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Tropical Diseases

Tropical Diseases

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Tro p i c a l D i s e a s e s

Definition, Geographic Distribution, Transmission, and Classification
Alimuddin Zumla, MD, MSc, PhD(Lond), FRCP(Lond), FRCP(Edin), FRCPatha,*, Andrew Ustianowski, PhD(Lond), FRCP(Lond), DTM&Hb
KEYWORDS  Classification  Tropical disease  Infectious diseases KEY POINTS 
The term tropical diseases encompasses all communicable and non-communicable diseases that occur principally in the tropics.  Approximately 15 million people die each year because of tropical infectious and parasitic diseases.  Tropical diseases are not restricted to the tropics. Increasing migration, international air travel, tourism, and work visits to tropical regions have contributed to an increased incidence of such diseases being seen in the United States, United Kingdom, and Europe.  Classification of tropical diseases is useful for microbiologists, pathologists, laboratory staff and practicing infectious diseases physicians.  This article gives an overview of the definition, geographical distribution, transmission and practical classification of tropical infectious diseases.

The term tropical diseases encompasses all diseases that occur principally in the tropics. This term covers all communicable and noncommunicable diseases, genetic disorders, and disease caused by nutritional deficiencies or environmental conditions (such as heat, humidity, and altitude) that are encountered in areas that lie between, and alongside, the Tropic of Cancer and Tropic of Capricorn belts. In tropical countries, apart from noncommunicable diseases, a severe burden of disease is caused by an array of different microorganisms, parasites, land and sea animals, and arthropods.1–3 Approximately 15 million people die each year because of tropical infectious and parasitic diseases, most living in developing countries.4 This wide array of diseases is compounded and made worse by the common issues of poverty, poor living conditions, malnutrition, human immunodeficiency virus (HIV)/acquired immune deficiency
Department of Infection, Division of Infection and Immunity, University College London Medical School, University College London Hospitals NHS Foundation Trust, London WC1E 6AJ, UK; b Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK * Corresponding author. E-mail address: a.zumla@ucl.ac.uk Infect Dis Clin N Am 26 (2012) 195–205 doi:10.1016/j.idc.2012.02.007 0891-5520/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved. id.theclinics.com
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Respiratory infectious diseases such as severe acute respiratory syndrome (caused by coronavirus) and the avian influenza8 are frequently causes of major concern. Although. cause much morbidity and mortality from envenomation and secondary infections. but presently emerging.9 TROPICAL DISEASES IN THE UNITED KINGDOM. EUROPE.9 Other previously rare. and wide geographic distribution. viral.1–4 Respiratory tract infections (RTIs) are caused by a variety of bacterial. including Chagas disease. Thus. and corruption) that afflict a large proportion of developing countries across the tropics. immigrants. enteric fever. viral. HIV/AIDS. RTIs remain major causes of morbidity and mortality in adults and children worldwide.5 Tuberculosis. and refugees. giardiasis. and diarrheal diseases have extremely high public health impacts. and their valuable Web site gives regularly updated information on geographic and temporal trends in disease-associated morbidity among travelers. tropical infectious diseases remain one of the major causes of preventable morbidity and mortality. Increasing migration. United Kingdom.6. and malaria alone are currently responsible for an estimated 6 million deaths annually. with 200 million people infected and 779 million at risk in more than 70 countries. and cerebrovascular accidents in resource-poor tropical countries. ecological niches.9. myocardial infarction.196 Zumla & Ustianowski syndrome (AIDS). and developing countries. AND THE UNITED STATES Tropical diseases are not restricted to the tropics. Bites from several animal species. such as the southern United States and the Mediterranean area. and cause significant morbidity and mortality in adults and children. The last decade of the twentieth century was marked by a resurgence in tropical diseases being encountered in countries outside the tropics. tourism. scorpions. African trypanosomiasis. Chagas disease. systemic. such as the United States. chronic obstructive airways disease. mismanagement. lifestyle issues and changes in diet have led to an increase in the number of noncommunicable disease such as hypertension.10 Climate change and global warming (with a resulting increase in average and nadir temperatures) may be causing tropical diseases and vectors to spread to higher altitudes in mountainous regions. including snakes. In addition to these. filariasis. These diseases share population targets. with advances in immunosuppression. in the past decade. and vector-borne viral encephalitides. diabetes. viral hemorrhagic fevers.7 The identification and diagnosis of acute and chronic bacterial (including tuberculosis). and work visits to tropical regions have contributed to an increased incidence of such diseases being seen in the United States. diseases from particular geographic areas include leptospirosis. international air travel. causing millions of deaths each year. Skin diseases are common in travelers returning from the tropics.1–4 Schistosomiasis is the second most important parasitic disease after malaria. and jellyfish. and poor health systems (consequential on poverty. The Global Surveillance Network of the International Society of Travel Medicine (ISTM) and the Centers for Disease Control (CDC) established a worldwide communications and data collection network of travel/tropical medicine clinics in 1995. helminthiases. and viral hemorrhagic fever. have started to . a chronic. onchocerciasis. and to higher latitudes that were previously spared. and Europe. make transplants an early therapeutic option for many diseases affecting a considerable number of people worldwide.3. and fungal respiratory infections remain an important challenge in medical inpatient and outpatient practice in Europe.3 The increasing success rates of solid organ and hematopoietic stem cell transplantations. transplant programs in Western countries. and fungal pathogens. leishmaniasis. as well as those in developing countries. rickettsioses. the United States. parasitic infection caused by the protozoan Trypanosoma cruzi. trypanosomiasis.

