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From 'break-bone Fever' To An Eye-bleeding Disease – The 9 Tropical Diseases You Can Catch In EUROPE This Summer

THE list of possible threats you might expect to come across on your summer holiday to Europe has, until now, been rather short.

Beyond expected airport delays, eating your body weight in carbs and getting a bit sunburnt - there isn't usually too much to worry about.

Where new disease-ridden critters have become established in Europe

But as temperatures rise in our favourite holiday destinations, there may be a new - and buzzier - risk on the horizon.

A range of disease-ridden insects have made their way to north Europe, from places like Africa, Asia and Central and South America.

Three different types of disease-riddled mosquito, three types of infection-prone ticks and one nasty fly species are 'established' in several European countries, according to the most recent annual report by the European Centre for Disease Prevention and Control (ECDC).

Prof Francois Balloux of the University College of London Genetics Institute warns we're likely to see more of these infections in parts of Europe as the climate becomes "more suitable".

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When an insect is 'established' this means they have developed a self-sustaining population that is reproducing.

Just because an insect is established somewhere, it does not mean the disease itself is endemic as not every insect will carry the disease.

Here, we look at nine different diseases you could catch from bugs that are residing in Europe...

1. Chikungunya virus

Spread by : Aedes invasive mosquitoes

Countries where bug is established: Italy, France, Spain, Portugal, Greece, Cyprus, Croatia, Serbia, Montenegro, Bosnia and Herzegovina, Albania, North Macedonia, Romania, Bulgaria Turkey and Madeira (Portugal).

Chikungunya is a virus spread by two different aedes invasive mosquitoes: Aedes and albopictus.

The disease name means "to become contorted" in the African Kimakonde language, as it causes severe muscle and joint pain.

Other symptoms include sudden fever, headache, fatigue, rash, nausea and red eyes.

Most victims will recover within a few weeks, but in some cases, the joint pain may persist for weeks, months or even longer.

It's usually found in tropical areas like central and South America, Asia and Africa, but the mosquito has made its way to warm parts of Europe.

Last month, one person tested positive for the bug in Paris days ahead of the Olympics.

Most cases in Europe have come from people travelling to places where the disease is endemic.

2. Crimean Congo haemorrhagic fever

Spread by: Hyalomma tick

Countries where bug is established: Spain, Bulgaria and Greece.

Crimean-Congo hemorrhagic fever is a tick-borne virus that can cause severe bleeding and high fever.

It's not very common, but it has been cropping up in Europe.

If someone gets infected, they might start suffering from flu-like symptoms before this progresses to severe bleeding from the eyes and organ failure.

It kills up to 40 per cent of infected people, according to the World Health Organisation (WHO).

In July, British scientists warned the disease could be expanding out of its usual territories and moving towards the UK and France due to climate change.

Ticks bury into the skinCredit: Alamy 3. Dengue virus

Spread by: Aedes invasive mosquitoes

Dengue - also called 'breakbone fever' because of the severe muscle and joint pain it can trigger - is becoming more common in Europe.

It is spread by the Aedes invasive mosquitoes, specifically the aegypti type - also known as the tiger mosquito.

Over the past two years, a record number of cases of dengue were detected in several countries across the continent, including France, Italy and Spain.

The most common symptoms are a high fever, headache and body aches.

About one in 10 of those infected will develop severe dengue, which can result in shock, internal bleeding, and even death.

Last year, the UK government installed additional mosquito traps at ports, service stations, and truck stops throughout south England to counter the growing spread of dengue fever.

4. Leishmaniasis

Spread by: Phlebotomine sand flies

Countries where bug is established: Spain, Italy, Greece and Portugal.

Leishmaniasis is a disease you can get from the bite of an infected sandfly.

It's common in the rainforests, deserts, and urban areas of the Americas, Asia, Africa - and in more recent decades, Europe.

However, a recent survey by the ECDC revealed that isn't mandatory in many European countries to report cases.

This means it is hard to get a true picture of how many countries the disease-carrying flies are established.

It can cause sores on the skin that may develop into painful ulcers.

In some cases, these ulcers can develop in the nose, mouth and throat, causing wounds that can permanently disfigure the patient.

The most serious form of the disease affects internal organs such as the liver and spleen, causing fever, weight loss and anaemia.

If not treated in time, it can cause death.

