A guide for health professionals working with
immigrant and refugee children and youth

Symptoms, signs and clinical problems: A tool for differential diagnosis

Common symptoms and laboratory findings that may be encountered among immigrant and refugee children arriving in Canada are provided below. Select from these options to perform a search for possible differential diagnoses.

When using this tool it is important to note the following:

  • The presenting symptoms and signs may be caused by illnesses common in Canada.   For example, fever may be caused by otitis media and upper respiratory infection; abdominal pain by appendicitis or urinary tract infection, etc.  This tool is intended to help you expand the differential diagnoses, where appropriate, to include infections and other diseases that may be related to travel history, country of origin, or ethnic background.  For example, those who have been in tropical countries may have infections such as malaria, tuberculosis (TB), or Chagas' disease. Those of African descent may have sickle cell disease, or beta-thalassemia, etc.
  • Your search results will not be all-inclusive lists, but will include some important possibilities.
  • Check to see if the disease is plausible, considering country of origin or travel history. The search options do not include the country of origin of the patient as epidemiological data can change quickly, and often do not align well with political boundaries. Geographic information is included in the search results, and a link to detailed information is provided for each condition listed. Consider not only the original country of the new immigrant or refugee but any other countries or regions visited on the travel to Canada or while visiting friends and relatives abroad.
  • Results are organized by (1) Do not miss! (2) More common diseases to consider. (3) Less common diseases to consider.  Within each of these categories, results are listed by type (e.g. viral, bacterial, parasitic, non-infectious), then in alphabetical order. 
  • You can create a shortlist. As you review your list of results, you can select likely possibilities by checking the box to the left of the disease name. Click the button below to create a ‘shortlist’ of items selected. You can print your shortlist or copy/paste it into your EMR system to keep a record of what you’ve investigated, what has been ruled out, and what’s next on the list to consider.

Caution

Consider the possibility of vaccine-preventable illnesses in unimmunized or only partially immunized immigrant or refugee children. Such conditions may be overlooked because they occur rarely in Canada. For example, if a patient presents with:

  • fever, confluent maculopapular rash, cough, coryza, conjunctivitis: consider measles.
  • fever, parotid gland swelling and pain: consider mumps.
  • fever, sore throat with gray-white membrane in the pharynx: consider diphtheria.
  • unilateral flaccid paralysis: consider poliomyelitis.
  • discrete maculopapular rash and enlarged posterior auricular nodes: consider rubella.
  • sepsis, meningitis, septic arthritis, or facial or periorbital cellulitis: consider Haemophilus influenzae type b.

If a family is coming to see you for a specific problem, don’t miss this opportunity to conduct recommended screening for refugee and immigrant children and to assess immunizations.

Webinars:

References

Diseases of children in the subtropics and tropics – which now can be available online. http://www.e-booksdirectory.com/details.php?ebook=1633

  • A world guide to infectious diseases, distribution, diagnosis. Mary E. Wilson. Oxford University Press Inc., 1991.
  • Hunter's tropical medicine and Emerging Infectious Disease, 9th ed. Magill, Ryan, Solomon and Hill. W. B. Saunders Co. 2012.
  • Manson's tropical diseases, 23rd ed. Gordon C. Cook, editor. W.B. Saunders Co., 2013.
  • Travel medicine advisor (updated yearly). E.C. Jong, J.S. Keystone, R. McMullen, editors. American Health Consultants Inc., P.O. Box 740056, Atlanta, GA 30374.

Also available at: http://www.kidsnewtocanada.ca/signs-and-symptoms/
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Caring for Kids New to Canada is a resource for health professionals. The information here is not a substitute for medical advice, nor does it indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

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