni, or E. histolytica is indicated when exposure to these agents may have occurred. Intestinal biopsy almost always yields nonspecific findings, although cases of tropical or nontropical sprue are occasionally discovered or an initial diagnosis of inflammatory bowel disease made. In many patients, the etiology of the frequently found nonspecific villus blunting is unclear. This syndrome has often been termed tropical enteropathy or postinfective tropical malabsorption and is believed to be the residual damage caused by an initial bacterial or other insult. A temporary luminal disaccharidase deficiency may occur. Diarrhea may persist for months before resolving. In the absence of definitive diagnosis in patients with chronic traveler's diarrhea, symptomatic treatment with loperamide is indicated. Elimination diets with restriction of lactose, fructose, gluten, and fat are sometimes of benefit. Those with preexisting irritable bowel syndrome may have it unmasked by travel and frequently have exacerbations during or after travel. Tegaserod, alosetron, antispasmodics, or other appropriate medication for the underlying disease may be needed. 56 , 57 , 58 , 59

Skin Problems

The proportion of ill returned travelers who present to infectious and tropical diseases specialists who have a dermatologic problem is 20%, with variation by region of travel ( Fig. 324-2 ). The most common skin-related diagnoses are cutaneous larva migrans (9.8% of all skin diagnoses), insect bites including superinfected bites (15%), skin abscess (7.7%), and allergic reaction (5.5%). Dengue (3.4%), leishmaniasis (3.3%), myiasis (2.7%), and the rickettsial spotted-fever diseases (1.5%) are other important reasons for presentation. Arthropod-related skin diseases accounted for 31% of all skin diagnoses. 60 , 61 Ulcerative lesions of travelers include leishmaniasis, mycobacterial disease, deep mycoses, and, rarely, anthrax. Rickettsial diseases frequently include black eschars at the site of the arthropod bite. Loiasis, 62 gnathostomiasis, 63 and cysticercosis present as painless subcutaneous nodules. Arthropod bites and infestations such as scabies, fleas, lice, and mites present similarly as in nontropical environments. Onchocerciasis presents as an intensely pruritic, evanescent papular rash. 64 , 65 Varicella, measles, or other childhood exanthems occur in nonimmune travelers and should not be forgotten in the quest for exotic diagnoses. Seabather's eruption (sometimes called “sea lice”) is a pruritic papular rash notable for being distributed only on skin covered by the patient's bathing suit. 66 Larval sea anemones become trapped by the fabric while the patient is swimming. The indurated erythematous chancre of Trypanosoma rhodesiense infection (see Chapter 279) should not be overlooked. 67 Arboviral eruptions usually present as acute febrile illnesses and not as predominant rash illnesses. HIV infection and sexually transmitted diseases should always be considered as a cause of exanthems and ulcerative lesions.

An external file that holds a picture, illustration, etc.
Object name is f324-002a-9781455748013.jpg

Some common diseases of travelers with pathologic effects localized to circumscribed areas of the skin and underlying tissue.

A, Painless ulcer with a clean base in a traveler to Peru with New World cutaneous leishmaniasis due to Leishmania braziliensis. B, More nodular and inflammatory lesions with crusting but only slight ulceration in a traveler to Afghanistan, which is more characteristic of Old World cutaneous leishmaniasis due to Leishmania major. C, Painless nasal perforation, which is often the earliest manifestation of mucocutaneous leishmaniasis due to metastatic spread of L. braziliensis from an earlier cutaneous lesion. D, Cutaneous larva migrans or creeping eruption due to the canine hookworm Ancylostoma caninum. E, Furuncular myiasis due to Dermatobia hominis (botfly). Patients often report a sense of movement inside; note tiny hole for the respiratory spicule of the botfly. F, D. hominis larva after migration to surface when the respiratory spicule was blocked with petroleum jelly. G, Characteristic multilesion presentation of African furuncular myiasis due to Cordylobia anthropophaga (tumbu fly). H, Phytophotodermatitis in a traveler to Ecuador after application of a lime juice–containing mixture by a shaman during a native ceremony; the same effect is seen when common tropical cocktails are spilled on sun-exposed areas. Pigmented lesions may take weeks to resolve. I, Tropical pyomyositis in a traveler to the Amazon. Pyomyositis due to deep staphylococcal infection is common in moist, warm climates and is characterized by brown pus as the muscle fibers dissolve. Initial lesions are characterized by exquisitely painful, localized erythematous areas overlying the affected muscle.

Eosinophilia

In addition to parasitic causes, peripheral blood eosinophilia may be associated with a variety of dermatologic, immunologic, inflammatory, neoplastic, and idiopathic causes. Returning travelers and long-term residents of tropical countries are as prone to nonparasitic causes of eosinophilia as is the general population, and these must be considered when obtaining a history and initiating a diagnostic workup in a returned traveler. Schistosomiasis and strongyloidiasis are the most common parasitic causes of significant eosinophilia in returning travelers, and serology should be sent on every traveler with potential exposure to either. 68 , 69

Eosinophilia is a reaction to a tissue-invasive helminth, with its intensity being proportional to the degree of tissue invasion. During the initial larval migration phase after a new infection with a specific parasite (e.g., hookworm), there may be an intense eosinophilia (up to 5000/mm 3 ). Weeks or months later, when the mature adults reside in the intestine with only minimal tissue contact, eosinophilia will be mild or absent. Although eosinophilia is not seen in protozoan infection, local eosinophilic infiltrates exceptionally occur in areas of the intestinal tract penetrated by E. histolytica, G. lamblia, or Cystoisospora belli.

Although most laboratory reports express the eosinophil count as a percentage of the total white blood cell count, this practice can make it difficult to follow serial determinations in an individual patient. The absolute eosinophil count can be calculated easily and ranges from 0 to 350/mm 3 (mean, 120/mm 3 ). Because the list of helminths inducing eosinophilia ( Table 324-3 ) is extensive, and because many of the parasitologic and serologic techniques required for specific diagnosis are laborious and expensive, a well-obtained epidemiologic history is needed to narrow the differential diagnosis down to a manageable size. Some helpful physical findings are dermatitis (onchocerciasis, cutaneous larva migrans, larva currens); migratory swellings (loiasis, gnathostomiasis); wheezing or cough ( Strongyloides, hookworm, Ascaris, or Schistosoma larvae in the lung); hemoptysis (Paragonimus); hepatomegaly (Toxocara, Echinococcus); lymphedema (filariasis); facial edema and myositis (trichinosis); subcutaneous mass (cysticercosis); meningeal signs (angiostrongyliasis, gnathostomiasis); and abdominal tenderness (angiostrongyliasis, anisakiasis, fascioliasis).