An extensive enquiry into the travel history is prudent because certain tropical infectious diseases can first present years or even decades after the last tropical travel. It is imperative to consider the possibility of a tropical disease in cases that are difficult to diagnose. specific listings and classifications are useful for streamlining the microbiological and clinical assessment of the patient’s illness. and fungal infections are being recognized.12 A high degree of clinical awareness of the possibility of a tropical disease enables an early diagnosis to be made and enables effective treatment measures to be initiated. and their treatment. pathologists. and prevention.13. and schistosomiasis (any Schistosoma spp).Tropical Diseases 197 face the impact of neglected tropical diseases transmitted via the donor tissue. The classification of infectious and tropical diseases.16 Epidemiologists usually describe tropical disease in terms of person. Such classifications use the routes of transmission or acquisition of the infectious disease (Table 3). DF-2 is now known as Capnocytophaga canimorsus. It is prudent to enquire about travel history and geographic origins early in consultations. bacterial. It is imperative that physicians globally are aware of the wide spectrum of tropical. CLASSIFICATION OF TROPICAL DISEASES The number and range of tropical and infectious diseases prevalent globally is extremely large and broad ranging. there are several ways in which tropical/infectious diseases are presented in century-old classic tropical diseases textbooks like Manson’s Tropical Diseases or other major treatises that present the classification of tropical diseases with a combination of clinical and microbiological approaches. being acquired near city airports where mosquitoes imported on aircraft arriving from the tropics can survive and transmit the infection during the summer months. trypanosomiases (T cruzi and Trypanosoma brucei gambiense). and according to their reservoirs in nature. and species and have large standard textbooks that give detailed classification and nomenclature. malaria can occur in patients who have not traveled overseas. . including malaria (Plasmodium ovale and Plasmodium vivax). They often classify infectious diseases according to their distribution. For example Rickettsia tsutsugamushi. or the important clinical manifestations of the specific disease (Table 2). Table 1 gives a basic classification of common infectious pathogens for clinical use.14 Microbiologists tend to prefer classifying infectious diseases according to the classic microbiological nomenclature codes of kingdom. has been reclassified into the genus Orientia. For example. reducing morbidity and mortality. microbiologists. and parasitic diseases to which their patients may have been exposed.11 More posttransplantation respiratory viral. Physicians also tend to classify infectious diseases according to the most important organ or organ system to be affected. family. microorganisms are frequently being reclassified and renamed. protozoal. the causal agent for scrub typhus. filariases. their means of transmission. and laboratory staff. even potentially in those without a suggestive travel history. to aid early diagnosis and treatment and thereby prevent poor outcomes in many patients. and clinicians. Classification of tropical diseases can also serve as aide´ memoires or checklists for guiding clinicians. place. order.1–3 Thus.15 They relate information according to microscopic appearance after staining or culture characteristics. and exposure. For the practicing infectious diseases physician. strongyloidiasis (Strongyloides stercoralis). with a view to developing control and prevention strategies to limit the spread of the diseases in the community. for practical purposes. genus. phylum. time. infectious. have historically involved the joint efforts of epidemiologists. However. microbiologists. class. to advise the clinician on the most appropriate antibiotic therapy and management. control. with advances in molecular technology.

