Tags

Type your tag names separated by a space and hit enter

Travel-related cerebro-meningeal infections: the 8-year experience of a French infectious diseases unit.
J Travel Med. 2010 Jan-Feb; 17(1):1-7.JT

Abstract

BACKGROUND

The etiological spectrum of cerebro-meningeal infections (CMI) in travelers has never been specifically analyzed.

OBJECTIVES

To assess the etiologies of CMI in hospitalized travelers and to propose a diagnostic approach to travel-related CMI.

METHODS

During an 8-year period, we retrospectively collected data on all travelers hospitalized in our department for a CMI occurring during travel or in the month after their return.

RESULTS

Fifty-six patients (35 men and 21 women; mean age 29 years (16-83); 44.6% tourists, 26.8% military, 16% immigrants, 12.5% expatriates) were included. The main destinations were Africa (57.2%), Europe (19.5%), and Asia (12.5%). The median duration of travel was 24 days (5-550). Symptoms occurred during travel in 20 patients (11 of which required a medical evacuation). In the remaining 36 patients, the median duration between return and clinical onset was 10 days. The median time from clinical onset to hospitalization was 4 days (0.5-96). Twenty-four patients presented with a meningeal syndrome and 20 others with encephalitic features. The remaining 12 patients had an incomplete clinical presentation (headaches or fever). The etiology was confirmed in 42 cases (75%) of which tropical diseases (n = 14) were less common than cosmopolitan ones (n = 28). Sub-Saharan Plasmodium falciparum malaria (n = 12) was the leading tropical infection, whereas viral infections (enterovirus, herpesviridae, HIV) were the main cosmopolitan etiologies. Only four bacterial infections were reported (Neisseria meningitidis, Mycoplasma pneumoniae, Brucella melitensis, Salmonella typhi). Sixteen patients were admitted to intensive care for a median time of 9.5 days (1-63). The average duration of hospitalization was 14 days (3-63). One death by herpes simplex virus 1 encephalitis was recorded. Four patients (7%) had neurological sequelae.

CONCLUSIONS

Among the diversified etiological spectrum of CMI, cosmopolitan infections are widely predominant, particularly viral infections, followed by tropical causes, of which malaria is the leading disease in returnees from endemic areas. The diagnostic approach should be driven by history and physical examination. Key investigations include: blood smear, cerebrospinal fluid polymerase chain reaction and culture as well as neuroimaging. Management should focus on curable causes.

Authors+Show Affiliations

Service des maladies infectieuses et tropicales, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France. rappchristophe@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20074095

Citation

Rapp, Christophe, et al. "Travel-related Cerebro-meningeal Infections: the 8-year Experience of a French Infectious Diseases Unit." Journal of Travel Medicine, vol. 17, no. 1, 2010, pp. 1-7.
Rapp C, Aoun O, Ficko C, et al. Travel-related cerebro-meningeal infections: the 8-year experience of a French infectious diseases unit. J Travel Med. 2010;17(1):1-7.
Rapp, C., Aoun, O., Ficko, C., Imbert, P., Barruet, R., & Debord, T. (2010). Travel-related cerebro-meningeal infections: the 8-year experience of a French infectious diseases unit. Journal of Travel Medicine, 17(1), 1-7. https://doi.org/10.1111/j.1708-8305.2009.00361.x
Rapp C, et al. Travel-related Cerebro-meningeal Infections: the 8-year Experience of a French Infectious Diseases Unit. J Travel Med. 2010 Jan-Feb;17(1):1-7. PubMed PMID: 20074095.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Travel-related cerebro-meningeal infections: the 8-year experience of a French infectious diseases unit. AU - Rapp,Christophe, AU - Aoun,Olivier, AU - Ficko,Cécile, AU - Imbert,Patrick, AU - Barruet,Régine, AU - Debord,Thierry, PY - 2010/1/16/entrez PY - 2010/1/16/pubmed PY - 2010/4/23/medline SP - 1 EP - 7 JF - Journal of travel medicine JO - J Travel Med VL - 17 IS - 1 N2 - BACKGROUND: The etiological spectrum of cerebro-meningeal infections (CMI) in travelers has never been specifically analyzed. OBJECTIVES: To assess the etiologies of CMI in hospitalized travelers and to propose a diagnostic approach to travel-related CMI. METHODS: During an 8-year period, we retrospectively collected data on all travelers hospitalized in our department for a CMI occurring during travel or in the month after their return. RESULTS: Fifty-six patients (35 men and 21 women; mean age 29 years (16-83); 44.6% tourists, 26.8% military, 16% immigrants, 12.5% expatriates) were included. The main destinations were Africa (57.2%), Europe (19.5%), and Asia (12.5%). The median duration of travel was 24 days (5-550). Symptoms occurred during travel in 20 patients (11 of which required a medical evacuation). In the remaining 36 patients, the median duration between return and clinical onset was 10 days. The median time from clinical onset to hospitalization was 4 days (0.5-96). Twenty-four patients presented with a meningeal syndrome and 20 others with encephalitic features. The remaining 12 patients had an incomplete clinical presentation (headaches or fever). The etiology was confirmed in 42 cases (75%) of which tropical diseases (n = 14) were less common than cosmopolitan ones (n = 28). Sub-Saharan Plasmodium falciparum malaria (n = 12) was the leading tropical infection, whereas viral infections (enterovirus, herpesviridae, HIV) were the main cosmopolitan etiologies. Only four bacterial infections were reported (Neisseria meningitidis, Mycoplasma pneumoniae, Brucella melitensis, Salmonella typhi). Sixteen patients were admitted to intensive care for a median time of 9.5 days (1-63). The average duration of hospitalization was 14 days (3-63). One death by herpes simplex virus 1 encephalitis was recorded. Four patients (7%) had neurological sequelae. CONCLUSIONS: Among the diversified etiological spectrum of CMI, cosmopolitan infections are widely predominant, particularly viral infections, followed by tropical causes, of which malaria is the leading disease in returnees from endemic areas. The diagnostic approach should be driven by history and physical examination. Key investigations include: blood smear, cerebrospinal fluid polymerase chain reaction and culture as well as neuroimaging. Management should focus on curable causes. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/20074095/Travel_related_cerebro_meningeal_infections:_the_8_year_experience_of_a_French_infectious_diseases_unit_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1111/j.1708-8305.2009.00361.x DB - PRIME DP - Unbound Medicine ER -