# data[].attributes.attachment_link.description
Read about athlete's foot, a common fungal infection of the foot. Find out about the symptoms, what causes it, and how it's treated.

# data[].attributes.attachment_link.description
Ringworm is a fungal infection that causes a rash. Find out about the symptoms and how it can be treated.

# data[].attributes.attachment_link.readable_text
Malaria is a serious tropical disease spread by mosquitoes. If it isn't diagnosed and treated promptly, it can be fatal.
A single mosquito bite is all it takes for someone to become infected.

Symptoms of malaria

It's important to be aware of the symptoms of malaria if you're travelling to areas where there's a high risk of the disease. Symptoms include:

a high temperature of 38C or above

feeling hot and shivery

vomiting

muscle pains

Symptoms usually appear between 7 and 18 days after becoming infected, but in some cases the symptoms may not appear for up to a year, or occasionally even longer.

Read more about the symptoms of malaria.

When to seek medical attention

Seek medical help immediately if you develop symptoms of malaria during or after a visit to an area where the disease is found.

You should still seek medical help even if it's several weeks, months or a year after you return from travelling.

If there's a possibility you have malaria, a blood test will be carried out to confirm whether or not you're infected.

You should receive the results of your blood test on the same day. If you have malaria, treatment will be started straight away.

What causes malaria?

Malaria is caused by a type of parasite known as Plasmodium. There are many different types of Plasmodia parasites, but only 5 cause malaria in people.

The Plasmodium parasite is mainly spread by female Anopheles mosquitoes, which mainly bite at dusk and at night. When an infected mosquito bites a person, it passes the parasites into the bloodstream.

Malaria can also be spread through blood transfusions and the sharing of needles, but this is very rare.

Read more about the causes of malaria and how it's spread.

Malaria risk areas

Malaria is found in more than 100 countries, mainly in tropical regions of the world, including:

large areas of Africa and Asia

Central and South America

Haiti and the Dominican Republic

parts of the Middle East

some Pacific islands

Malaria is not found in the UK - it may be diagnosed in travellers who return to the UK from risk areas.

The TravelHealthPro website has more information about the risk of malaria in specific countries.

Preventing malaria

Many cases of malaria can be avoided. An easy way to remember is the ABCD approach to prevention:

Awareness of risk - find out whether you're at risk of getting malaria before travelling.

Bite prevention - avoid mosquito bites by using insect repellent, covering your arms and legs, and using an insecticide-treated mosquito net.

Check whether you need to take malaria prevention tablets - if you do, make sure you take the right antimalarial tablets at the right dose, and finish the course

Diagnosis - seek immediate medical advice if you develop malaria symptoms, as long as up to a year after you return from travelling.

Speak to your GP if you're planning to visit an area where there's a malaria risk. It may be recommended that you take antimalarial tablets to prevent infection.

Read more about preventing malaria.

Treating malaria

If malaria is diagnosed and treated promptly, virtually everyone will make a full recovery. Treatment should be started as soon as the diagnosis has been confirmed.

Antimalarial medication is used to both treat and prevent malaria. Which type of medication is used and the length of treatment will depend on:

the type of malaria

the severity of your symptoms

where you caught malaria

whether you took an antimalarial to prevent malaria

whether you're pregnant

In some cases, you may be prescribed emergency standby treatment for malaria before you travel. This is usually if there's a risk of you becoming infected with malaria while travelling in a remote area with little or no access to medical care.

Read more about treating malaria.

Complications of malaria

Malaria is a serious illness that can get worse very quickly. It can be fatal if not treated promptly.

It can also cause serious complications, including:

severe anaemia - where red blood cells are unable to carry enough oxygen around the body, leading to drowsiness and weakness

cerebral malaria - in rare cases, the small blood vessels leading to the brain can become blocked, causing seizures, brain damage and coma

The effects of malaria are usually more severe in pregnant women, babies, young children and the elderly. Pregnant women in particular are usually advised not to travel to malaria risk areas.

Read more about the complications of malaria.

# data[].attributes.attachment_link.description
Malaria is a serious tropical disease spread by mosquitoes. If it isn't diagnosed and treated promptly, it can be fatal. A single mosquito bite is all it takes for someone to become infected. It's important to be aware of the symptoms of malaria if you're travelling to areas where there's a high risk of the disease.

