Increasing global conflicts and climate change are leading to ever-larger migration movements. In 2017 alone, around 250 million people were no longer in their country of birth. Europe is also experiencing these developments, with African refugees being the main arrivals. With these trends, also long-forgotten urological diseases find their way to different parts of the world. Preparations for resurgent diseases cannot wait any longer, as a recent paper in the Journal European Urology shows.
But this is no reason for panic, nonetheless, because the danger of urological infections are rare or have become rare in Germany and is usually greater for those seeking protection than for the general population of a target country.
Nevertheless, there are two problems in Europe and thus also in Germany that could pose a risk in principle: On the one hand, the local population is not familiar with the new, mostly tropical pathogens and therefore has no natural immunity. On the other hand, healthcare professionals, such as doctors and nurses, are no longer trained to recognize such infections and the associated risks.
Climate change also increases the chance for tropical pathogens to find a suitable vector or substrate for permanent "colonization" in Europe. An example cited in the current work of Mantica and colleagues occurred in 2013 on the island of Corsica. At that time, a Schistosoma species originating from Africa spread in the water, which could have infected hundreds of people. The pathogen apparently originally found its way to Corsica with the streams of refugees.
Schistosoma, the causative agent of schistosomiasis, requires a freshwater snail of the genus Bulinus for its development cycle. On Corsica, the pathogen found a closely related snail species and was thus able to establish itself very well on site. Similar freshwater snails can also be found in Portugal and Spain so that there is in principle a future possibility of an endemic reservoir for Schistosoma, especially in Southern Europe.
In countries of tropical Africa, where schistosomiasis has been at home for decades if not centuries, doctors will immediately be able to correctly assess the characteristic symptoms and take appropriate measures. In Europe, however, the disease is far less common and therefore usually little known.
In addition, knowledge about tropical urology-relevant diseases and infections is not necessarily part of the teaching content of the medical disciplines in Germany. However, this should change as soon as possible, because the classical initial symptoms of schistosomiasis are often more likely to be regarded as urinary tract infection (UTI) or neoplasm. This delays the time until "bilharzia" is diagnosed and thus also until an adequate start of therapy.
The situation is dramatic: In a small survey of 200 urologists, the authors found a "frightening" picture. In the small multiple-choice test, doctors from South Africa had compiled questions on urologically relevant tropical diseases, which in Africa were intended as a knowledge test for students and prospective doctors. In more than 80% of the cases, the participating European doctors had insufficient knowledge about the diseases in the test. Every ninth colleague was a resident urologist. Colleagues who had already had experiences in Africa or another tropical country, however, also scored better in the test.
It turned out that European urologists are insufficiently prepared for the diagnosis and treatment of tropical diseases with urological symptoms. The migration movements in the world lead, however, over the short or long term, to such cases of sickness occurring more frequently in practices throughout Europe.
Nevertheless, the authors of the work from European Urology propose to offer more webinars and further training courses in order to enable every colleague in urology at least to have a basic level of knowledge that enables the recognition of such a tropical infection in individual cases.
Original work:
Mantica G et al., European Urology 2019; 76: 140-141