TABLE 324-3

Parasitic Causes of Eosinophilia

The examination of stools for ova and parasites is the first step and, unfortunately, this crucial diagnostic procedure is dependent on the expertise of the individual laboratory. A concentration technique should be used and at least three separate stools examined. Eggs are produced only by mature adult worms, so stool examinations will be negative during the initial larval migratory phase of intestinal helminths for up to 6 weeks after exposure. Strongyloides eggs hatch while still in the intestine, and Baermann concentration or agar plate cultures are indicated if suspicion is high. Because most anthelmintic drugs only work on adult worms and not immature larvae, empirical therapy for a traveler with eosinophilia soon after return is of no benefit.

The following ancillary procedures are indicated when epidemiologically appropriate 70 or when dictated by specific symptoms: day and night blood concentrations (filariasis); skin snips (onchocerciasis); rectal snips or scrapings (schistosomiasis); urine concentration (schistosomiasis); duodenal aspirate (strongyloidiasis); sputum tests for ova and parasites (migrating larvae, Strongyloides, Paragonimus ); and biopsy of any abnormal lesions. Serology is available for many of the common helminthic infections but is hampered by lack of standardization and broad cross-reactivity among many helminth species. Nevertheless, an unequivocally elevated parasite-specific serum IgG level can be extremely helpful when positive in the setting of a previously naïve traveler with a history of exposure to only one or a few specific parasites. Schistosomiasis and strongyloidiasis are the two most common causes of parasitic eosinophilia. Stool and more invasive examination is often negative, and diagnosis often depends on positive serology.

The detection of one parasitic infection does not preclude the presence of another. All individuals should complete the diagnostic workup that is clinically and epidemiologically indicated. Similarly, all treated patients should be observed to be certain that both infection and eosinophilia have resolved. An anomalous exacerbation of the eosinophilia may occur for 2 to 3 weeks after treatment as parasites die and release their antigens. Eosinophilia may not totally resolve for 6 months or more after adequate treatment of the inciting helminth, but no response whatsoever for a month or more after treatment may be a sign of inadequate response to treatment.

Screening for Asymptomatic Infection

Completely asymptomatic returned travelers may present with a request to be checked for possible tropical disease. The limited number of available cost-effectiveness studies have yet to show significant benefit to this approach on a population basis. 71 , 72 , 73 Neither a clinic visit nor any nondirected laboratory screening of returned very short-term travelers is indicated. Exceptions are those with known discrete high-risk exposure events in situations conducive to transmission of specific agents. This would include testing for HIV and other sexually transmitted infections, a purified protein derivative skin test or interferon-γ release assay, or Schistosoma serology. For those who have spent 6 months or more under any conditions in a developing country, a purified protein derivative skin test or interferon-γ release assay is the highest priority even without a specific exposure. For those living under harsher conditions, any abnormalities found on a complete physical examination, including a dermatologic assessment, that would lead to specific laboratory testing should be sought first. For general screening, a stool sample for ova and parasite testing and an eosinophil count are used by most. Serologic studies for schistosomiasis, filarial infection, and strongyloidiasis are often performed but should be strictly limited to those with extended travel to a known endemic area for each pathogen tested for. Those with new sexual partners should be screened for HIV and sexually transmitted infections at an appropriate interval after last potential exposure. Malaria smears are not indicated in asymptomatic travelers, even those with a remote history of malaria exposure during the travel, but primaquine treatment for those at risk for later relapse of disease due to P. vivax or P. ovale is indicated.

Key References

The complete reference list is available online at Expert Consult.

Measles in the United States — March 2024

March 8, 2024, 4:15 PM EDT

Updates on respiratory illness and vaccine-preventable diseases.

Thanks to a strong childhood vaccination program, measles was declared eliminated from the United States in 2000. Although overall childhood vaccination rates remain high in the U.S., measles still occurs frequently in other parts of the world. That’s especially true right now. The World Health Organization has noted a significant increase in measles cases worldwide, with a 30-fold increase in Europe.  This includes popular international tourist destinations for Americans, like England.

Measles can easily come to the United States by way of unvaccinated travelers, and measles cases have been increasing around the country. This most commonly happens when people who live in the United States visit countries where there are measles outbreaks . Once someone gets measles and returns to America, measles can spread if people in their community aren’t up-to-date on their vaccinations.

  • Measles is so contagious that if one person has it, up to 90% of the people close to them can also become infected if they are not protected by vaccination (or, less commonly, prior infection).
  • The measles virus can stay in the air for up to 2 hours after an infected person left an indoor space.
  • Someone can get infected by simply being in a room where a person with measles walked through.
  • In addition, people with measles can transmit to others when their symptoms are fever, cough, and runny nose, which look like common respiratory viruses.

Worse, measles can be very serious . Children younger than 5 years and adults older than 20 years are more likely to suffer from complications. Common measles complications include ear infections and diarrhea. More severe complications like pneumonia (lung infection) and encephalitis (infection and swelling of the brain) are possible and often require hospitalization and even intensive care. This is a real risk for people who are not vaccinated, especially for young children, adults, pregnant persons, and people who are immunocompromised. On average, nearly 1 in 5 unvaccinated people in the United States who get measles need to be hospitalized. For example, in a recent outbreak in Ohio , over 40% of infants and children infected with measles were hospitalized.

When outbreaks do occur, local health departments lead the response. The playbook for ending measles outbreaks is decades old, and it works. People who are infected or who are exposed to measles but haven’t been vaccinated are recommended to stay home and away from settings where unvaccinated people may be exposed, like schools and daycares. By following these simple procedures, countless jurisdictions have successfully curbed local measles outbreaks and limited the illness and suffering that accompany them.