5. Lyme disease

Spread by: European deer tick (Ixodes ricinus)

Countries where bug is established: United Kingdom, Ireland, France, Germany, Netherlands, Belgium, Luxembourg, Switzerland, Austria, Italy, Spain, Portugal, Greece, Cyprus, Turkey, Poland, Czech Republic, Slovakia, Hungary, Romania, Bulgaria, Serbia, Croatia, Slovenia, Bosnia and Herzegovina, Montenegro, Albania, and North Macedonia.

A bite from tiny ticks, usually found in grassy areas, can result in debilitating Lyme disease.

This is a bacterial infection that is passed on to humans from infected ticks - usually European deer ticks.

Symptoms of Lyme disease include a circular or oval rash around the bite area, as well as fatigue and flu-like symptoms.

In most cases, Lyme disease can be effectively treated with a course of antibiotics.

However, if left untreated, the infection can spread to the heart, joints and nervous system.

Bella Hadid suffered an excruciating 15-year battle with the disease, which she often shared moments of on her social media.

The supermodel, 27, was diagnosed with the condition in 2012 but was struggling with debilitating symptoms long before.

Bugs carrying the disease are mainly located in central Europe, including Austria, Switzerland and Spain.

However, in the last years, there has been a spread of infected ticks northbound, towards Scandinavia and the UK.

How to prevent tick bites - and remove the bugs

There are a few things you can do to lessen your likelihood of tick bites.

Firstly, try and cover as much of your skin as possible while walking outdoors and tuck your trousers into your socks.

You should also be using insect repellent containing DEET on your clothes and skin, and wearing light coloured clothing so you can spot a tick easily.

Also stick to paths where possible when you're out walking.

How can I remove a tick safely?

To remove a tick safely:

Use fine-tipped tweezers or a tick-removal tool. You can buy these from some pharmacies, vets and pet shops.

Grasp the tick as close to the skin as possible.

Slowly pull upwards, taking care not to squeeze or crush the tick. Dispose of it when you have removed it.

Clean the bite with antiseptic or soap and water.

The chance of getting ill is low. You do not need to do anything else unless you notice a rash or become unwell.

If either of these happen, make sure to see a GP so you can get treatment as soon a possible.

6. Malaria

Spread by: Anopheles mosquitoes

Countries where bug is established: Spain, Portugal, Italy, Greece, Cyprus.

Malaria is an infection caused by a tiny, blood-borne parasite, transmitted by the bites of infected female Anopheles mosquitoes.

It's known as the most deadly mosquito-borne disease on the planet.

Most cases you hear about are from people who catch it while travelling to places where malaria is more common, like Africa or parts of Asia.

Anopheles are present in certain parts of Europe, but, at present do not carry the disease.

However, there have been some cases of local transmission in Europe, when a mosquito becomes infected by a human or 'imported case', and then bites someone in the area.

There are concerns incidents of malaria could also spike on the continent in the future, if conditions are right.

A feeding female Anopheles Stephensi mosquitoCredit: AP 7. Tick-borne encephalitis

Spread by: European deer tick (Ixodes ricinus) and the Siberian tick (Ixodes persulcatus)

Countries where bug is established: European deer tick - United Kingdom, Ireland, France, Germany, Netherlands, Belgium, Luxembourg, Switzerland, Austria, Italy, Spain, Portugal, Greece, Cyprus, Turkey, Poland, Czech Republic, Slovakia, Hungary, Romania, Bulgaria, Serbia, Croatia, Slovenia, Bosnia and Herzegovina, Montenegro, Albania, and North Macedonia.

Siberian tick - Estonia, Latvia, Lithuania, Finland, Sweden (northern parts).

Tick-borne encephalitis is a virus that both the European deer and Siberian tick can carry, and it's something to watch out for in certain parts of Europe.

Most people who catch the virus will have no or only mild flu-like symptoms.

However, the bug can progress to affect the brain and central nervous system and can sometimes be fatal.

The disease-carrying critters, mostly found in long grass or woodland areas, were traditionally only found in central and Eastern Europe.

Nowadays, the virus is also reported in areas of Northern Europe not previously thought to be infected, including the UK.

8. West Nile virus

Spread by: Culex mosquitoes

Countries where bug is established: Spain, Portugal, France, Italy, Greece, Cyprus, Bulgaria, Romania, Serbia, Croatia, Hungary, and Turkey.

West Nile virus is transmitted to humans through Culex mosquitoes that feed on infected birds, which are natural reservoirs for the disease.

