Awareness and perceptions of medical students and doctors regarding Tropical Medicine education and training in Europe: An international, online-based survey.

BACKGROUND: Multifactorial health determinants and shifts in global patterns of disease increase the need for Tropical Medicine training across Europe. A survey of university and postgraduate opportunities in Europe was conducted to identify and analyse gaps. METHOD: An online survey was circulated to medical students and doctors in Europe between April and June 2021. Significance tests and a thematic analysis of the data were conducted. RESULTS: 500 respondents (285 students and 215 doctors) from 27 countries were included. 17.2% of doctors were unsure whether postgraduate training in Tropical Medicine was available in their country. 20% of students and 10.7% of doctors said they were unsure whether they had been taught Tropical Medicine during university. 67.7% of students and 79.1% of doctors stated that the amount of Tropical Medicine training they encountered was or had been "not enough". CONCLUSIONS: Respondents demonstrated great interest in Tropical Medicine. Their self-reported knowledge, awareness, and perceived competence were partly dependent on whether there is specific teaching accessible at the university. Postgraduate training options were available in some countries but not all respondents were aware of these. There is a pressing need for harmonized curricula and expanded postgraduate training to improve Tropical Medicine competencies across Europe.

Double trouble: visceral leishmaniasis in twins after traveling to Tuscany - a case report.

BACKGROUND: Leishmaniasis is endemic in many countries worldwide, with a prevalence of 12 million people infected, and an estimated annual incidence of 500 000 visceral leishmaniasis cases. In Europe visceral leishmaniasis is considered endemic mainly in the Mediterranean countries and cases in non-endemic European countries north of the Alps have primarily been reported in returning travellers. The incubation period is typically described between 6 weeks to 6 months. The cases presented highlight the occurrence of longer incubation periods and illustrate the individual variability for progression from infection to disease. CASE PRESENTATION: We report the cases of 18-months-old twin girls living at the German-Swiss border, who developed visceral leishmaniasis 7 and 15 months after travelling to Tuscany. They presented with fever of unknown origin and pancytopenia. Both had splenomegaly and in the first case haemophagocytic lymphohistiocytosis or leukaemia was initially included in the differential diagnosis. Diagnosis of visceral leishmaniasis was confirmed by presence of intracytoplasmic localised leishmania parasites on bone marrow aspirate and/or positive leishmania serology. Both girls responded well to treatment with liposomal amphotericin B. The mother and two older siblings remained uninfected, while the father was diagnosed to be an asymptomatic carrier. CONCLUSION: Visceral leishmaniasis is an important differential diagnosis for fever of unknown origin and pancytopenia in young children living in countries with endemic disease and highlights the importance of obtaining a detailed travel history. Hemophagocytic lymphohistiocytosis and acute leukaemia present with similar symptoms and consequently are important differential diagnoses. Factors determining progression from infection to disease are not fully understood but younger age seems to be an important risk factor. Screening of siblings from affected individuals therefore may be warranted.