Navigating the risk of tropical disease clinical negligence claims

From malaria to monkeypox, dengue to travellers’ diarrhoea, tropical diseases vary in severity. Some can be life-threatening, while others are self-limiting and will go away on their own within two to three weeks. Malaria is the most well-known tropical disease, with 1,500 cases annually in travellers returning to the UK, but also in the mix are Ebola, cholera, typhoid and TB.

Tropical diseases have been known of since ancient times, from Greek physicians who wrote about malaria, to traces of malaria found in the analysis of Egyptian mummies. Scientific interest into tropical diseases didn’t begin until the 19th century, brought along by the increase in worldwide exploration and colonial expansion of Europeans and Americans.

However, despite advancements in travel medicine, not all medical professionals in the UK are familiar with or aware of conditions to which international travellers are being exposed. Some may feel out of their comfort zone when diagnosing an unwell traveller. This potential lack of awareness and education leaves patients open to a public health risk and NHS trusts at risk of potential clinical negligence claims for delays to diagnosing tropical diseases. These delays can cause serious, life-changing effects for patients, as in the case of one of our recent clients.

Medical Solicitors recovers £30,000 compensation for traveller left scarred by delays to diagnosing and treating tropical infection

In May 2022, Sonia Parkes settled the case of a woman who experienced the consequences of the delays in diagnosis and treatment of a tropical disease.

Our client ‘C’ had recently returned from Tanzania when she developed a sudden pain in her shoulder and neck along with a high fever. She was taken by ambulance to her local urgent care centre where a doctor on duty ordered blood tests, but diagnosed acute neck pain before the test results were returned. She was sent home with Naproxen pain killers.

Five days later, with her condition worsening, C went via ambulance to A&E where she was diagnosed with a rare bacterial infection called pyomyositis which is commonly found in tropical areas.

Pyomyositis infects muscles and usually results in an abscess, which had happened in C’s case. She was admitted to hospital for extensive drainage to an abscess in her neck. However, due to the delay in diagnosis and treatment, nine days later she needed further drainage and surgical removal of infected muscle tissue that had become necrotic. She also developed sepsis.

C was left with severe scarring to her neck and chest from the two invasive drainage procedures which has impacted her self-confidence. C sought the help of Medical Solicitors to make a claim for clinical negligence for the various failings in her care.

The main issues stemmed from the urgent care doctor’s failure to recognise the significance of a fever in a returning traveller from sub-Saharan Africa. This should have been a red flag that would prompt urgent ultrasound imaging which would have shown abnormal findings. However, there were no investigations to confirm nor exclude tropical diseases.

Another failing related to discharging C with acute neck pain before the blood tests were returned. These tests determined her CRP (c-reactive protein) level, which checks for inflammation due to infection, was 44. Anything above 10 is classed as high. She was not contacted for a follow-up, neither were the blood test results sent to her GP.

Together, these failings led to a delay in diagnosis of C’s infection. Had she been admitted earlier for intravenous antibiotics, it was likely she wouldn’t have needed extensive draining of the abscess which would have resulted in less scarring and limited pain.

Liability was denied throughout. After an initial offer of £10,000 damages, Sonia was able to encourage the proposed settlement up to £30,000 for our client.

What should NHS trusts do to manage tropical diseases?

Preventing the spread of tropical diseases is paramount so early diagnosis is very important, as is surveillance. After the effects of the Covid pandemic and the concerns around the current monkeypox outbreak, NHS Trusts should be hypervigilant to the dangers posed by such viruses and diseases.

The initial focus should be to rule out conditions that are progressive, transmissible and treatable. NHS trusts can do this be developing a diagnostic sieve to exclude serious and potentially fatal tropical diseases.

Urgent response is needed if a patient shows signs of neurological symptoms, respiratory distress, or bleeding disorders.

Symptoms will vary with each type of tropical disease, but include fever, rash, headaches, muscle aches, fatigue, change in consciousness, bruising, vomiting, jaundice and paralysis.

NHS Trusts should then look at the likely cause which will vary with the area a patient has travelled to. Some important considerations for tropical diseases will be:

• Symptoms – nature, onset and duration
• Travel dates – risk increases the longer a trip is
• Area of travel and exposure in that country
• Nature of terrain – rural, urban, rainforest, mountains
• Purpose of travel – relief, healthcare and humanitarian aid worker are at increased risk
• Contact with locals
• Lifestyle – did patient undertake riskier activities such as swimming in fresh water
• Any known bites, scratches, illness or injuries acquired while travelling
• Unprotected sex
• Diet
• Vaccination history
• Pre-travel malaria prevention

If left untreated, complications of tropical diseases can include seizures, organ damage, coma and death.

In the UK we have various regional infectious disease units across the country as well as a specialist tropical diseases hospital in London. There is also the world’s first centre dedicated to research and teaching of travel medicine in the form of Liverpool School of Tropical Medicine which offers online courses for physicians to improve their knowledge around tropical diseases.

How can you reduce the risk of contracting a tropical disease?

Before you pack your suitcase, ensure you check the health advice for the country you’re planning to travel to. The Foreign and Commonwealth Office has all the latest advice for travel including entry requirements and vaccinations needed.

Tropical diseases are generally found in countries that have a hot or humid climate. Continents include Africa, Asia, South America, the Caribbean, Middle East and Oceania. Areas of poverty and lack of sanitation are high risk, but it’s not just developing countries where tropical diseases are prevalent; tropical diseases can be picked up in Barbados, Cuba, Hawaii and Jamaica.

Maldives is popular with people looking for a luxury getaway but there is a risk of contracting the zika virus which is spread by mosquitoes. In the Dominican Republic, there is a warning against dengue which is also spread by mosquitoes. Travellers’ diarrhoea is common in South Asian countries such as India, Pakistan, Sri Lanka and Nepal.

For most people, tropical diseases will be mild and leave you feeling generally unwell. However, if you have a pre-existing health condition, there is an increased risk of complications.

You will also be more at risk if you’re travelling off the beaten track to rural areas, going backpacking, or staying in hostels due to unsanitary conditions.

Anyone preparing to travel to a tropical or sub-tropical country should visit their GP at least eight weeks before their departure to begin anti-malarial treatment and receive any vaccinations needed. Some community pharmacies also offer travel vaccinations.

While you’re away, be mindful of risk-taking activities such as swimming in open water, consuming food that has been left uncovered, or consuming unsafe drinking water. Most tropical diseases are spread by mosquitoes so take care not to get bitten where possible and keep an eye on any bites or wounds for signs of infection.

The Travel Health Pro website is an excellent point of reference for travellers, with up-to-date outbreak surveillance, country information, and lots of fact sheets.