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To the Editor
With respect to the article entitled ‘Montezuma’s revenge’: neurological disorders in the returning traveller, the authors make an important point about the treatment of malaria: hopefully GPs and potential travellers in the UK are always extra-ordinarily careful about malaria prophylaxis.
However, I believe it worth pointing out that the list of illnesses which may be acquired in certain countries is, unfortunately, simply wrong (Figure 1). The following infectious diseases are not found in South Africa:
1. Relapsing fever (except described in penguins!).
3. African sleeping sickness.
Following successful treatment of the outbreak in Madagascar perhaps one should also note that the Western half of the United States is historically a region where plague is found (not mentioned by the authors). I appreciate that the list provided in the article is derived from another source, but I am sure the authors will agree on the importance of avoiding the promulgation of inaccurate information.
Finally, despite what the authors may maintain, the correct treatment, if any, of cerebral neurocysticercosis does indeed continue to remain controversial, and adequate RCTs have not been performed. Decisions on treatment may well need to be made on a case by case basis, and it is important that neurologists should be aware of the dearth of hard evidence concerning the treatment of neurocysticercosis.
1 Yabsley MJ, Parsons NJ, Horne EC, et al. Novel relapsing fever Borrelia detected in African penguins (Spheniscus demersus) admitted to two rehabilitation centers in South Africa. Parasitol Res 2012;110:1125–30. doi:10.1007/s00436-011-2602-2
2 Global distribution of natural plague foci. WHO. 2016.http://www.who.int/csr/disease/plague/Plague-map-2016.pdf?ua=1
3 Carpio A, Fleury A, Romo ML, et al. Neurocysticercosis: the good, the bad, and the missing. Expert Rev Neurother 2018;18:289–301. doi:10.1080/14737175.2018.1451328
4 Singh G, Sharma R. Controversies in the treatment of seizures associated with neurocysticercosis. Epilepsy Behav 2017;76:163–7. doi:10.1016/j.yebeh.2017.05.033