Altered Mental Status in Febrile Returning Traveler

Aka: Altered Mental Status in Febrile Returning Traveler, Seizures in Febrile Returning Traveler, Neurologic Findings in the Febrile Returning Traveler

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II. Precautions

  1. Altered Level of Consciousness in a returning febrile patient is a medical emergency
    1. Consider cerebral Malaria
    2. Consider Hemorrhagic Shock

III. Causes: Altered Level of Consciousness in febrile travelers

  1. See Altered Level of Consciousness Causes
  2. Bacterial Infection
    1. Bacterial Meningitis
    2. Enteric Fever
    3. Meningococcemia or Neisseria Meningitidis (Sub-Sahara Africa)
    4. Tuberculous Meningitis
  3. Viral Infection
    1. Japanese Encephalitis
    2. Venezuelan Equine Encephalitis
    3. Tick-Borne Encephalitis (esp. Eastern European outdoor travelers)
    4. Rabies
    5. Yellow Fever
    6. Viral Hemorrhagic Fever
  4. Parasitic Infection
    1. African Trypanosomiasis
    2. Cerebral Malaria due to Plasmodium Falciparum
    3. Cryptococcal Meningitis

IV. Causes: Seizures in febrile travelers

  1. See Seizure Causes
  2. Uncommon causes in casual travelers (but common in local residents of endemic areas worldwide)
    1. Neurocysticercosis
    2. Schistosomiasis
  3. Fever, Diarrhea and Seizures
    1. Shigellosis
  4. Other causes (based on travel locations)
    1. Japanese Encephalitis
    2. Dengue Hemorrhagic Fever
    3. Cerebral Malaria

V. Differential Diagnosis

  1. See Altered Level of Consciousness Causes
  2. See Seizure Causes

VI. References

  1. Lo Re (2003) Am Fam Physician 68(7):1343-50 [PubMed]
  2. Strickland (1992) Med Clin North Am 76:1375-92 [PubMed]

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