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Measles: an important cause of fever and rash in a returned traveller

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Clinical record

A previously well 21-year-old woman went to her general practitioner in September 2013, before a holiday to Bali, Indonesia, and was vaccinated for hepatitis A and typhoid. Malaria prophylaxis was not prescribed, as her intended destinations were deemed to confer a low risk of acquiring malaria. Notably, she had not received routine childhood vaccinations because of parental preference, receiving only “homeopathic immunisation” in infancy.

During October 2013, she spent 11 days in Bali, primarily in large holiday resorts in the Kuta district, but she did travel to a rural village. She reported receiving several mosquito bites during her trip.

Two days before her return to Australia, she developed fever, vomiting and diarrhoea. These symptoms continued until she presented to her GP 1 day after returning to Australia. She was prescribed metronidazole and loperamide and her diarrhoea resolved, but nausea and lack of appetite persisted. The following day she developed chills with associated headache, myalgias and cough — these symptoms continued until she presented to hospital 7 days after her return to Australia.