25 Finally, besides an infectious origin, the possibility of a toxinic (ciguatera) or toxic cause (mefloquine

and quinolones) should be considered. CMI are a rare cause of illness in travelers. Among the diversified etiological spectrum, cosmopolitan pathogens are widely predominant, particularly enteroviruses. Tropical germs are uncommon, apart from P. falciparum in returnees from endemic areas especially sub-Saharan Africa. The diagnostic approach, driven by history and physical examination, should focus on BIRB 796 nmr curable causes such as bacterial meningitides, herpetic encephalitis, and malaria. Key investigations include full blood count, blood smear, blood cultures, CSF PCR, and culture as well as neuroimaging. We would like to dedicate this paper to our teacher Michel Le Bras, professor in Tropical and Travel Medicine DAPT ic50 and member of the French Travel Medicine Society, who recently passed away. The authors state they have no conflicts of

interest to declare. “
“Background. As the incidence of dengue increases globally, US travelers to endemic areas may be at an increased risk of travel-associated dengue. Methods. Data from the US Centers for Disease Control and Prevention’s laboratory-based Passive Dengue Surveillance System (PDSS) were used to describe trends in travel-associated dengue reported from January 1, 1996 to December 31, 2005. The PDSS relies on provider-initiated requests for diagnostic testing of serum samples via state health departments. A case of travel-associated dengue was defined as a laboratory-positive dengue infection in a resident of the 50 US states and the District of Columbia who had been in a dengue-endemic area within 14 days before symptom onset. Dengue infection was confirmed by serologic and virologic techniques. Results. One thousand one hundred and ninety-six suspected travel-associated dengue cases were reported—334 (28%) were laboratory-positive, 597 (50%) were laboratory-negative, and 265 (22%) were laboratory-indeterminate. The incidence of laboratory-positive cases varied Megestrol Acetate from 1996 to 2005, but had an overall increase with no significant

trend (53.5 to 121.3 per 108 US travelers, p = 0.36). The most commonly visited regions were the Caribbean, Mexico and Central America, and Asia. The median age of laboratory-positive cases was 37 years (range: <1 to 75 y) and 166 (50%) were male. Of the 334 laboratory-positive cases, 41 (12%) were hospitalized, and 2 (1%) died. Conclusions. Residents of the US traveling to dengue-endemic regions are at risk of dengue infection and need to be instructed on appropriate prevention measures prior to travel. Especially in light of the potential transmissibility of dengue virus via blood transfusion, consistent reporting of travel-associated dengue infections is essential. Dengue, the most common arboviral infection in the world, is caused by one of the four dengue viruses (DENV-1, -2, -3, and -4).