Confusion and reduced conscious level in the returning traveller

This article provides a practical approach to the management of travellers returning from tropical countries and presenting with confusion or reduced consciousness. The most common treatable causes of neurological symptoms in this cohort are malaria, bacterial meningitis and viral encephalitis. There is an extensive list of less common causes including HIV, leptospirosis, rickettsia, syphilis, tuberculosis and typhoid. Each differential diagnosis should be considered based on presentation and travel history, including any risk behaviours. A thorough history and examination is the starting point to forming a differential diagnosis, which should be based on up-to-date endemic and epidemic data, incubation periods and presentation. A knowledge of the distribution of infectious diseases and mode of transmission is essential. There are very good online resources to use as references for information about tropical infections. Alongside these, expert advice should always be sought from a specialist in infectious diseases or tropical medicine.