Clinical Review

Recent advances

Tropical medicine

BMJ 2000; 320 doi: 10.1136/bmj.320.7233.490 (Published 19 February 2000)
Cite this as: BMJ 2000;320:490

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  1. Henry W Murray, professor (hwmurray@mail.med.cornell.edu)a,
  2. Jacques Pépin, associate professor of medicineb,
  3. Thomas B Nutman, headc,
  4. Stephen L Hoffman, director, malaria programmed,
  5. Adel A F Mahmoud, presidente
  1. aDepartment of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA
  2. bCentre for International Health, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
  3. cHelminth Immunology Section and Clinical Parasitology Unit,Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, MD 20892, USA
  4. dNaval Medical Research Center, Rockville, MD 20852, USA
  5. eMerck Vaccines, Whitehouse Station, NJ 08889, USA
  1. Correspondence to: H W Murray

    Considerable progress has been made towards three key objectives in tropical infectious diseases in recent years: a clearer understanding of basic microbiology, pathogenesis, and host defence; expanded epidemiology; and new approaches to overall clinical management. However, problems have also emerged. Development of vaccines has been slow or non-existent, the efficacy of conventional treatment has fallen, HIV has affected the course of some diseases,1 the cost of some new drugs has prohibited their use, and drug development for tropical diseases has fallen.2 Inadequate vector control; poor nutrition, sanitation, and drinking water; civil war; and bare bones health budgets continue to present obstacles to preventing and controlling epidemics.2 3

    This report highlights the current state of and recent advances made in diagnosis, treatment, and prevention in five tropical infections:African trypanosomiasis, leishmaniasis, lymphatic filariasis, malaria, and schistosomiasis. We have focused on these diseases because of their high level morbidity or mortality.2 Although we have discussed only clinical management, experimental work in research laboratories continues to drive these clinical advances.4

    Methods

    This article is based on the hands-on clinical and laboratory research knowledge of the authors, who are experts in the diseases discussed. HWM wrote the section on leishmaniasis, JP the section on African trypanosomiasis, TBN the section on lymphatic filariasis, SLH the section on malaria, and AAFM the section on schistosomiasis. Personal knowledge was supplemented by review of relevant recent literature.

    Recent advances

    In Central Africa, Gambian sleeping sickness has surged dramatically

    New drug development in African trypanosomiasis is impossible for commercial reasons; priority should be given to improving the use of old drugs

    Vaccine testing is under way in cutaneous and visceral leishmaniasis, and short-course parenteral and oral treatment alternatives to pentavalent antimony are now available

    Widespread annual distribution of single-dose combinations of albendazole plus either diethylcarbamazine or ivermectin may …

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