Key to maintaining the elimination of measles in the U.S. is vaccination. The measles-mumps-rubella vaccine (MMR)  is part of the national immunization schedule for all children and adults. Vaccination with MMR is the best and safest way to prevent measles. When both doses of MMR vaccine are given (typically when the child is about 1 and 4 years old), MMR is 97% effective at preventing measles.

CDC recommends the safe and effective MMR vaccination as part of the routine immunization schedule for all children and adults , with special guidance for those travelling internationally . With spring break travel coming up and people going to and coming from countries that have seen sharp upticks in measles cases, the time to be sure you and your family members are up to date on their MMR is now.

Exit Notification / Disclaimer Policy

  • The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
  • Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
  • You will be subject to the destination website's privacy policy when you follow the link.
  • CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Watch CBS News

U.S. measles milestone: 60 cases so far in 2024 — more than all of 2023

By Alexander Tin

Edited By Paula Cohen

Updated on: March 15, 2024 / 9:54 PM EDT / CBS News

The U.S. has now tallied at least 60 confirmed or suspected measles cases investigated so far this year by authorities in 17 states — more than the 58 cases reported nationwide in all of 2023. It comes as health officials are grappling with multiple major outbreaks of the highly contagious virus around the world . 

Now with spring break travel looming, health officials have ramped up pleas for Americans to double check whether they are up to date on the highly effective vaccines used to protect against measles.

"This is why it's urgent for us to sort of address vaccination so that we can really decelerate sort of the march of measles, given the global scenario as well as what we're seeing with some vaccination rates in the country," said Dr. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases. 

Friday's tally of measles cases is up from 45 counted by the CDC last week. Additional infections have since been announced in Arizona , California , Illinois and Ohio . 

While infections have climbed, Daskalakis said counts still remain small enough to make it difficult for officials to navigate privacy concerns in releasing additional demographic trends of cases so far. Investigations are also still ongoing to collect that information.

Daskalakis said the majority of cases so far have been linked to unvaccinated Americans returning to the U.S. with the virus.

"Measles is a easily preventable disease with a readily available and safe vaccine. And so, as we are seeing more cases in the U.S., we have the technology and the ability to be able to prevent measles," he said.

The CDC updated its guidance Wednesday to counsel Americans who are unsure if they're up to date on their shots to seek out a doctor at least six weeks before their trip.

Here's what we know about the outbreaks so far this year.

Which states have reported the largest measles outbreaks in 2024? 

So far this year, 17 states – Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, Virginia, and Washington – have reported at least one case.

Illinois has reported the most measles cases in recent weeks, with 12 total infections reported in Chicago. Of them, 10 were residents at a migrant shelter . Two cases are not related to the shelter outbreak, a spokesperson for the city's health department said.

The CDC deployed a team to Chicago on March 12 to work with the city to investigate and curb the spread of the virus, and support the city's vaccination campaign.

Daskalakis praised the Chicago team responding to the cases. The city was the first to invite CDC to help in a measles outbreak response so far this year. 

He said the agency would likely gather lessons learned from Chicago's response to help other cities too, citing his previous experience as a top-ranking health official in New York City during past large outbreaks there.

"I could see the lessons from the New York experience being built into this response. So the answer is yes, we always iterate and I'm sure we'll learn some things from Chicago that will be valuable in other settings as well," Daskalakis said.

Florida has reported the next most cases, with 10 infections so far this year. All but one of the cases was reported in Broward County, after a Miami-area elementary school reported an outbreak . 

CDC laboratories were tapped to help in investigating the genotype of the virus behind that outbreak, which can aid in narrowing down leads for the outbreak's origin.

Most of the cases nationwide have been confirmed through laboratory testing. Two cases remain suspected, in Ohio's Clermont County and Arizona's Coconino County. 

Why are measles cases on the rise in 2024?

Most outbreaks this year in the U.S. have been blamed on unvaccinated travelers bringing the virus back with them and exposing others who don't have immunity.  

Measles is extremely contagious, and a person who has the infection can spread it for four days before developing symptoms . Symptoms often do not appear until 11 days after exposure.

At least six cases this year were in people who were first exposed to the virus abroad, according to CDC data updated Thursday. Last year ended with 13 of these "imported" cases reported, as of the agency's preliminary tally from the end of December.

Parents may not be aware that babies are recommended to get a vaccine for measles before international travel as early as six months old , officials have said , while older travelers may not realize that their destinations are facing outbreaks.

Cases have been on the rise around the world, blamed on a wide gap in immunity in many countries resulting from missed vaccinations during the COVID-19 pandemic. 

Records obtained by CBS News through a Freedom of Information Act request show the CDC had launched investigations of measles exposures through Feb. 20 in arriving international flights that departed from Saudi Arabia, Egypt and Turkey. 

Health officials in Georgia and California have also confirmed at least one of their cases this year was linked to travel through the Middle East. Other outbreaks in recent months have also been linked to travel in other parts of the world like Europe , which has also been facing a resurgence of infections.

"These fires are popping up all across the world, really creating the sparks that can kindle these small outbreaks in the U.S., with our goal of not letting that spark go beyond a small outbreak and kindle like a larger fire," said Daskalakis.

However, some recent clusters have also not been tied to international travel. 

Louisiana's health department said their cases this year were exposed in another U.S. state. A spokesperson for Arizona's Coconino County said their recent cases had not been linked to recent international travel or the other cases reported previously in the state this year.

When was the last time the U.S. saw a surge of measles cases?

The most measles cases seen in the U.S. since the COVID-19 pandemic was in 2022, with 121 cases reported in just six states. 

Many of the infections in 2022 resulted from low immunity among the thousands of evacuees airlifted from Afghanistan that year, prompting a mass vaccination campaign to curb further spread. 

Before the pandemic, the last peak in infections came in 2019, when 1,274 measles cases were reported across 31 states.

This marked the largest number of measles infections on record nationwide since 1992, driven in part by outbreaks that continued for months among large, close-knit Orthodox Jewish communities in New York. Other countries around the world also saw major outbreaks that year.

At the time, federal health authorities worried the outbreaks could threaten the U.S. status of having eliminated the virus — a status it officially achieved in 2000.

But Daskalakis says at this point "we are nowhere close to" seeing measles elimination being threatened.

