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NEWS: Peter Moszynski UK doctors increasingly likely to encounter tropical diseases, symposium told BMJ 2008; 336: 1039-c [Full text]

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The Art and science of treating tropical infections

Muthukrishnan J   (14 May 2008)

The Art and science of treating tropical infections 14 May 2008
Muthukrishnan J, Senior resident Endocrinology Medwin Hospital, Hyderabad, India-500001 Send response to journal: Re: The Art and science of treating tropical infections	The article emphasizes the need for UK physicians to know about tropical illnesses as many natives travel to these regions and import bugs with them. What has not been highlighted is the large influx of immigrants from tropics who may manifest these infections after settling down in UK. These immigrants would behave differently from British people with the same infections because of innate immunity developed against these infections in the immigrants. Immune response established over years of stay in endemic areas in these people may modify the clinical picture and microbiological evaluation may often turn out to be negative for the causative organism of the infection. Hence, to be strict about the presence of typical clinical features and positive microbiological cultures for establishing diagnosis before starting definitive antimicrobial treatment may not be the right approach. Having high index of suspicion for such infections, giving greater relevance to clinical data available and instituting empirical antimicrobials when in dilemma, without delaying treatment can save lives. It is highly recommended that when you are treating an immigrant from the tropics, you must think and behave like a physician from the tropics.In the process, frequently the science of evidence based medicine and established management guidelines may need to give place to the art of clinical suspicion, instincts and empirical approach. Competing interests: None declared