# data[].attributes.attachment_link.readable_text
1. Sam Ghebrehewet , consultant in communicable disease control and head of health protection 1,

2. Peter MacPherson , academic clinical lecturer 1 2 3,

3. Antonia Ho , specialty registrar in infectious diseases 4 5

1. 1Cheshire and Merseyside Health Protection Team, Public Health England North West, Liverpool, UK

2. 2Department of Public Health and Policy, The Farr Institute@HeRC, University of Liverpool, UK

3. 3Department of Clinical Research, Liverpool School of Tropical Medicine, Liverpool, UK

4. 4Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK

5. 5Institute of Infection and Global Health, University of Liverpool, Liverpool, UK

Corresponding author: S Ghebrehewet sam.ghebrehewet{at}phe.gov.uk

What is influenza virus?

There are four types of influenza viruses: influenza A, B, C, and D, 3 4 5 6 but only influenza A and B viruses cause clinically important human disease and seasonal epidemics (table 1 ⇓ ). 1 Influenza A viruses cause the most severe clinical disease and are the commonest cause of seasonal epidemics and pandemics in human populations. 1

What are the symptoms of influenza?

Influenza is characterised by sudden onset of fever, myalgia, headache, malaise, dry cough, sore throat, and nasal congestion (fig 1 ⇓ ). 13 14 15 Gastrointestinal symptoms including nausea, vomiting and diarrhoea are also common. 16 The incubation period of influenza (time from infection to development of symptoms) is 1 to 4 days. 17 Viral shedding, when the virus is infectious, usually occurs from one day before the onset of symptoms, to 5-7 days after. 18 19 20

Influenza can cause severe illness or death, particularly in high risk populations (box 1). 23 Mortality is higher among individuals with complicated influenza (illness necessitating hospital admission, or an exacerbation of an underlying chronic illness) across all age groups, but is highest in infants aged 6 months or younger. 2

How do influenza epidemics and pandemics occur?

Minor changes that occur in virus proteins between influenza seasons (known as antigenic drift) result in annual epidemics, with winter peaks in temperate regions (November-April in the northern hemisphere, and May-October in the southern hemisphere, see fig 2 ⇓ ). 3 In tropical and subtropical regions the seasonality of influenza is less well defined (fig 2 ⇓ ). 24 25

In contrast, pandemics (severe global epidemics) of influenza occur when a new influenza A subtype emerges abruptly because of a major shift in the proteins on the virus surface (antigenic shift), often because of combination with viruses circulating in animals. 26 As most people have no immunity to the new subtype, infection spreads quickly (table 2 ⇓ ).

How is influenza diagnosed?

Most influenza is diagnosed clinically in the community at times when the virus is known to be circulating. Patients admitted to hospital may have respiratory samples taken for testing by polymerase chain reaction (PCR), rapid antigen test, or immunofluorescence assay. With respiratory outbreaks in a closed setting (such as care homes, schools, hospitals) nasal swabs may be taken from the first few symptomatic individuals to identify the responsible organism.

What treatments are available for influenza?

Influenza is usually self limiting in healthy individuals. Treatment of uncomplicated disease in healthy individuals is supportive and includes antipyretics, adequate fluid intake, rest, and staying off work or school until 24 hours after resolution of fever to limit spread to others. 21

Most randomised trials of antiviral drugs have been conducted among otherwise healthy individuals and have shown modest reductions in symptom duration (0.7 days). 27 Fewer studies have been conducted among individuals at risk of complicated influenza. Data from observational studies and trials suggests that antiviral treatment may reduce adverse outcomes. 28 29 30 For example, the meta-analysis from 2015 reported fewer lower respiratory tract complications requiring antibiotics after oseltamivir treatment compared with placebo (risk difference −3.8%) and fewer hospital admissions (risk difference −1.1%). 30 NICE, 21 Public Health England, 12 UK Chief Medical Officers, 31 and the WHO 32 recommend treatment of suspected and confirmed influenza for individuals at risk of complicated influenza (box 1). General practitioners considering prescription of antivirals should discuss with patients likely benefits, as well as possible harms including nausea (number treated to cause nausea in one patient=28) 27 and vomiting (number treated to cause vomiting in one patient=22). 27

Individuals with complicated influenza may be helped by antiviral treatment. 21 22 Treatment is most effective if started within 48 hours of symptom onset, and it should not be delayed while awaiting results of investigations. 12 28 Neuraminidase inhibitors oseltamivir and zanamivir inhibit viral release from infected cells and reduce the rate of viral replication. Meta-analysis of individual participant data found that, compared with late treatment, early treatment (within 48 hours of symptom onset) of hospitalised individuals with complicated influenza reduced the odds of mortality by 52%. 28 Some individuals may require antibiotic therapy to treat secondary bacterial infections.