T rangeli) ii. pin/threadworms. Plasmodium malariae. Trypanosoma spp (T cruzi. Babesia microti iii. Trichinella spiralis. Acanthamoeba spp iii. Rhizopus spp. Necator americanus) ii. rhabdo. Intestinal tapeworms (Taenia solium. whipworms. Central nervous system nematodes (Angiostrongylus cantonensis) Trematodes (flatworms/flukes) i. Schistosoma mansoni. Cryptosporium spp Helminths Nematodes (roundworms. Opisthorchis spp) ii. Gnathostoma spinigerum. papova. Trichuris trichiuria. Taenia saginata. Borrelia burgdorferi) Spirillum minus Rickettsia Rickettsia spp Spotted fever group Typhus group Scrub typhus group (now Orientalis) Viruses DNA viruses Group 1: double-stranded DNA (pox. Entamoeba histolytica ii. Echinococcosis (larvae of dog tapeworms Echinococcus granulosus. . Tissue/muscle nematode (Dracunculus medinensis. Naegleria fowleri Ciliates i. hookworms) i. Ancylostoma spp.198 Table 1 Basic microbiological classification of common infectious pathogens for clinicians Microbiological or Clinical Grouping Bacteria Morphologic descriptions Cocci. Clonorchis sinensis. Schistosoma intercalatum. Fasciolopsis buski. T brucei gambiense. Cysticercosis (Taenia solium larvae) b. Linguatella serrata. herpes. Blood flukes (Schistosoma haematobium. Giardia lamblia iii. Balantidium coli Sporozoans i. Schistosoma japonicum. guanine and cytosine. Plasmodium ovale) ii. Plasmodium vivax. Armillifer armillatus) iii. Intestinal tapeworm larval infections in organs: a. Treponema carateum) Leptospira spp (Leptospira icterohaemorrhagica. Trichomonas spp Ameboids i. Plasmodium spp (Plasmodium falciparum. T brucei rhodesiense. Schistosoma mekongi) iii. Enterobius vermicularis. picorna. vibrios Gram staining Gram-positive (high or low GC) Gram-negative Oxygen requirements Aerobes and anaerobes Chlamydia Chlamydia pneumoniae Chlamydia trachomatis Mycoplasma Mycoplasma pneumoniae Mycoplasma arthritidis Mycoplasma genitalium Spirochetes Treponema spp (Treponema pallidum. Diphyllobothrium latum. and Echinococcus multilocularis) Abbreviation: GC. Leptospira canicola) Borrelia spp (Borrelia recurrentis. Hymenolepis nana) ii. Marburg) Fungi Ascomycetes (sac fungi) Basidiomycetes (club fungi) Zygomycetes (mucor fungi) Phycomycetes (algal fungi) Morphology Unicellular (Candida spp. hepadna) Group II: single-stranded DNA (parvo) RNA viruses Group III: double-stranded (reo) Group IV: single-stranded (positive sense: orthomyxo. Gut nematodes (Ascaris lumbricoides. Toxoplasma gondii iv. Histoplasma spp) Multicellular (Aspergillus spp. Leishmania spp iv. toga) Group V: single-stranded (negative sense: Ebola. Treponema pertenue. Lung flukes (Paragonimus westermani) Cestodes (tapeworms) i. Microsporidium spp v. Liver flukes (Fasciola hepatica. Fusarium spp) Dimorphic (Penicillium marneffei) Parasitologic Grouping and Examples Protozoa Flagellates i. bacilli.

