Neglected Tropical Diseases key aspects for the rheumatologist

Neglected tropical diseases (NTDs) are a group of 20 infectious diseases that are no longer restricted to tropical regions and that will be increasingly encountered by physicians of the Northern hemisphere.

In this article, we review key aspects of tropical medicine relevant for rheumatologists or doctors working with autoimmune diseases or immunosuppressive drugs in order to be aware of NTDs, look out for them and prevent their complications.

The article addresses four main topics:

• eosinophilia workup,
• rheumatic presentations of NTDs, such as myositis or arthritis
• lupus, granulomatosis with polyangiitis or vasculitis mimickers, such Leishmaniasis, Leprosy or Human African Trypanosomiasis and
• screening before starting immunosuppression, including Strongyloidiasis and Chagas disease

With this review, we intend to raise awareness for NTDs amongst rheumatologists and internists working in the Northern hemisphere. NTDs should be considered and excluded in patients with relevant travelhistory or exposure in following situations:

1. during the differential diagnosis of a suspected new autoimmune condition,
2. in case of poor response or flare of symptoms on initiating immunosuppressive therapy,
3. during systematic screening prior to starting immunosuppressive medication, along with blood born viruses and tuberculosis.