The returned traveller.

10 Talan DA, Guterman JJ, Overturf GD, Singer C et al. Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med 1989;18: 856–62. 11 Heyderman RS, Lambert HP, O’Sullivan I, Stuart JM et al. Early management of suspected bacterial meningitis and meningococcal septicaemia in adults. J Infect 2003; 46:75–7. 12 Begg N, Cartwright KA, Cohen J, Kaczmarski EB et al. Consensus statement on diagnosis, investigation, treatment and prevention of acute bacterial meningitis in immunocompetent adults. British Infection Society Working Party. Review. J Infect 1999;39:1–15. 13 Quagliarello VJ, Scheld WM. Treatment of bacterial meningitis. Review. N Engl J Med 1997;336:708–16. 14 Schaad UB, Lips U, Gnehm HE, Blumberg A et al. Dexamethasone therapy for bacterial meningitis in children. Swiss Meningitis Study Group. Lancet 1993;342:457–61. 15 Molyneux EM, Walsh AL, Forsyth H, Tembo M et al. Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. Lancet 2002;360:211–8. 16 de Gans J, van de Beek D; European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002;347: 1549–56. 17 Purcell B, Samuelsson S, Hahne SJ, Ehrhard I et al. Effectiveness of antibiotics in preventing meningococcal disease after a case: systematic review. BMJ 2004;328:1339. 18 Joint Tuberculosis Committee of the British Thoracic Society. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998. Thorax 1998;53:536–48. 19 Weidmann M, Meyer-Konig U, Hufert FT. Rapid detection of herpes simplex virus and varicella-zoster virus infections by real-time PCR. J Clin Microbiol 2003;41:1565–8. UK residents made almost 60 million visits abroad in 2002, three times the number in 1981. Most were to the European Union but there were over four million visitors to tropical or near-tropical areas, and since 1995 there has been a steady increase in UK travel to Asia, the Caribbean and South and Central America. The number of travellers to sub-Saharan Africa has risen only slightly. However, there has been a marked increase in immigration from Africa and the distinction between traveller and immigrant is irrelevant to the acute medical team. The public usually expects to be immunised against infections such as typhoid and hepatitis A before travelling to more exotic destinations but are largely unaware that avoiding the more significant threats to health and life depends more on their behaviour abroad and on prompt presentation to informed doctors should they become ill on return. What is special about returned travellers?