Losing measles elimination status requires months of sustained transmission of the virus in a community, Daskalakis said, which has yet to be seen.

"We're being, with our local and state health officials, being really persistent on the issue that we address these outbreaks, as well as the bigger picture of catch up vaccination. But I think that this is the time to act so we don't get anywhere close to losing our measles elimination," he said.

What are the symptoms of measles?

Around two weeks after first being exposed to someone else infected with measles, the earliest symptoms of the virus tend to be a high fever alongside at least one of what experts call "the three C's" of measles: 

  • Runny nose, which doctors call coryza
  • Pink eye, which doctors call conjunctivitis

Daskalakis stressed that fever was a key part of the early signs of measles that set it apart from other causes of these common symptoms.

"We don't want every runny nose to say, I need to get tested for measles. It is allergy season, after all," he said.

A few days after that begins the distinctive rash caused by measles, which usually starts around the face before spreading to the upper body. Measles rashes are typically not itchy. Common complications include ear infections and diarrhea.

Tests are usually most sensitive to detecting measles infections when administered by a doctor at least three days after the rashes begin. 

Health authorities say people worried they may be sick with measles should call ahead to their doctor or hospital before visiting, given precautions that providers need to take to avoid spreading the highly contagious virus to other patients.

What are the complications of measles?

The CDC says about 1 in 5 unvaccinated Americans who catch measles are hospitalized. 

During 2019's record outbreak, 5% of the hospitalized patients had infections in their lungs, which doctors call pneumonia, and one developed encephalitis, or brain swelling. No deaths were reported. 

Measles can be fatal, especially in young children. Before the disease was eliminated in the U.S., thanks to the widespread adoption of the vaccine in the 1960s, around two to three deaths occurred for every 1,000 cases reported.

The last U.S. death from measles was in 2015, a CDC spokesperson said. Daskalakis said that measles fatalities are rare in U.S. patients, but cautioned even mild cases can face longer-term issues.

"There's a pretty good body of evidence that measles itself can cause reduced immunity to other pathogens. So even if we are seeing folks who are having mild cases, there's other things that could be further downstream that worry me," he said.

Alexander Tin is a digital reporter for CBS News based in the Washington, D.C. bureau. He covers the Biden administration's public health agencies, including the federal response to infectious disease outbreaks like COVID-19.

More from CBS News

Going abroad? CDC updates measles vaccination guidance for travelers

What women can learn from Olivia Munn's breast cancer diagnosis

Putin renews nuclear war threat, warns NATO not to send troops to Ukraine

HIV prevention drugs are effective, but many who need them are left out

  • Side Hustles
  • Power Players
  • Young Success
  • Save and Invest
  • Become Debt-Free
  • Land the Job
  • Closing the Gap
  • Science of Success
  • Pop Culture and Media
  • Psychology and Relationships
  • Health and Wellness
  • Real Estate
  • Most Popular

Related Stories

  • Millennial Money This 41-year-old mom bought an   affordable house in Italy for $62,000
  • Food, Travel and Tech 34-year-old mom's 4-month world cruise with family cost   $50K: 'Some of the best money I ever spent'
  • Food, Travel and Tech I quit my dream job at 32 and spent $34,000 to   travel the world—here are my 4 biggest regrets
  • Work 34-year-old quit her 6-figure tech job   to go to pastry school in France
  • Millennial Money How much money six-figure earners   spend on food in a month

This 31-year-old spent $20,000 to travel after he was laid off

thumbnail

Forget the "quarter-life crisis." These days, millennials are turning to the " quarter-life sabbatical ."

Amid the waves of mass layoffs, people are choosing to repurpose their unemployment into soul-searching, and many are extending their time away from the cubicle to travel the world.

Peter Lancaster, 31, was laid off from his technology job in California in May last year. Although he was sad to leave a job he loved, it was finally an opportunity for him to take a real break and enjoy life a little.

By the end of June, he sold most of his belongings, put the rest in storage, handed his cat to a friend and left for his first destination — Mexico City .

For the next eight months, Lancaster traveled to eight different countries: Mexico, Colombia, Peru, Argentina, Guatemala, Japan, Ecuador and Brazil. He said he spent about $20,000 during that time.

His plane tickets and transportation ended up being his highest expenses.

While Colombia and Guatemala were the most affordable destinations, Argentina and the Galapagos Islands were the most expensive, he added.

Here are six things he learned during his adventure abroad.

Be flexible

The biggest principle Lancaster stuck to while traveling overseas was staying flexible and knowing that plans can change along the way.

About six months into his travels, Peter met and fell in love with his girlfriend Alejandra, or as he likes to call, his "pp" (short for "Peruvian Princess").

His initial plan was to stay in Peru for four days, but after meeting Alejandra, he extended it to six weeks.

"I met her in Peru — in Cusco. I was doing laundry and she saw that I was struggling, so she helped me out and then we decided to get drinks," he told CNBC Make It .

"You think you would want to make an itinerary, but truthfully, your plan changes so much with who you meet," he said. "Be open minded to change your motive from seeing as much as possible to maybe just spending time with somebody for a bit."

"It's a lot easier to be flexible when you have a 'to be determined' timeline," he added.

Pack lightly

"I never had more than a week's worth of clothes," he said. "Downside is that I had to find a laundry place, but upside is that you can move around so easily."

For the first three weeks, he only traveled with a small backpack. Along the way, he was able to purchase items he needed.

Carrying less allowed him to be more agile when plans inevitably changed.

Be friendly

After first landing in Mexico City, Lancaster began to be homesick. "I wanted to go home because I was like: 'oh, it's going to be a long journey,'" he said. "But then then I started making friends and got comfortable real quick."

For most of the trip, he chose to stay in hostels as a way to save money, as well as to meet fellow travelers.

"Just start talking to people," he said. "Everyone's really approachable and thinking the same thing."

Travel smart

When traveling around foreign countries, it is important to maintain a level of caution.

"I think it's always good to just have a mentality that a lot of people might be trying to rip you off," Lancaster said. When making purchases or decisions, he suggests: "Take your time."

If something is too good to be true, it probably is too good to be true. Peter Lancaster Traveler

"Especially in a foreign country, use the buddy system," he said.