Typically, the infection is found in Africa, the Middle East, and parts of Asia.

A few decades ago, the disease made its way to Europe - but only more recently have we seen a rise in cases.

Throughout 2023, 713 locally acquired human cases of the West Nile virus were detected in 123 different regions of nine EU countries, the ECDC said.

Roughly one in five people will develop symptoms, including headache, joint pains, and a rash.

And one per cent will develop severe illness including two brain swelling conditions called encephalitis or meningitis - both of which can be fatal.

9. Zika Virus

Spread by: Aedes invasive mosquitoes

Zika is generally a mild virus, causing a fever, rash or headache - although most people infected will never develop symptoms.

But the disease is dangerous for pregnant women because it can lead to premature births, miscarriages and birth defects - including microcephaly, which affected some 2,000 children in Brazil.

There is also an increased risk of neurological complications, including Guillain-Barré syndrome.

What can I do to prevent mosquito bites?

The Fit for Travel website says if you are travelling to an area affected by diseases such as malaria, dengue fever and yellow fever, spread by mosquitoes, you should take action to protect yourself.

Some mosquitoes are more active in the day time while others at night - so it is important to protect yourself at all times.

It says: "If you develop a high temperature (fever) either during or after travelling to an affected area, you should seek medical advice as soon as possible and give details of your recent travel history."

To protect yourself:

Use a good quality insect repellent

The higher the strength, the longer the repellent should prevent mosquitoes landing on you.

An effective repellent contains at least one of; DEET (50% concentration for areas where there is malaria), Icaradin/Picardin (at least 20% concentration, Eucalyptus citriodora oil, hydrated, cyclized (at least 30% concentration), IR3535 (but not for malaria areas).

Apply:

On all areas of skin not covered by clothes

After sun screen

Regularly, particularly if you notice mosquitoes around you

After swimming, washing or excessive sweating

On the face, by spraying the repellent on the hands first

Loose clothing

Mosquitoes can bite through tight clothing, so loose-fitted clothing is ideal.

Consider a high neckline, long sleeves, long trousers and socks.

Remember to apply insect repellent on areas not clothed.

Mosquito nets

Mosquito nets can protect you at night when sleeping and are even better if treated with insecticide.

Check for any holes in the net before using it. If a hole is apparent, then this should be mended.

You should tuck the net under your mattress or ground sheet during the night, and either collapse it down, or keep it tucked up during the day to stop insects flying under and into the net.

Breakthrough In Bid To Develop Vaccines And Drugs For Neglected Tropical Disease

Scientists have developed a new, safe and effective way to infect volunteers with the parasite that causes leishmaniasis and measure the body's immune response, bringing a vaccine for the neglected tropical disease a step closer.

The breakthrough, by a team from the University of York and Hull York Medical School, is described in the journal Nature Medicine and lays the foundations for vaccine development and for testing new preventative measures.

Controlled human infection studies, where volunteers are exposed to small amounts of the microbes that cause disease, play a vital role in allowing scientists to provide evidence of the safety and efficacy of new vaccines, but their use in the fight against neglected tropical diseases has been limited.

Leishmaniasis is caused by infection with microscopic Leishmania parasites that are transmitted into the skin during the bite of an infected sand fly.

The disease affects over one million people every year, the majority developing a slow to heal ulcer at the site of the infection. Though the ulcer eventually heals, the scar has a significant impact on quality of life, especially for women and children and when the infection is on the face.

No vaccines or drugs are currently available to prevent people from becoming infected with leishmaniasis, in part due to the difficulties and costs associated with conducting clinical trials in the countries where these diseases are most common.

Lead investigator, Professor Paul Kaye from the Hull York Medical School at the University of York, said: "This is a landmark study that now provides a new approach to test vaccines and preventative measures for leishmaniasis in a rapid and cost-effective way. It also allows us to learn more about how our immune system fights the infection. Thanks to the generosity of the volunteers that took part in our study, we are now well-positioned to bring new hope to those that are affected by this disease."

Clinical lead for the study, Professor Alison Layton from the Medical School's Centre for Skin Research, said: "Research on skin diseases that affect people in the UK and in developing countries is a priority at the Medical School. This study, which demonstrates that this infection model is safe and well tolerated by participants, exemplifies our global approach to skin health and has the potential to impact the lives of many millions worldwide."

