The etiologies distribution according to the visited region is showed in Table 4. Diagnosis was confirmed in 42 cases (75%). In 12 cases (21.5%), P. falciparum was confirmed by thin blood smear. A micro-organism was demonstrated in CSF in 19 cases, of which 16 by polymerase EPZ015666 mouse chain reaction (PCR) (eight enteroviruses and eight Herpesviridae). Blood cultures were positive in three cases: brucellosis, typhoid fever, and a P. falciparum–Salmonella enteritidis coinfection. Three patients had a positive viraemia [HIV (n = 2)

and enterovirus (n = 1)]. Significant plasma seroconversion was reported in six cases (dengue, Toscana, HIV (n = 2), M. pneumoniae, and brucellosis). Throat and stool cultures were positive for enteroviruses in 11 cases. Among the confirmed diagnoses, viral CMI accounted for 57% (24 cases). Enteroviruses, herpes group viruses, and HIV represented 91.5% of identified viral CMI. There were only four bacterial infections (N. meningitidis, M. pneumoniae, B. Atezolizumab melitensis, and S. typhi) and one fungal disease (cryptococcosis). The 14 other undetermined cases were considered as

possible viral CMI due to their clinical presentation, biological parameters (86% had a lymphocytic or mixed CSF profile), and spontaneously favorable outcome. Sixteen patients (28.5%), including 10 cases of severe malaria, were admitted in an intensive care unit with median stay duration of 9.5 days (range: 1–63 d). The mean hospitalization duration for the whole study population was 14 days. Malaria-related CMI had a significantly higher median stay duration than the other causes (18.5 vs 8 d, p < 0.05). One patient died of herpes simplex virus 1 (HSV-1) meningoencephalitis and four (7%) had sequelae (severe malaria, enteroviral encephalitis, brucellosis, and undetermined encephalitis, respectively). Little is known about the etiological

spectrum of travel-related CMI. Along with the recent travel-associated studies,1–8 we found that CMI are uncommon, accounting for 4.5% of all our hospitalized travelers, Carbohydrate all etiologies included and 3.5% excluding malaria. On a recent traveler’s health problems scale, tick-borne encephalitis and meningococcal infections have monthly incidence rates of 1/10,000 and 1/1 million, respectively.9 Travel-related CMI represented the third of all CMI. Thus, when examining a patient presenting with fever and/or neurological and/or psychiatric features, a history of recent travel should always be sought. As for the health care itinerary, we would like to emphasize the difficulties in diagnosis, the late management, and the important number of medical evacuations that are due to the atypical presentation rate (21%) and the unfamiliar etiologies of travel-related CMI.