Locals can usually tell if you are a foreigner, which can put you in a compromised position. So it's important to be always aware of your surroundings and the situation.

Enjoy local cuisine

"I don't understand people that like go travel and eat burgers and pizza," he said. "Going to McDonald's is more expensive than some of these local places."

During his time abroad, Lancaster made it a point to enjoy the local cuisine, which added to his travel experience.

More to life than work

On Feb. 29, Lancaster returned to the United States feeling happy with everything he had experienced.

"If I had an unlimited budget, I'd probably keep going, but I felt like I just I saw everything and I was ready to work," he said.

"I feel content... it's just nice to have time off and have like a different routine than going to work," he said.

When asked why he went on the adventure, Lancaster said: "I guess it was more of a sense that if you were to die tomorrow, having on your tombstone the only thing you did was to work ... at least I can check one thing off."

Want to make extra money outside of your day job?  Sign up for  CNBC's new online course How to Earn Passive Income Online  to learn about common passive income streams, tips to get started and real-life success stories. Register today and save 50% with discount code EARLYBIRD.

Plus,  sign up for CNBC Make It's newsletter  to get tips and tricks for success at work, with money and in life.

We live better in Costa Rica than we did in the U.S. - here's how much it costs

The journey toward AI-enabled railway companies

Many types of artificial intelligence (AI) capabilities have accelerated in recent years due to tumbling costs of data storage and processing, rapidly expanding data availability, and improved data storage and modelling techniques. In general, analytical AI can analyze historical data and make numeric predictions, while generative AI (gen AI) allows machines to produce new outputs similar to human-generated content. Gen AI, in particular, has been building momentum since 2017 and hit an inflection point at the end of 2022 when applications such as ChatGPT became publicly available.

It’s no surprise, then, that AI adoption has surged across industries. For instance, in 2023, a third of respondents taking part in McKinsey’s annual global survey on the state of AI indicated that their organizations regularly use gen AI in at least one business function, and 60 percent of organizations that have adopted analytical AI said they are also developing gen AI use cases. 1 “ The state of AI in 2023: Generative AI’s breakout year ,” McKinsey, August 1, 2023.

Historically, the rail industry faced challenges in adopting digital technologies due to limited data availability and quality, regulatory considerations, and lack of standardization. Today, analytical AI and gen AI provide an opportunity for companies across the railway value chain to further embrace digitization.

A recent report, The journey toward AI-enabled railway companies , produced by the International Union of Railways (UIC) in partnership with McKinsey, examines the adoption of analytical AI and gen AI in the rail industry, and the business potential that these new technologies can bring. The report finds that railway companies have already begun to implement various AI technologies for around 20 key use cases. Greater adoption could unlock an estimated $13 billion to $22 billion in impact a year, globally.

At present, only a few railway companies and OEMs are implementing multiple use cases at scale. The report identifies use cases that have been deployed, or have the potential to be deployed, and looks at success factors for implementation.

Railway companies are focusing their efforts on about 20 use cases

Although there are more than a hundred potential use cases, railway companies’ efforts are mostly focused on a few analytical AI use cases. Some gen AI use cases were noted but gen AI was not defined as the preliminary focus of the study and is still nascent in most of the cases. Use cases tend to target business priorities relating to four KPIs: on-time performance, customer engagement, safety, and operational performance. These KPIs are aligned with the top four criteria that passengers, across geographies, use when choosing their mode of transport. A 2022 report by UIC and McKinsey, Boosting passenger preference for rail , identified these criteria as price, safety, reliability, and convenience. Exhibit 1 summarizes the key areas of potential for railway companies looking to leverage AI.

While the range of potential applications is substantial, for most railway companies AI is only an emerging trend—few have implemented any kind of AI at scale with success. Around 25 percent of companies have implemented multiple use cases at scale, and roughly 35 percent of companies have one or two use cases at scale, with other use cases being in pilot stage.

Use cases vary in terms of the maturity of the technology and their adoption by the rail industry. There are around 20 common use cases, at different stages of maturity, across the four groups of business activities: Railway undertakings; infrastructure management; passenger experience; and support functions.

Exhibit 2 plots the most common use cases in terms of maturity and adoption. Use cases higher up on the curve are likely to have been adopted by all the major railway companies. Use cases lower down have been adopted by fewer companies.

In some instances, use cases are identified as being mature but not yet deployed at scale—often when the use case was pioneered in an adjacent industry that helped mature the technology. Take, for example, revenue management systems used in the airline industry. The technology and use case are mature, but the level of adoption in rail is relatively low as reservation systems work differently in each industry.

Would you like to learn more about our Travel, Logistics & Infrastructure Practice ?

Railway undertakings.

Railway undertakings are companies or entities responsible for operating and managing railway services, including the provision of train transportation. Here the most mature analytical AI use cases, in the process of being fully deployed in the field as well as those already deployed and capturing impact, focus on shift planning and energy efficiency. AI solutions that optimize crew planning and shift planning have been deployed across all business units that work in shifts including train drivers, onboard staff, and maintenance operators. In some instances, adoption has generated a 10 to 15 percent optimization in shifts as well as reductions in labor costs.

Use cases in pilot phase, that have shown ability to drive impact through proof of concept (PoC) and are currently being improved before being deployed at scale, include predictive maintenance for rolling stock. Depending on the type of rolling stock and the type of component, predictive maintenance has enabled a 15 percent increase in reliability, and a 20 percent reduction in maintenance costs.

Autonomous trains are currently at the PoC stage. A few railway companies are exploring the potential of semi-autonomous and driverless trains intended to improve capacity and efficiency.

Use cases still in the early stages of exploration include disruption management through AI-powered digital twins of real-time operations.

Infrastructure management

In the context of the railway industry, infrastructure management encompasses planning, operation, and maintenance of the physical and organizational components of rail networks, including tracks, stations, and signaling systems. At-scale use cases are focused on predictive maintenance for rail infrastructure and crew and shift optimization. Use cases in pilot phase span passenger flow management, capacity planning, and real-time traffic management.

Use cases at PoC include inventory management, and maintenance co-pilots. As seen in railway undertakings, nascent use cases involve AI-powered digital twins, in this instance for optimizing the design and construction of infrastructure projects.

