Management should focus on curable causes. Cerebro-meningeal infections (CMI) are a rare but potentially severe cause of morbidity in travelers. As seen in recent studies,1–8 their overall incidence in travel-related morbidity is only 1% to 2%, far behind that of gastrointestinal

infections, acute respiratory tract infections, dermatoses, and malaria. To our knowledge, no previous study has focused specifically on the etiological spectrum of travel-associated CMI. The main aims of our study were to assess the etiologies of CMI in hospitalized travelers and then to propose a diagnostic approach to travel-related CMI. The study was carried out in the infectious and tropical diseases department and in the intensive care unit of the Bégin military hospital in Saint-Mandé, GDC-0199 in vitro France. Data were collected retrospectively between January 1, 1998, and December 31, 2005. Included in the study were adult patients

hospitalized for a CMI, occurring during travel outside Small molecule library metropolitan France or less than a month after their return from abroad. Also included were those who contracted a travel-related CMI with a long incubation period (>1 mo). The diagnosis of a CMI was established according to clinical findings combined with at least one biological or imaging parameter. These include the following: 1 Fever ≥38°C (upon admission or in the clinical history) These include the following: 1 Abnormality of the cerebrospinal fluid (CSF) cell count and/or chemistry (glucose and protein

concentration) These include neuroimaging abnormalities [computed tomography (CT) or magnetic resonance imaging (MRI)]. The exclusion criteria were: children (<16 y), immigrants, and refugees whose pathology was acquired during a prior exposure (eg, meningeal tuberculosis), cerebral tumor, cerebral thrombophlebitis, carcinomatous meningitis, intracranial vascular disorders, toxic or metabolic L-gulonolactone oxidase encephalopathy, human prion disease, and meningismus. Data collected included patient demographics, classification (tourist, military, immigrant, expatriate), pre-travel advice, vaccinations, malarial prophylaxis, travel history, clinical history, and outcome. Data were recorded using Microsoft Excel software. Statistical significance was determined using the Student t-test for quantitative variables and the χ2-test for qualitative variables. The significance threshold was of 5%. Fifty-six patients were included in the study, representing approximately 4% of the 1,200 travelers admitted in the same period within our unit. Our sample also accounted for 32% of all hospitalized CMI patients (n = 174) in our department, in the same time frame. The sample was composed of 35 males and 21 females (male-to-female ratio: 1.66). Median age was 29 years (range: 16–83 y). Two patients were HIV-infected and followed up by our team. Twenty-five patients (44.6%) were classified as tourists, 15 (26.8%) as military, 9 (16.1%) as immigrants, and 7 as expatriates (12.5%).