Exotic infections and infestations

Abstract

A disease that is exotic (‘introduced from abroad’, to quote a contemporary dictionary) in the experience of a pathologist working in any one part of the world is not necessarily exotic in the experience of colleagues who work elsewhere. In the context of this paper “exotic disease’ refers primarily to diseases that do not occur naturally in Britain: if this seems a parochial approach it merely reflects the parochial role of the laboratories in which the investigations that led, sometimes fortuitously, to the diagnosis, were carried out. The paper comprises short accounts of cases that, because the diseases are exotic, caused diagnostic perplexity or confusion. Some of the diseases are as ‘exotic’ in medical practice in much or all of Australasia as they are in Britain and other parts of Europe: it is hoped that a summary of the illnesses and of the steps to diagnosis may be as interesting in the context of an annual meeting of the Royal College of Pathologists of Australasia as the original investigations were in the practice of pathology laboratories in England. The approach in this paper being primarily histological some important infections-- Lassa fever, for instance--are not considered. The cases include bacterial infections, mycoses, protozoal infections and metazoal infestations, singly or in combination. Granuloma inguinale (‘donovaniosis”), leprosy and scleroma, blastomycoses, coccidioidomycosis. histoplasmosis, mycetomas and rhinospondiosis. leishmaniasis, malaria and trypanosomiasis, infestation by Fasciola giguntiea , filariasis. myiasis, onchocerciasis, porocephaliasis, schistosomiasis and strongyloidiasis are among the diseases of known causation; to these are added ‘Wewak disease’ (‘sago palm granuloma’) and other infections by unidentified organisms. The patients were seen in general hospitals in Britain during the 1970s. The variety of these diseases reflects the great increase in international travel since the war of 1939-45. Tourists and refugees, business people and students come to our lands from abroad, bringing diagnostic problems. We also travel, and may return infected from parts of the world—and perhaps beyond it—that harbour diseases outwith our locally acquired experience. We should know about these diseases that we call exotic.