Evaluation and Management of Severe Fatigue in New Immigrants

Initial Assessment and Screening

The American College of Physicians recommends quantifying fatigue severity using a 0-10 numeric rating scale over the past 7 days, or categorizing as none/mild/moderate/severe 1, 3
Scores of 4-10 warrant immediate focused evaluation, and scores ≥7 typically indicate marked functional impairment requiring urgent workup 1, 3
The Centers for Disease Control and Prevention suggests documenting country of origin and regions visited, as 51% of febrile travelers have visited Africa and 29% Asia, where tropical diseases are endemic 4

Assess for B symptoms: fever, drenching night sweats, unexplained weight loss >10% over 6 months, and evaluate for pain, pulmonary complaints, and unintentional weight loss 2, 5, 6
Document lymphadenopathy, hepatosplenomegaly, and skin manifestations, and assess for emotional distress, depression, and anxiety 2, 3
Evaluate sleep quality, quantity, and hygiene, and assess alcohol and substance use 3

Complete blood count with differential, comprehensive metabolic panel, thyroid-stimulating hormone, erythrocyte sedimentation rate, and C-reactive protein are essential initial screenings 1, 2
Malaria testing, tuberculosis screening, and HIV testing are critical for new immigrants given disease prevalence 2, 4
Schistosomiasis serology, dengue fever serology, enteric fever blood cultures, and rickettsial serology may be necessary based on exposure history 4

Chest X-ray is recommended as initial screening for pulmonary pathology, and contrast-enhanced CT chest/abdomen/pelvis may be necessary if red flags are present 1, 2
Initiate structured physical activity with stretching and aerobic exercise, and treat identified infections promptly 1
Avoid psychostimulants and dietary supplements as they lack efficacy for fatigue management 1