The study, which builds on significant achievements by the University of York and its international partners, involved 14 volunteers recruited from around York.

The volunteers were exposed to sand flies infected with a parasite species that causes one of the mildest forms of leishmaniasis. The researchers followed the development of the lesion at the site of the sand fly bite to evaluate the progress of the infection and then terminated the infection by biopsy of the skin. The scientists then studied the biopsy to examine the immune responses at the site of infection.

This major new approach uses natural transmission by sand fly to initiate infection and state of the art technologies, allowing the researchers to track the infection and the body's immune response in real-time.

The model will accelerate efforts to test new vaccines and understand how immunity to infection arises, the researchers say.

The researchers now hope to use their model to design clinical trials to test a vaccine developed at Hull York Medical School, along with other candidate vaccines available in the future. Controlled human infection models have already been used to support the development of vaccines for cholera, malaria, influenza, dengue fever and most recently COVID-19.

The research was a collaboration between the Hull York Medical School, York and Scarborough Teaching Hospitals NHS Trust, the Department of Parasitology at Charles University in Prague, the Center for Geographic Medicine and Tropical Diseases at Chaim Sheba Medical Center, Tel Aviv University and the Kuvin Centre for Study of Tropical & Infectious Diseases, Hebrew University-Hadassah Medical School, Jerusalem.

Funding for the research was through a Developmental Pathways Funding Scheme award from the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 program supported by the European Union.

Is There An Emerging Threat Of Drug-resistant Fungal Infections? The Jock Itch Case Study

The rise of drug-resistant fungal infections, notably Trichophyton indotineae, is emerging as a significant health concern in India. This resilient dermatophyte, linked to the misuse of topical steroids, poses challenges for both patients and healthcare providers.

Imagine battling a skin infection that refuses to heal despite multiple treatments. This is the reality for many who face infections caused by Trichophyton indotineae, commonly known as ringworm or jock itch. First identified in India, this fungus has now spread to several countries worldwide. The inappropriate use of steroid creams has exacerbated the problem, making this strain particularly hard to treat.

Shyam Verma, one of the world's leading experts in dermatophytosis and based at Nirvan Skin Clinic, Vadodara, Gujarat, emphasises the need for careful classification: "It's premature to label it Trichophyton indotineae based on a few cases. This dermatophyte, found in various regions including Australia and Oman, belongs to genotype VIII within the T. Mentagrophytes/T. Interdigitale species complex," he says.

Clinical Challenges and Symptoms

Patients often present with persistent, treatment-resistant rashes that can easily be mistaken for eczema or other skin conditions, delaying effective treatment. These rashes can be red, scaly, and itchy, making them similar to more common dermatological issues. The misdiagnosis of these infections often leads to the use of ineffective treatments, which not only prolongs patient suffering but also allows the infection to worsen.

The diagnostic process involves not just clinical examination but also laboratory tests, such as fungal cultures and molecular diagnostics, to confirm the presence of resistant fungal strains. Educating patients about the importance of following through with recommended tests and treatments is vital. Misdiagnosis and delayed treatment can lead to the spread of the infection, not only worsening the individual's condition but also increasing the risk of transmission within the community.

Ravi (name changed), a patient managing Trichophyton indotineae, shares, "I experienced persistent rashes for months, and was misdiagnosed initially as eczema. Once correctly identified, the appropriate treatment made a significant difference. However, the infection spread among my family members, and the relentless itching was unbearable." His experience underscores the importance of accurate diagnosis and specialised care in managing these infections effectively. By improving diagnostic accuracy and educating both healthcare providers and patients, we can better manage and treat these challenging infections, ultimately reducing their impact on public health.

Treatment options

Trichophyton indotineae is a newly-identified dermatophyte species that has been found in near-epidemic form on the Indian subcontinent. This fungus, identical to genotype VIII within the T. Mentagrophytes/T. Interdigitale species complex, was described in 2019 by sequencing the Internal Transcribed Spacer (ITS) region of ribosomal DNA. More than 10 ITS genotypes of T. Interdigitale and T. Mentagrophytes can now be identified. T. Indotineae causes inflammatory and itchy, often widespread dermatophytosis affecting the groins, gluteal region, trunk, and face, affecting patients of all ages and genders.

