3 Exotic Diseases Pharmacists Should Know

Pharmacists should learn how to properly diagnose foreign-acquired diseases in order to optimize outcomes for infected patients.

During a session at the American Society of Health-Systems Pharmacists (ASHP) Midyear meeting, panelists gave attendees a crash course on how to identify certain exotic diseases and described optimal treatments for each.

Elizabeth Giesler, PharmD, BCPS, an emergency medicine clinical pharmacist for the John Peter Smith Health Network, told attendees that while these diseases are rarely seen in US emergency departments, health-system pharmacists might nevertheless encounter them during their careers.

“It’s important to recognize these diseases and know what you need to help them, [but] you don’t need to be an expert,” she said.

Pharmacists can also play a role in preventing these diseases by reminding patients that they must follow their entire prescribed regimen when taking drugs prior to travel.

Pharmacists’ training, skills, and knowledge afford them opportunities to expand their services to offer health information to travelers, who are often ill prepared for the health risks.

The following are some exotic diseases primarily coming from Southeast Asia that pharmacists should know:

1. Malaria

Malaria is primarily transported via mosquitos, and 3.3 billion people in the world live in areas considered high-risk for transmission. In the United States, 1500 to 2000 cases of malaria are reported annually.

It is “absolutely crucial” for health care providers to determine whether and where a patient has traveled because “malaria treatment is specific to the plasmodium species and the country where the patient was infected,” Dr. Giesler explained to ASHP attendees.

Additionally, there are 2 different stages of malaria: uncomplicated and severe. Each stage is treated differently.

Dr. Giesler said the initial symptoms of malaria are “very similar to appendicitis,” as they include fatigue, abdominal discomfort, muscle aches, fever, chills, sweating, and vomiting.

Recommended drugs for uncomplicated malaria include atovaquone/proguanil, chloroquine, doxycycline, mefloquine, and primaquine.

On the other hand, advanced malaria has more severe symptoms, such as impaired consciousness, seizures, coma, acidosis, hypoglycemia, renal failure, and severe anemia.

The first-line treatment for severe malaria is quinidine. Patients intolerant of quinidine should be given artesunate.

2. Dengue Fever

Aedes aegypti mosquitos are the primary vehicles for spreading dengue fever. About 50 million infections occur each year.

Similar to malaria, dengue fever is classified into 2 stages.

Early dengue fever symptoms include high fever and 2 of the following: muscle and joint pain, nausea, rash, headache and pain behind the eyes, and low white blood cell count.

“Notice many of these symptoms look just like the flu,” Dr. Giesler cautioned.

Severe dengue symptoms include severe plasma leakage, severe bleeding, and organ involvement.

“While there are no medications that specifically treat dengue fever, pharmacists have a role in ensuring adequate fluid resuscitation and appropriate monitoring,” Dr. Giesler told session attendees.

Beyond fluids, severe dengue fever may also require blood transfusions.

The FDA currently designates DengueCide as an orphan drug for this exotic disease.

3. Typhoid Fever

The most common way patients contract typhoid is through contaminated water sources, and humans are the fever’s only known natural host and vector. There are 5700 cases in the United States annually.

Non-complicated typhoid fever symptoms include high fever, diarrhea or constipation, and malaise, while complicated typhoid fever symptoms are intestinal bleeding/perforation and hypotension.

First-line treatment for full sensitive typhoid patients is fluoroquinolone, while amoxicillin, bactrim, and chloramphenicol serve as alternatives.

Azithromycin or ceftriaxone should be first line-treatments for fluoroquinolone-resistant patients, with cefixime serving as alternative treatment.