Chagas disease in the United Kingdom: A review of cases at the Hospital for Tropical Diseases London 1995-2018. The current state of detection of Chagas disease in the UK.

BACKGROUND: Chagas disease (CD), is a parasitic disease endemic in Latin America. Presentation in non-endemic areas is either in the asymptomatic indeterminate phase or the chronic phase with cardiac and/or gastrointestinal complications. METHODS: The Hospital for Tropical Diseases (HTD) based in central London, provides tertiary care for the management of CD. We reviewed all cases managed at this centre between 1995 and 2018. RESULTS: Sixty patients with serologically proven CD were identified. Most were female (70%), with a median age at diagnosis of 41 years. Three quarters of the patients were originally from Bolivia. 62% of all patients were referred to the HTD by their GP. Nearly half of the patients were asymptomatic (47%). Twelve patients had signs of cardiac involvement secondary to CD. Evidence of gastrointestinal damage was established in three patients. Treatment was provided at HTD for 31 patients (47%). Most patients (29) received benznidazole, five of them did not tolerate the course and were switched to nifurtimox. Of the seven patients receiving this second line drug, five completed treatment, whilst two interrupted it due to side effects. CONCLUSIONS: Despite the UK health system having all the resources required to diagnose, treat and follow up cases, there is lack of awareness of CD, such that the vast majority of cases remain undiagnosed and therefore do not receive treatment. We propose key interventions to improve the detection and management of this condition in the UK, especially in pregnant women and neonates.

The prevalence and association with health-related quality of life of tungiasis and scabies in schoolchildren in southern Ethiopia.

BACKGROUND: The prevalence of skin disease in low and middle income countries is high and communicable skin diseases are a significant public health problem. Tungiasis is an ectoparasite infestation caused by the flea Tunga penetrans, which has a widespread geographical distribution. Tungiasis causes painful skin lesions and may affect activities of daily living. OBJECTIVE: We wished to determine the prevalence and impact of tungiasis and scabies in schoolchildren in southern Ethiopia. METHODS: A cross-sectional study was performed in which students were examined by dermatologists and the skin disorders recorded. Individuals with pyogenic skin infections, scabies and tungiasis were also invited to complete the Children's Dermatology Life Quality Index. RESULTS: There was a high burden of skin disease amongst this cohort with more than 40% having an ectodermal parasitic skin disease. The majority of these were due to tungiasis. Tungiasis was evident in more than a third of children and was associated with onychodystophy. There was a significant association between wearing "closed" footwear and a greater number of tungiasis lesions but not tungiasis per se. Dermatophyte infections, acne and plantar maceration secondary to occlusive footwear were also common. Scabies and tungiasis appeared to have a significant negative effect on quality of life. CONCLUSION: Tungiasis is highly prevalent in schoolchildren in the part of Ethiopia where the study was conducted and is associated with a deleterious effect on quality of life. The role of footwear in both preventing and possibly exacerbating cutaneous ailments in this setting requires further study.

Correlation of multimodality imaging in Paget's disease of bone.

PURPOSE: The aim of this study is double: 1. to review the known and less known radiographic patterns of Paget's disease of bone, employing the most recent imaging techniques; 2. to propose a rationale algorithm for the diagnosis and management of the disease. considering its inconsistency and clinical variability. MATERIALS AND METHODS: Forty-eight patients with Paget's disease of bone (30 males and 18 females, aged 45 and 88 years, mean age 71) were examined in the period 1999-2003. The patients were classified into two groups: symptomatic and asymptomatic. The first group, comprising 32 patients with generic ''low back pain'' with or without sciatica, or ''coxarthritis'' underwent conventional radiography. In the second group (16 patients), bone disease was discovered in course of radiological and/or scintigraphic examinations performed for other conditions. Subsequently, all the patients completed the diagnostic algorithm, consisting of radiographs of the remaining skeletal areas and those segments with abnormal scintigraphic uptake. RESULTS: Monostotic Paget's disease was observed in 31 cases (64.6%), of whom 20 males (64.6%) and 11 females (35.4%), whereas polyostotic disease was found in 17 cases (35.4%), of whom 10 males (58.8%) and 7 females (41.2%). The sites most frequently affected in the monostotic form were: pelvis, 13 cases (43.3%); femur, 5 cases (16.7%); lumbar spine, 5 cases (16.7%); humerus, 2 cases (6.7%); tibia, 2 cases (6.7%); dorsal spine, skull, radius, patella, 1 case respectively (3.3%). In the polyostotic disease (17 cases), the affected bones were predominantly the skull, vertebral spine and pelvis (see text for their variable association). Pathologic fractures of the femur were found in two males. Osteogenic sarcoma (histological diagnosis) developed in the proximal femur in a 81 year-old male. CONCLUSIONS: Paget's disease is asymptomatic in the majority of affected individuals, and may be discovered incidentally with diagnosis being made on routine radiographs obtained for other purposes. Sometimes the x-ray features are so typical that the diagnosis is straightforward. Bone scan should be the imaging technique of choice, because tracer uptake is directly related to degree of activity of disease, and it may advance any radiographic evidence. Vertebral involvement is better evaluated by CT. Both CT and MRI are recommended in spine complications (pathological fractures, radicular or cord compression syndromes, malignant degeneration).