trypanosomiasis Helminthic: schistosomiasis. malaria. tuberculosis Helminthic: schistosomiasis Protozoal: Plasmodium falciparum Bacterial: Neisseria meningitidis and other bacterial meningitis. syphilis Protozoal: Chagas disease Helminthic: schistosomiasis Bacterial: poststreptococcal. herpes viruses Bacterial: tuberculosis. Gnathostoma. hydatidosis Viral: hepatitis A–E. blastomycosis Helminthic: paragonimiasis. A granuloma17–19 is defined as a chronic. histoplasmosis. Penicillium Protozoal: leishmaniasis Helminthic: acute schistosomiasis. usually formed as a result of an undegradable product. myiasis. tuberculosis. compact collection of inflammatory cells in which mononuclear cells predominate. in the case of tropical infectious diseases. HTLV-1. cysticercosis. Japanese encephalitis. mycoplasma pneumonia Fungal: aspergillosis. Giardia. amebiasis. Infectious diseases transmitted through medical procedures (eg. hydatid. Mycobacterium ulcerans). molecular methods. onchocerciasis. transfusion of blood . coccidia Helminthic: multiple Bacterial: leptospirosis. strongyloides hyperinfection. and these can reactivate to cause active disease when the patient becomes immunosuppressed from HIV or immunosuppressive therapy. tuberculosis Protozoal: Chagas disease. or culture to try to identify further. liver trematodes. Some of the organisms contained within the granuloma remain viable. tropical pulmonary eosinophilia Protozoal: Plasmodium falciparum Bacterial: endocarditis. larva currens Arthropods: bites and stings. polymicrobial. are classic examples. pneumococcal pneumonia. Loa loa. Angiostrongylus cantonensis. scabies. anthrax Fungal: sporotrichosis. and Chagas disease in transplant recipients. legionnaires. rheumatic fever. enteroviruses. yellow fever. leprosy. Acanthamoebae. botulism. rabies Bacterial: tropical ulcers. trypanosomiasis. leprosy. syphilis. Pathologic reports often describe the presence of a granuloma in biopsy tissue and the tissue may be processed with special stains. anaerobes Protozoal: amoebic hepatitis/abscess. gnathostomiasis Viral: HIV. tuberculosis. diphtheria Protozoal: Naegleria fowleri. trichinosis. mycetoma. Plasmodium falciparum Helminthic: cysticercosis. hydatid Hepatic Respiratory Cardiovascular Renal tract Neurologic Dermatologic Musculoskeletal Many tropical infectious diseases are characterized by chronic inflammation as the battle between the host and pathogen becomes protracted.Tropical Diseases 199 Table 2 Some examples of tropical infectious diseases by main organ system involved Main Organ System Involved Common Pathogens Gastrointestinal Bacterial: all gastroenteritides. cutaneous larva migrans. tuberculosis. examples are given in Table 4. tungiasis Pyomyositis. coccidioidomycosis. Tuberculosis in HIV-infected individuals or in those on antiTNF-a therapy. hydatid. mycobacteria (eg.