Passenger experience

In the railway industry, this refers to the overall satisfaction and comfort of individuals using train services, encompassing aspects such as service quality, convenience, amenities, and customer interactions. At-scale use cases focus on revenue management, security, and providing real-time intermodal information. A quarter of the railway companies in the research sample have pursued the use of artificial vision and predictive algorithms that support security. Other use cases, mostly in pilot phase include passenger flow management and content generation.

Support functions

Support functions include essential non-operational activities such as HR, finance, communication, IT, and procurement that contribute to the overall efficiency and effectiveness of railway undertakings and infrastructure managers.

Most use cases are still nascent or in pilot phases such as people analytics, talent training, software development, and using gen AI to quickly access and understand complex documentation.

Implementing AI: The size of the prize

Overall, various AI technologies can support railway companies to better invest, build, plan, and deliver efficient operations and meet passenger needs. To illustrate, for a €5 billion rail company, AI could deliver around €700 million a year in value (Exhibit 3). 2 Different business models exist for the rail industry. While the baseline may vary, the saving percentages are likely to remain similar as use cases can be applied across all types of rail activities. This includes increasing revenue through revenue management solutions and infrastructure capacity use cases, as well as optimizing labor, maintenance, and corporate costs.

Implementation is key for realizing this value. Many use cases can be successfully designed and deployed at scale within 12 to 18 months to realize value. The journey to become a data-driven company, fully integrating analytical or gen AI use cases in ways of working and operating can be challenging. In fact, over 60 percent of companies across industries experience a stall at some point on their digital transformation journey. 3 Only 28 percent of companies succeed in digital journeys, and many do not have a program to oversee their transformation. See, “ How to restart your stalled digital transformation ,” McKinsey, March 6, 2020.

Railway companies can take inspiration from data-driven companies in adjacent industries. What these companies have in common is that they put six building blocks in place that are key to a successful digital and data transformation: strategic roadmap, talent, agile operating model, technology, data, and adoption and scaling. Companies interested in exploring the power of all AI technologies, and those continuing to innovate with AI at an enterprise level, can focus their efforts on these six key components.

Delivering on the promise of AI may not be easy. Many railway companies have not deployed use cases at scale, yet. For those that have, successful deployments are characterized by investment in dedicated capabilities and talent, and the definition of clear objectives—aligned with business priorities—which helped focus investment on a few game-changing use cases. While transformative, AI can bring a new set of risks that may need to be addressed from the beginning. Accordingly, organizations looking to adopt AI would do well to prioritize strong data governance and robust cyber security.

If this seems daunting it is worth remembering that railway companies do not need to act alone. There is a wide ecosystem of partners and vendors with deep technical and business expertise to support this journey.

Raphaëlle Chapuis is consultant in McKinsey’s Montreal office, Leo Melnikov is a partner in the New York Office, and Nicola Sandri is a senior partner in the Milan office.

The authors wish to thank Marwan Dupuis Guillemet, Mary Ryder, and Sina Fahimi for their contributions to this article.

Explore a career with us

Related articles.

Scenic View Of Forest - stock photo

Good, better, best: Railways are advancing their ESG agenda

Waiting for the Train - stock photo

How to entice travelers to change tack to track

Transportation | Southwest, United airlines issue Colorado…

Share this:.

  • Click to share on Facebook (Opens in new window)
  • Click to share on Reddit (Opens in new window)
  • Click to share on Twitter (Opens in new window)

Digital Replica Edition

  • Latest Headlines
  • Environment

Transportation

  • News Obituaries

Transportation | Southwest, United airlines issue Colorado travel alerts ahead of winter storm

Customers traveling wednesday, thursday or friday can rebook their flights.

DENVER, CO - OCTOBER 10: Denver Post reporter Katie Langford. (Photo By Patrick Traylor/The Denver Post)

United and Southwest airlines issued travel alerts and offered free rebookings for Colorado travelers on Tuesday ahead of a winter storm set to drop several feet of snow across the region this week.

The incoming storm is forecast to bring up to 20 inches of snow to Denver International Airport and up to 4 feet in some areas of the Front Range foothills and mountains, according to the National Weather Service.

United Airlines issued a travel alert for airports in Denver, Colorado Springs, Aspen, Vail/Eagle, Gunnison and Steamboat Springs for Wednesday through Friday. The airline also issued an alert for Casper, Cheyenne and Laramie, Wyoming.

Southwest Airlines also issued a travel alert for airports in Denver, Colorado Springs and Steamboat Springs for the same days.

United customers who purchased their tickets on or before Sunday and are set to travel Wednesday, Thursday or Friday can reschedule their trip through March 19 with no fee or fare difference.

Southwest customers can rebook or travel standby within 2 weeks of their original travel date without additional charges, according to the alert.

Get more Colorado news by signing up for our Mile High Roundup email newsletter.

  • Report an Error
  • Submit a News Tip

More in Transportation

RTD operators on Sunday will start leaving elevator doors open at three busy rail and bus stations in a test to try to reduce rampant drug use, urination, and other illegal activities inside elevators.

Colorado News | Hundreds of RTD riders report illegal activities in elevators. A test starting Sunday may deter crime.

As the snow melts away from Thursday's massive upslope snowstorm, more than 500 flights have been canceled or delayed at Denver International Airport Friday.

Transportation | More than 500 flights delayed, canceled at Denver International Airport Friday morning

"Road conditions are still severe in several places," Jeffcom 911 dispatch tweeted. "Please stay home if you are able."

Weather | Colorado road conditions: “Hazardous” travel, slushy roads, highway closures continue Friday

Families travel on a bus as they leave Denver's then-largest migrant encampment at 27th Avenue and Zuni Street

Colorado News | Douglas County plans measure to prevent buses from dropping off migrants and challenge of state laws

U.S. flag

An official website of the United States government

Here's how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

  • The Attorney General
  • Organizational Chart
  • Budget & Performance
  • Privacy Program
  • Press Releases
  • Photo Galleries
  • Guidance Documents
  • Publications
  • Information for Victims in Large Cases
  • Justice Manual
  • Business and Contracts
  • Why Justice ?
  • DOJ Vacancies
  • Legal Careers at DOJ
  • About USAO-WY

Pierce Brosnan fined for foot travel in a thermal area in Yellowstone National Park

Pierce Brosnan, 70, of Malibu, California, was fined $500, and required to pay a $1,000 community service payment to the Yellowstone Forever Geological Fund, a $30 court processing fee, and a $10 special assessment. U.S. Magistrate Judge Stephanie A. Hambrick imposed the sentence on Mar. 14, in Mammoth, Wyoming.

