Knowledge gaps in the diagnosis & management of patients with tropical diseases presenting to Canadian emergency departments 

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Canadian Association of Emergency Physicians (

November 10, 2014

Travelers returning to Canada from exotic locations may return with more than memories. Imported diseases, including malaria, dengue, and Ebola, can be acquired abroad and brought back to Canada in unsuspecting individuals. Often, the first point of contact for these patients are the emergency physicians across our country.

Dr. Nazanin Meshkat (from the University of Toronto) and colleagues published a study looking at Canadian emergency physicians’ management of tropical diseases in the November 2014 issue of the Canadian Journal of Emergency Medicine (

In the study, they surveyed Canadian emergency physicians about tropical disease training and conducted case studies to assess knowledge about the identification and management of specific tropical diseases.

Although the survey was directed at experienced emergency physicians, most had minimal or no specific training in tropical diseases. Overall, emergency physicians indicated an unacceptably low level of comfort when faced with patients with tropical disease symptoms. From the tropical disease case studies, 40% of the cases were incorrectly diagnosed or managed. Although concerning, it is substantially better than a similar 2006 study of UK physicians where 78% were incorrectly diagnosed (doi: 10.1111/j.1708-8305.2006.00019.x). In Dr. Meshkat’s study, the Canadian emergency physicians were aware of the knowledge gap, and the desire for more training was high. Those in the study indicated that conference workshops, case studies, and podcasts would all be good continuing medical education opportunities to improve their knowledge about the diagnosis and management of tropical disease. The authors investigated the current continuing medical education opportunities for physicians interested in tropical disease and found that only minimal resources are available.

In an accompanying commentary on Dr. Meshkat’s work, Dr. Niranjan Kissoon (from the University of British Columbia) and Dr. Tim Uyeki (from the CDC [Influenza Division], Atlanta) highlighted the dangers of the mismanagement of tropical disease, which included their further spread (especially for respiratory diseases, like measles and tuberculosis) and the safety of health care workers (English: and French version: They also proposed updating policies on global health awareness and tropical disease education. Drs. Kissoon and Uyeki indicated that training for emergency physicians must include how to take a thorough travel history and the necessity of consultation with travel medicine and infectious disease specialists. They concluded that this study, conducted prior to the threat of the Ebola epidemic, is a wake-up call, and there is an urgent need for improved education for the diagnosis and management of tropical diseases for Canadian physicians.

For additional information or to speak with  Dr. Meshkat please contact CJEM Assistant Managing Editor Jennifer Artz  via 613.523.3343 ext. 18 or

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