Rationale: A diagnosis should be aggressively sought in patients who present with severe neurologic symptoms and fever. It is always important to rule out bacterial meningitis initially. Epidemiology is important for a patient to determine the possible history of exposure in an area endemic for a variety of infections. Typhoid fever and parasitic infections should be considered. Many of the above infections are geographically limited, so a good history of travel is important as well. Babesiosis is found in the northeastern and upper midwestern U.S., and leptospirosis is associated with animal exposure. Dengue, malaria, and trypanosomiasis are all endemic in Africa, with the latter two infections typically causing periodic fever.