Dengue

• Arbovirus infection. No specific treatment. Dengue and severe dengue (WHO fact sheet), Dengue (NHS Choices), Dengue (CDC)​, Dengue fever (gov.uk)

Ebola virus disease (EVD)

• Transmitted to people from wild animals and spreads in the human population through human-to-human transmission. Average case fatality rate is around 50% (have varied from 25% to 90% in past outbreaks). Early supportive care with rehydration, symptomatic treatment improves survival. Ebola virus disease (WHO factsheet), Ebola (CDC), Ebola virus disease (NHS Choices)

• Ebola virus disease (gov.uk)

Leishmaniasis

• 3 main forms visceral (AKA kala-azar and the most serious form of the disease), cutaneous (the most common), and mucocutaneous. Caused by the protozoan Leishmania parasites which are transmitted by the bite of infected sandflies.​ Leishmaniasis (WHO fact sheet), Travel-acquired / worldwide cutaneous infections (PCDS), Leishmaniasis (CDC)

• With increasing international travel, it is important to take a travel history. Leishmaniasis is found in the rain forests of Central and Southern America. It can commonly present as an infected chalazion.

Leprosy

• Chronic disease caused by the bacillus, Mycobacterium leprae. Multiplies slowly- incubation period of the disease, on average, is 5 years (symptoms may occur within 1 year or as long as 20 years). Mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Curable with multidrug therapy (MDT). Transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases (although not highly infectious). Untreated, can cause progressive and permanent damage to the skin, nerves, limbs, and eyes. Leprosy (WHO factsheet), Leprosy (gov.uk)

Malaria

• Life-threatening disease caused by parasites that are transmitted through the bites of infected female Anopheles mosquitoes.

Uncomplicated

• Artemisinin combination therapy (ACT) and is the preferred treatment for mixed infection

• Atovaquone-proguanil (Malarone) if ACT is unavailable

• Quinine plus doxycycline may be used to treat uncomplicated falciparum malaria (doxycycline should not be given to children <12Y)

Severe/complicated

• parenteral artesunate (can cause haemolysis and follow-up blood tests are required)

• Quinine if artesunate is unavailable

Non-falciparum

• Chloroquine may be used to treat uncomplicated P. malariae, P. ovale and P. knowlesi and most cases of P. vivax malaria but use depends upon patterns of resistance and tolerance

• Primaquine is the only currently effective drug for the eradication of hypnozoites (dormant parasites which persist in the liver after treatment of P. vivax and P. ovale)

• Screening for G6PD deficiency is essential before treatment with primaquine is started as it can cause haemolysis in G6PD deficient individuals, which can be fatal. It is contraindicated in pregnancy and breastfeeding.

• Malaria (CKS), Malaria (WHO factsheet), Malaria (CDC), Malaria (gov.uk), Malaria (NHS Choices)

Schistosomiasis

• An acute and chronic disease caused by parasitic worms. Schistosomiasis (WHO factsheet), Schistosomiasis (CDC), Schistosomiasis (bilharzia) (NHS Choices)

Zika

• Arbovirus (Aedes mosquitoes). Symptoms include mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache - normally last for 2-7 days.A cause of microcephaly and Guillain-Barré syndrome. Zika virus (patient.info), Zika virus (NHS Choices), Zika virus (gov.uk)