botulism. bancroftian filariasis (Wuchereria bancrofti) Arbovirus encephalitis (eg. hepatitis viruses. Chlamydia spp and Mycoplasma spp (eg. rubella. Mycobacterium xenopi). kissing. lobal pneumonia. protozoa (eg. trematodes. and C). fungal infections Sexually transmitted diseases RTIs caused by bacteria. cholera. viral. fomite contaminated by microbes Contact of skin/mucosa Direct (touching. cestodes. tuberculosis) Sexually transmitted diseases. Sicilian. West Nile virus) Yellow fever. and Naples virus infections). hepatitis A. scrombrotoxin. MRSA Boils. blood. respiratory infections. influenza. plasma. filariasis (bancroftian) Leishmaniasis (all forms). Bacillus cereus. C difficile and so forth Disease (Examples) Perinatal Vaginal/cervical contact during delivery Contact via breast milk Airborne/inhalational Inhalation of air. aerosol. cytomegalovirus. Herpes simplex. pneumonic plague. mushroom (Amanita phalloides) Infections caused by nematodes. HIV. Japanese B encephalitis. scabies. mycobacteria (eg. sex) Indirect (indirect contact with infected fomite.200 Zumla & Ustianowski Table 3 Main routes of transmission of tropical and parasitic diseases Route/Mode of Transmission Mother to child Congenital/vertical Transplacental transmission via blood TORCHES group of infections (toxoplasmosis. sexually transmitted diseases. Toscana. bacterial infections Bacterial. or pus) Ingestion Ingestion of any food or water contaminated with: Microorganisms Infections caused by bacteria (eg. mycosis. viruses. syphilis). typhoid. sandfly fever (or Pappataci 3 day fever. T brucei gambiense) Onchocerciases (river blindness) (Onchocerca volvulus) (continued on next page) . viruses (eg. stool. protozoa (Entamoeba histolytica. dysentery). Cryptosporidium spp) Staphylococcal. B. secretions. St Louis encephalitis. MRSA. Entamoeba histolytica. malaria. bartenellosis (Bartonella bacciliformis) Sleeping sickness (Trypanosoma brucei rhodesiense. fungi. Lutzomyia spp) Tsetse flies and disease transmission (Glossina spp) Black flies (Simulium spp) Malaria (all Plasmodium spp). trypanosomiases. Cryptosporidium spp) Toxins Parasite ova/cysts Insect/arthropod-borne injection through skin penetration Mosquitoes and disease transmission Anopheles spp Culicine spp Aedes spp Sandfly and disease transmission (Phlebotomus spp. body fluid.

and ingestion of contaminated meat Insect bites. HIV. hepatitis C. bacteria. endemic/murine typhus (Rickettsia typhi). louse-borne relapsing fever (Borrelia recurrentis) Plague (Yersinia pestis). Pasteurella multocida. scrub typhus (Orientia tsutsugamushi) Scabies Lyme disease (Borrelia burgdorferi). or fungal infections Fly larvae Innoculation or injection Breach of skin or mucous membrane caused by needles. Omsk hemorrhagic fever. Triatoma spp. relapsing fever (Borrelia recurrentis). rat bite fever (Spirillum minus). hepatitis B. airborne. and cat scratch disease (Bartonella henselae). actinomycosis. ingestion of contaminated meat (gastrointestinal anthrax) eg. blood transfusion. hepatitis B Multiple modes of transmission Insect bites and airborne Direct contact. Malaria: Plasmodium spp eg. Anthrax: Bacillus anthracis skin contact with animal hides (cutaneous anthrax). needles. tick typhus (Rocky Mountain spotted fever). Crimean-Congo hemorrhagic fever. tularemia (Francisella tularensis) Pediculosis Trench fever. acupuncture. bacterial infections (anaerobic and aerobic) including tetanus. dwarf tapeworm (Hymenolepis nana) Chiggers. blood transfusion . Panstrongylus spp) Direct penetration through skin Helminth larvae Helminth larvae penetration into subcutaneous tissue: swimmers itch (Schistosoma spp). ehrlichiosis (Anaplasma phagocytophilum). and congenital Skin/mucosa contact. Plague: Y pestis flea bite (bubonic plague). cupping. Capnocytophaga canimorsus eg. ear piercing. bartonellosis. Herpes spp). arboviruses (eg. needles. tularemia (Francisella tularensis). airborne (pulmonary anthrax). hookworm and roundworm larvae Fly (bots and warbles) larvae (cutaneous myiases) Viruses. tattoos. bacillary angiomatosis and endocarditis (Bartonella quintana). airborne (pneumonic plague) eg. epidemic typhus (Rickettsia prowazekii). babesiosis (Babesia microti) Chagas disease: feces of reduvid bugs with T cruzi spp are rubbed into skin by scratching) Fleas Arachnids Mites Ticks Insect feces rubbed into skin Reduvid bugs (Rhodnius spp. HIV.Tropical Diseases 201 Table 3 (continued) Route/Mode of Transmission Horse/deer flies (Chrysops spp) Lice Disease (Examples) Filariasis (Loa loa). traditional scarification via blades Animal and human bites Viruses (rabies.

