Diagnosis and treatment of neglected tropical diseases in Europe: laboratory infrastructure, diagnostic techniques, disease notification, and surveillance systems

An accurate laboratory diagnosis of neglected tropical diseases (NTDs) is crucial for targeted treatment, as the clinical symptomatology alone is frequently insufficient to distinguish between specific disease entities. This chapter provides an overview on the diagnostic infrastructure pertaining to NTDs in Europe and describes existing quality control and disease notification and surveillance systems. The availability of drugs used to treat NTDs is also discussed. With the recent migration from areas of high endemicity for NTDs, echinococcosis, schistosomiasis and soil-transmitted helminthiasis including strongyloidiasis are nowadays more frequently encountered in European laboratories. Chagas disease, in particular, is an important imported protozoal infection in some European countries. Microscopy and serological techniques remain the mainstay for diagnosis of these NTDs, whereas more sensitive diagnostics such as polymerase chain reaction (PCR) are limited to a set of European reference laboratories. Disease notification systems and the list of notifiable infectious diseases vary among European countries and these lists include only a subset of NTDs. Most drugs needed to treat NTDs are licensed and accessible in European countries, whereas some specific compounds (e.g., benznidazole to treat Chagas disease) can only be obtained through international initiatives or the World Health Organization.