Radiological Diagnoses in the Context of Emigration: Infectious diseases

Abstract

Background Globalization and emigration impact on the spectrum of diseases challenging health care systems. Medical practitioners have to particularly prepare for infectious diseases. Methods The database of a health care center specialized on tropical medicine was screened for patients with history of migration and one of the following diagnoses: Cystic echinococcosis, tuberculosis, schistosomiasis, visceral leishmaniosis, and neurocysticercosis. Representative casuistics were prepared from select case histories. Radiological pertinent knowledge was compiled based on literature search. Results A small selection of frequently imported infectious diseases covers a considerable fraction of health care problems associated with migration. For cystic echinococcosis, schistosomiasis, and neurocysticercosis imaging is the most relevant diagnostic procedure defining also disease stages. Tuberculosis and visceral leishmaniosis are important differentials for malignant diseases. Conclusion Imaging plays a meaningful role in diagnosis, treatment stratification, and follow-up of imported infectious diseases. Radiological skills concerning these diseases are important for providing health care for patients in context of migration. Key Points Citation Format

Multiple Nodular Lesions in Spleen and Liver in Visceral Leishmaniasis

“…We described the clinical, laboratory and radiological features of 10 cases with VL, which is sporadic in our region. Generally, there is a long duration from symptom onset until the diagnosis of VL like in our series (6,14,15). We found that the mean duration between symptom onset and diagnosis was long, with over 60 days.…”

“…The diagnosis of VL can be frequently difficult due to the long incubation period and non-specific symptoms (1,7). In sporadic regions, VL is not number one in the differential diagnosis list and specific diagnostic tests, such as detection of amastigotes in BM smears and serological tests may not be positive in the early period of the disease (6,7). Although the serological tests were positive in all patients presented here, there was a delay…”

“…Ultrasonography, CT and MRI detect multiple hypoechoic/hypodense nodules in the spleen. However, these images are non-specific and can be detected in septic emboli or abscesses, splenic infarction, metastatic disease, lymphoma, and granulomatous inflammatory diseases such as mycobacterial, fungal infections, cat-scratch disease, and sarcoidosis, as well as VL (6,(8)(9)(10)16). Most of our patients (7/10 patients) had multiple hypodense nodules in the spleen in which the parenchyma was usually homogeneous.…”

“…In newly endemic areas or in regions where sporadic cases have been reported, VL can be misdiagnosed leading to a significant delay in treatment (5). Over time mortality of VL increases if it is not treated (6). Therefore, early diagnosis is critical for the survival of VL cases.…”

“…Abdominal imaging is frequently performed in patients with prolonged fever, pancytopenia, and hepatosplenomegaly. Although radiological signs of VL are non-specific, many patients with VL had pronounced hepatosplenomegaly and intraabdominal lymphadenopathy (6). Additionally, recent reports state that multiple hypodense nodules in the spleen are present which are superimposed to homogeneous parenchyma in abdominal computed tomography (CT) or magnetic resonance imaging (MRI) (6)(7)(8)(9)(10).…”