Mr. Brosnan pleaded guilty to foot travel in a thermal area. According to court documents, on or about Nov. 1, 2023, Brosnan uploaded pictures to his Instagram page of himself standing on a Yellowstone National Park thermal feature at Mammoth Hot Springs. There are signs posted in the area that warn visitors of the dangers of thermal features and state that visitors must remain on the designated boardwalks and trails.  

The United States Attorney’s Office asked the court to sentence Brosnan to 2 years’ probation and the maximum fine of $5,000.

The National Park Service (NPS) reminds Yellowstone visitors that the ground in thermal areas is fragile and thin, and scalding water is just below the surface. Therefore, trespassing on thermal features is dangerous and can harm delicate natural resources within the park. Additionally, the park was established primarily to protect these hydrothermal areas. NPS encourages visitors to exercise extreme caution around thermal features by staying on boardwalks and trails.

NPS also urges people to protect themselves and the fragile environment by taking the Yellowstone Pledge: act responsibly and safely and set a good example for others. If you see someone, in person or online, whose behavior might hurt them, others, or the park, tell a ranger. If you’re in the park, dial 911. Learn about safety in Yellowstone.

For additional information related to Yellowstone National Park, please contact the Public Affairs Office at 307-344-2015 or [email protected] .

This crime was investigated by the National Park Service. The case was prosecuted by Assistant U.S. Attorney Ariel Calmes.

Contact: Lori Hogan (Contractor) Public Information Officer Office: 307-772-2124  Email: [email protected] Twitter: @usaowy  

Related Content

Stephen Clifford Swingle, age 45, of Evansville, Wyoming, was sentenced to six years’ probation for willfully injuring government property.

Ronald Ostrom, age 54, of Powell, Wyoming, was sentenced to two years’ probation, including six months of home confinement, for 6 felony convictions related to stealing a horse owned by...

Christopher Parish, age 41, London B. Beaudoin, age 19, and Leo Smith, age 20, from Houston, Texas, were arraigned on Jan. 18. The defendants are charged with bank theft.

IMAGES

  1. Edema: Stages, Types, Causes, Treatment, Risks

    travel related edema

  2. What Is Edema: 6 Types, Symptoms, And Causes » 2024

    travel related edema

  3. Edema: Stages, Types, Causes, Treatment, Risks

    travel related edema

  4. Peripheral Edema Symptoms + 7 Natural Treatments

    travel related edema

  5. Peripheral Edema: Symptoms, Causes & Treatment

    travel related edema

  6. Edema: Symptoms, Causes, Treatments

    travel related edema

COMMENTS

  1. Swelling When Traveling? Here's Why It Happens + What to Do

    If you feel the onset of swelling coming, get up and go for a walk. Even in the flight cabin when there's limited space, just going for a short walk to the bathroom or down the aisle and back will help. Walking helps to bring back proper blood circulation, which stops the swelling from getting worse. #3. Do Cardio.

  2. Swollen ankles from flying: Causes and when to see a doctor

    Summary. It is very common for a person's ankles to swell during or after flying. This is often due to a buildup of fluid known as edema. Swollen ankles due to edema are often harmless and the ...

  3. Foot swelling during air travel: A concern?

    Leg and foot swelling during air travel is common. It's usually harmless. The most likely reason for it is sitting for a long time without moving during a flight. Sitting with the feet on the floor for a long time causes blood to pool in the leg veins. The position of the legs while seated also increases pressure in the leg veins.

  4. Edema

    Edema occurs when tiny blood vessels in the body, also known as capillaries, leak fluid. The fluid builds up in nearby tissues. The leak leads to swelling. Causes of mild cases of edema include: Sitting or staying in one position for too long. Eating too much salty food. Being premenstrual.

  5. Travel-Induced Edema and Swelling During Travel

    Causes of Travel-Related Edema. Edema during travel, particularly on long flights or car rides, is primarily caused by prolonged periods of inactivity. When you're seated for an extended duration, the lack of movement can lead to poor circulation, especially in the lower extremities. This reduced circulation can cause blood to pool in the leg ...

  6. Why Do My Feet Swell When I Travel?

    Feet swelling is something that most regular fliers may experience at some time. Foot swelling is known medically as dependent edema and is usually innocuous during plane travel. The fluid accumulation is due to inactivity and gravity's effect on your body's fluids. You have undoubtedly experienced the discomfort of swollen feet after a ...

  7. How to Avoid Swollen Feet and Ankles During Travel

    4. Stretch Your Legs on Long Flights. If possible, get up to walk the aisle every hour or so, especially on flights over two hours, recommends Dr. Ford. Standing or walking to the bathroom can get ...

  8. Patient education: Edema (swelling) (Beyond the Basics)

    Travel — Sitting for prolonged periods, such as during air travel, can cause swelling in the lower legs. This is common and is not usually a sign of a problem. ... Not all types of edema require treatment. Edema related to pregnancy or menstrual cycles is not usually treated. Peripheral edema and ascites are usually treated slowly to minimize ...

  9. Edema

    Treatment. Mild edema usually goes away on its own. Wearing compression garments and raising the affected arm or leg higher than the heart helps. Medicines that help the body get rid of too much fluid through urine can treat worse forms of edema. One of the most common of these water pills, also known as diuretics, is furosemide (Lasix).

  10. Foot swelling during air travel: A concern?

    January 1, 2020. Leg and foot swelling during air travel is common and typically harmless. The most likely culprit is inactivity during a flight. Sitting with your feet on the floor for a long period causes blood to pool in your leg veins. The position of your legs when you are seated also increases pressure in your leg veins.