and trends. Necator americanus Helminth larvae or blood-related products20 and via transplantation) can also be classified microbiologically according to the type of microorganism (Box 1). subcutaneous tissue) Granulomas (cutaneous and visceral) around dead larvae Examples Clinical Disease and Site of Granulomas Brucella spp Yersinia spp Listeria spp Spirochetes Brucella abortus. and therefore published World Health Organization data and map resources can rapidly become outdated because of the lag between data collection and publication. prevalence. which are updated on a regular basis. The incidence and prevalence of each disease varies with time. GEOGRAPHIC DISTRIBUTION OF TROPICAL DISEASES There are geographic differences in the distribution and intensity of tropical infectious diseases and knowledge of these in relation to travel history or country of origin may increase the likelihood of making an accurate and rapid diagnosis.202 Zumla & Ustianowski Table 4 Infectious causes of granulomas Class of Organism Bacteria Mycobacteria spp Mycobacterium Mycobacterium Mycobacterium Mycobacterium Mycobacterium tuberculosis leprae kansasii marinum bovis Tuberculosis (any organ) Leprosy (skin and nerves) Pneumonia (lung) Fish tank granuloma (skin) BCGiosis (skin) Brucellosis (any organ) Plague (skin. The Global Health Observatory (GHO)21 is a unique and useful service providing a gallery of global maps illustrating the prevalence of an extensive list of major health topics including tropical diseases. bile duct) Granuloma around cysticerci (muscle. database views. Brucella mellitensis. publications. and links to relevant Web pages. liver) Granulomas (any organ) Granulomas (liver. Each theme page provides information on the global situation. Opisthorchis spp Clonorchis sinensis Taenia solium Ascaris lumbricoides. Ancylostoma spp. The GHO also issues analytical reports . using core indicators. spleen. Brucella suis Y pestis Listeria monocytogenes Treponema pallidum Treponema carateum Histoplasma capsulatum Coccidioides immitis Aspergillus fumigatus Cryptococcus neoformans Toxoplasma gondii Leishmania spp Fungi Protozoa Helminth ova/larvae Trematodes Cestodes Schistosoma spp Fasciola spp. lung) Listerioses (brain) Primary syphilis (skin) Yaws (skin/mucous membranes) Histoplasmosis (any organ) Cocciodomycoses (any organ) Pulmonary aspergillosis (lung) Cryptococcosis (any organ) Toxoplasmosis (eye or brain) Leishmaniases (skin. mucous membranes. including all major infectious and parasitic diseases. brain. These maps are classified by disease themes.

Pseudomonas spp. Brucella spp) Spirochetes Spirochetes (eg. Staphylococcus spp. cytomegalovirus Kaposi sarcoma herpesvirus (HHV-8) Parvovirus West Nile virus Severe acute respiratory syndrome Bacteria Gram-negative bacteria (eg. immunoglobulin. or plasma) Parasites Plasmodium spp Babesia microti ssp Trypanosma cruzi Trypanosoma brucei ssp Leishmania donovani Toxoplasma gondii Viruses HIV-1. HIV-2 Human T-lymphotropic virus (HTLV) type I. and sole reliance on such sources for specialist tropical medicine information does not usually suffice. clotting factors. which compiles statistics for key health indicators and also includes a brief report on progress toward health-related Millennium Development Goals. as with all clinical specialties. A key output of the GHO is the annual publication World Health Statistics. Borrelia burgdorferi) Ehrlichia Fungi Candida spp Other New variant Creutzfeldt-Jakob disease prion on the current situation and trends for priority health issues. Treponema pallidum.Tropical Diseases 203 Box 1 Classification of infections related to transfusion (of blood. C. Salmonella spp) Gram-positive bacteria (eg. B. tend to be distributed throughout the general medical and scientific literature. Advances in tropical medicine. Streptococcus spp. D. SOURCES OF LITERATURE ON TROPICAL DISEASES Ongoing research and surveillance continues to yield new information. In addition. HTLV type II Hepatitis A. E Epstein B virus. platelet. Yersinia spp. the GHO provides analytical reports on cross-cutting topics such as the report on women and health and burden of disease. There are several major textbooks focusing on clinical and laboratory aspects of tropical and parasitic . Leptospira spp.