Resistance to terbinafine due to genetic mutations in the squalene epoxidase gene is a significant concern. Additionally, growing resistance to another major antifungal, itraconazole, is also an area of concern. For infections resistant to standard antifungal medications, alternative treatments such as itraconazole may be necessary. However, these alternatives often come with significant side effects, including gastrointestinal issues, liver toxicity, and interactions with other medications, and will require close monitoring by healthcare providers.

Dr. Verma explains, "One of the major reasons this is happening is not only because of the topical steroid combinations being used, but also because the itraconazole drug formulations available are not of good quality. This results in suboptimal dosing, even if patients take it as prescribed. Unregulated sales of steroid-containing combination creams that may temporarily reduce the itch but contribute to resistance further complicate treatment efforts."

In addition to antifungal medications, integrating comprehensive skin care regimens can enhance treatment efficacy. This includes maintaining skin hydration, using barrier creams to protect affected areas, and avoiding irritants that can exacerbate the condition. Proper skin care supports the healing process and reduces the likelihood of recurrent infections.

Regular follow-ups with healthcare providers are essential to ensure effective management. Monitoring the patient's response to treatment allows for timely adjustments to the treatment plan. This might include altering dosages, switching medications, or incorporating additional therapies to address side effects or emerging symptoms.

Dr. Verma emphasises the complexity of treating this infection: "We don't even know whether only steroid use is the reason for its resistance or if it inherently does not respond to itraconazole. Practical challenges include identifying the infection through routine tests and the necessity of genomic sequencing, which is only available in academic settings."

Patients are also encouraged to adhere strictly to the prescribed treatment regimen, even if symptoms improve before the medication course is completed. This adherence is crucial in preventing the recurrence of the infection and reducing the risk of developing further resistance.

Prevention strategies

Healthcare professionals strongly advise against the unsupervised use of combination creams containing steroids and antifungals, as these can contribute to drug resistance and worsen infections. Public awareness campaigns are crucial to inform the public about the risks of self-medication and the importance of consulting healthcare professionals for skin conditions.

Of course, the bottom line is that maintaining good hygiene practices is key to preventing the spread of these infections. Keeping the skin dry and clean is essential since moisture creates an ideal environment for fungal growth. Regularly washing and drying areas prone to sweating, such as the feet, groin, and armpits, can help reduce this risk. Avoiding sharing of personal items like towels, clothing, and grooming tools is another important preventive measure. These items can carry fungal spores and spread the infection. Wearing breathable clothing, particularly loose-fitting fabrics like cotton, helps keep the skin dry and reduces sweating.

In communal environments such as locker rooms and showers, it's important to wear sandals to prevent picking up fungi from the floor. Proper footwear, along with regular cleaning of bed linens, towels, and clothing in hot water, can kill fungal spores and reduce the risk of infection.

Jyothi Jayaraman, a senior member of the special interest group IADVL Dermatophytosis, and Assistant Professor in the Department of Dermatology, Father Muller Medical College, Mangalore, advises: "Simple measures such as regular washing of personal items and maintaining personal hygiene can greatly reduce the spread of these infections. Educating the public about these practices is essential."

Educating oneself about the signs and symptoms of fungal infections can also help in seeking early treatment. Maintaining a healthy lifestyle by boosting the immune system through a balanced diet, regular exercise, and adequate sleep is also beneficial. By incorporating these practical tips into daily routines, we can significantly reduce the incidence and spread of drug-resistant fungal infections.

Continuous research is essential to understand the genetic basis of resistance in Trichophyton indotineae and to develop new treatment strategies. Collaborative efforts between dermatologists, researchers, and public health officials are necessary to tackle this growing threat.

Public health concerns in India

Indians, living in a land that has a tropical climate and high population density, are particularly vulnerable to fungal infections. The prevalence of Trichophyton indotineae is a growing public health concern, especially in rural areas where access to healthcare is limited. Public health initiatives must focus on improving diagnostic facilities and ensuring the availability of effective treatments.

Dr. Verma adds, "Dermatophytosis has been a rising challenge in India, only now gaining the spotlight, which is regrettable. More studies need to be done, and we need to call it based on the species it represents and not assign it to a particular country."

Through prudent medication use, public education, good hygiene practices, and ongoing research, we can combat these infections and improve patient outcomes. Healthcare providers and the public must remain vigilant and proactive in addressing this emerging threat.

(Dr Monisha Madhumita is a consultant dermatologist at Saveetha Medical College, Chennai and member of the International Alliance for Global Health Dermatology, London, UK. Mail.Monisha.M@gmail.Com )

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