  11. Tips To Avoid Swollen Feet And Ankles During Travel

    Leg swelling, comfort and fatigue when sitting, standing, and sit/standing. Journal Of Thrombosis And Haemostasis. Effect of leg exercises on popliteal venous blood flow during prolonged immobility of seated subjects: implications for prevention of travel-related deep vein thrombosis. European Journal Of Internal Medicine.

  12. Edema: Causes, Symptoms & Treatment

    Swelling occurs when a part of your body gets bigger because there is a buildup of fluid in your tissues. Swelling can happen anywhere on your body but most often affects your feet, ankles and legs. Symptoms of swelling include: An area of your body is larger than it was a day ago. The skin over the swollen area looks stretched and shiny.

  13. Common Skin Infections in Travelers

    The purposes of this review were to identify the most common travel‐related skin infections and to familiarize health providers with their epidemiology, clinical features, prevention, diagnosis, and treatment. ... The mean number of lesions per person varies from one to three. 8,15,16 Two other major clinical signs are edema and ...

  14. Medical Conditions and High-Altitude Travel

    This response is usually well tolerated, but in persons with pulmonary hypertension (mean pulmonary-artery pressure >20 mm Hg at sea level), right-heart failure, or both, it may confer a ...

  15. Swelling (Edema): Symptoms, Causes, and Treatment

    Swelling is categorized based on the impacted body part. The four major types of edema include: Peripheral edema: This is swelling that affects the limbs, including the feet, ankles, legs, arms, or hands.Pitted edema, in which pressure on the skin leaves an impression (or pit), is a type of peripheral swelling.; Chest edema: A type associated with heart failure or lung injury, chest edema is ...

  16. Edema: Types, causes, symptoms, and treatment

    Peripheral edema: This affects the feet, ankles, legs, hands, and arms. Symptoms include swelling, puffiness, and difficulty moving certain body parts. Pulmonary edema: This occurs when excess ...

  17. Peripheral Edema: Definition, Causes, and Treatment

    Edema occurs when something disrupts the usual balance of fluids in your cells. As a result, an abnormal amount of fluid accumulates in your tissues (interstitial space). Gravity pulls the fluid ...

  18. Travel and Lower Leg Swelling

    Some people experience problems on shorter flights, while others do not experience problems unless flight time is four hours or longer. Contributors to the swelling include inactivity, the position of your legs while seated, low cabin pressure, low humidity, dehydration and certain medications. A small amount of lower-leg and foot swelling that ...

  19. Causes, Symptoms, Treatments, and Prevention of Edema (Swelling)

    Get up and walk when traveling, especially during air travel. Minimally Invasive Edema Treatments. Edema can be an external sign of venous insufficiency (a vein problem). Patients with vein-related symptoms can experience chronic pain and discomfort as well as, leg heaviness, leg fatigue, leg swelling, itching, or leg cramping.

  20. Acute Mountain Sickness

    As the number of international, adventure, and wilderness travelers increase, physicians in all locations and types of practices may be asked to counsel and provide prophylaxis or self-treatment for a variety of travel-related illnesses. At higher altitudes, the decreased partial pressure of oxygen can cause several pathological presentations, including High Altitude Pulmonary Edema, High ...

  21. Pitting Edema: What It Is, Symptoms, & Treatments

    Physical examination: Alongside grading, this involves checking pulse, heart rate, and other vitals.Medical history and medications are also assessed. Blood tests: Doctors test albumin levels in the blood, a protein derived in the liver, as these are directly related to edema and can signal liver or kidney problems.; Urinalysis: Chemical and microscopic analysis of urine is performed to assess ...

  22. Leg swelling Causes

    Leg swelling related to fluid buildup. Leg swelling caused by the retention of fluid in leg tissues is known as peripheral edema. It can be caused by a problem with the venous circulation system, the lymphatic system or the kidneys. Leg swelling isn't always a sign of a heart or circulation problem. You can have swelling due to fluid buildup ...

  23. Infections in Returning Travelers

    Of the approximately 80 million people who travel from industrialized to developing countries each year, 22% to 64% of travelers report some illness.1, 2 The approach to the patient requires knowledge of world geography, the epidemiology of disease patterns in 230 or so countries, and the clinical presentation of a wide spectrum of disorders. 3 Most illnesses are mild, most are self-limited ...

  24. Measles in the United States

    Related Pages. Updates on ... ear infections and diarrhea. More severe complications like pneumonia (lung infection) and encephalitis (infection and swelling of the brain) are possible and often require hospitalization and even intensive care. ... With spring break travel coming up and people going to and coming from countries that have seen ...

  25. Measles cases on the rise: Transmission, symptoms and vaccine info

    Related article More than 20 million children worldwide miss out on the measles vaccine each year Adults can be presumed to have immunity if they were born before 1957, according to the CDC.

  26. U.S. measles milestone: 60 cases so far in 2024

    The U.S. has now tallied at least 60 confirmed or suspected measles cases investigated so far this year by authorities in 17 states — more than the 58 cases reported nationwide in all of 2023 ...

  27. This 31-year-old spent $20,000 to travel after he was laid off

    Related Stories. Millennial Money This 41-year-old mom bought an affordable house in Italy for $62,000. Food, Travel and Tech I quit my dream job at 32 and spent $34,000 to ...

  28. The journey toward AI-enabled railway companies

    Many types of artificial intelligence (AI) capabilities have accelerated in recent years due to tumbling costs of data storage and processing, rapidly expanding data availability, and improved data storage and modelling techniques. In general, analytical AI can analyze historical data and make numeric predictions, while generative AI (gen AI) allows machines to produce new outputs similar to ...

  29. Southwest, United airlines issue Colorado travel alerts ahead of winter

    United and Southwest airlines issued travel alerts and offered free rebookings for Colorado travelers on Tuesday ahead of a winter storm set to drop several feet of snow across the region this week.

  30. District of Wyoming

    Pierce Brosnan, 70, of Malibu, California, was fined $500, and required to pay a $1,000 community service payment to the Yellowstone Forever Geological Fund, a $30 court processing fee, and a $10 special assessment. U.S. Magistrate Judge Stephanie A. Hambrick imposed the sentence on Mar. 14, in Mammoth, Wyoming. Mr. Brosnan pleaded guilty to foot travel in a thermal area.