increasingly. p. ISBN: 9780199204090. Pandemic planning in China: applying lessons from severe acute respiratory syndrome. McCarthy M. 2011. are now available online. . 16. Weller PF. 2. ISBN: 9781405180481. Wag DH. 2008 (NLM classification: W 74). Cost of illness. Mortality .1111/j. This issue of Infectious Diseases Clinics of North America on tropical diseases covers the epidemiologic. Guerrant R. BMJ 1988. The Global Surveillance Network of the ISTM and CDC. Many traditional print resources. editors. 2011. 10.1–3 The information they contain is comprehensive.aetiology and classification. 9. Manson’s tropical diseases. Munoz P.org/geosentinel/main. 22nd edition. A worldwide communications and data collection network of travel/tropical medicine clinics. vol. books. et al. EuroTravNet 2009. 2001.14690691. Zumla A. 3rd edition.2011. New York: Elsevier Saunders.24(2):461–95. 2012.78(8):995–1004. I. Oxford University Press. editors. WHO Report 2008. Clin Infect Dis 1996. 402. and management aspects of most of the common tropical infectious and parasitic diseases that may present to the physician in the west. London: Elsevier Saunders. Emerging respiratory infections of the 21st century.statistics. 12. The Global Burden of Disease 2004 update: 1. Infectious Diseases Clinics of North America.html. databases. Steffen R. Brent A. Davidson R. et al. 5. Hui D. 17. Mabey D. World Health Organization. 4th edition. Principles. 15. Yew WW. James DG. Zumla A. Clin Microbiol Infect 2011. 3.x. 3rd edition. London: Saunders. 4. DOI: 10. Curr Opin Pulm Med 2010. 2008.22 It is important that any comprehensive search encompasses general and specialist sources. but some details may become outdated rapidly because of new developments. Valerio M. Cambridge (UK): Cambridge University Press. Respirology 2008. Zumla A. Geneva: World Health Organization. Infect Dis Clin North Am 2010. Tropical infectious diseases. et al. ˜ 11. Hunters tropical medicine and emerging infectious diseases. Oxford handbook of tropical medicine. Emerging respiratory infections of the 20th century.istm. and poisoning are also described to emphasize that not all tropical diseases are caused by microorganisms.204 Zumla & Ustianowski diseases.03596. and readers are advised to look up more current sources of literature on each subject area. Issue 3. p. REFERENCES 1.16:165–7. Parola P. Cocksedge W. and. pathogens and practice. Why aircraft disinsection? Bull World Health Organ 2000. books. Gill G. Zeng GQ. 7. Available at: http://www. 24. Accessed September 26. 843. Diseases caused by venomous bites. Whitty C. World health .13(Suppl 1):S33–5. Cook GC. Principles of medicine in Africa. 6. et al. editors. Garrity GM. Beeching NJ. 2009. Parasitic infections in solid organ transplant recipients. Puga D. 2000. 2010. indexes. 14. London (UK): Springer. Zhong NS. clinical. 2009. Granulomatous infections .297:1355–6. Zumla A.trends. 3. Lecture notes in tropical medicine. editors. Travel-related imported infections in Europe. Gratz NG. Gill GV. Castenholz RW. such as journals. laboratory. Blackwell Publishing. and Web sites. Bergey’s manual of systematic bacteriology. 2. 13. stings. 8. Gkrania-Klotsas E. p. DF-2 infection (may follow dog bites and hazardous to the immunosuppressed). Odolini S.23:1–13. editors. including journals. 1830. Eddleston M. Zumla A. Boone DR. 2nd edition.

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