How can influenza be prevented?

New developments in prevention and treatment of influenza

Vaccine candidates have recently been developed that can elicit antibodies against multiple influenza strains, and thus could overcome the need for annual influenza vaccines. 55 56 57 Several antiviral drugs are currently in development for influenza treatment, including favipiravir, 58 nitazoxanide, 59 60 and arbidol. 61 62

Footnotes

Contributors: SG and PM conceived of the review. SG is the guarantor of the manuscript. SG, PM, and AH undertook the literature review, and were supported by Dr Bethan Roberts, foundation year 2 trainee in health protection, Cheshire and Merseyside Health Protection Team, Public Health England North West. SG, PM, and AH contributed to writing drafts of the manuscript. PM designed and wrote code for the interactive application. All authors have seen and approved the final manuscript version.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.

Provenance and peer review: Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.

View Abstract

# data[].attributes.attachment_link.description
Sam Ghebrehewet , consultant in communicable disease control and head of health protection 1, Peter MacPherson , academic clinical lecturer 1 2 3, Antonia Ho , specialty registrar in infectious diseases 4 5 1Cheshire and Merseyside Health Protection Team, Public Health England North West, Liverpool, UK 2Department of Public Health

# data[].attributes.attachment_link.description
Read about the symptoms of HIV and AIDS, what treatments are available and how to prevent getting or spreading the infection.

# data[].attributes.attachment_link.readable_text
Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges).
It can affect anyone, but is most common in babies, young children, teenagers and young adults.

Meningitis can be very serious if not treated quickly.

It can cause life-threatening sepsis and result in permanent damage to the brain or nerves.

A number of vaccinations are available that offer some protection against meningitis.

Symptoms of meningitis

Symptoms of meningitis develop suddenly and can include:

a high temperature (fever)

being sick

a headache

a rash that does not fade when a glass is rolled over it (but a rash will not always develop)

a stiff neck

a dislike of bright lights

drowsiness or unresponsiveness

seizures (fits)

These symptoms can appear in any order. You do not always get all the symptoms.

When to get medical help

Call 999 for an ambulance or go to your nearest A&E immediately if you think you or someone you look after could have meningitis or sepsis.

Trust your instincts and do not wait for all the symptoms to appear or until a rash develops. Someone with meningitis or sepsis can get a lot worse very quickly.

Call NHS 111 for advice if you're not sure if it's anything serious or you think you may have been exposed to someone with meningitis.

If you've had medical advice and are still worried or any symptoms get worse, get medical help again.

How meningitis is spread

Meningitis is usually caused by a bacterial or viral infection.

Bacterial meningitis is rarer but more serious than viral meningitis.

Infections that cause meningitis can be spread through:

Meningitis is usually caught from people who carry these viruses or bacteria in their nose or throat but are not ill themselves.

It can also be caught from someone with meningitis, but this is less common.

Vaccinations against meningitis

Vaccinations offer some protection against certain causes of meningitis.

These include the:

MenB vaccine - offered to babies aged 8 weeks, followed by a second dose at 16 weeks and a booster at 1 year

6-in-1 vaccine - offered to babies at 8, 12 and 16 weeks of age

pneumococcal vaccine - 2 doses offered to babies at 12 weeks and 1 year, and a single dose offered to adults aged 65 or over

Hib/MenC vaccine - offered to babies at 1 year of age

MMR vaccine - offered to babies at 1 year and a second dose at 3 years and 4 months

MenACWY vaccine - offered to teenagers, sixth formers and "fresher" students going to university for the first time

Treatments for meningitis

People with suspected meningitis will usually have tests in hospital to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection.

Bacterial meningitis usually needs to be treated in hospital for at least a week.

Treatments include:

antibiotics given directly into a vein

fluids given directly into a vein

oxygen through a face mask

Viral meningitis tends to get better on its own within 7 to 10 days and can often be treated at home.

Getting plenty of rest and taking painkillers and anti-sickness medication can help relieve the symptoms in the meantime.

Outlook for meningitis

Viral meningitis will usually get better on its own and rarely causes any long-term problems.

Most people with bacterial meningitis who are treated quickly will also make a full recovery, although some are left with serious long-term problems.

These can include:

hearing loss or vision loss, which may be partial or total

problems with memory and concentration

recurrent seizures (epilepsy)

co-ordination, movement and balance problems

loss of limbs - amputation of affected limbs is sometimes necessary

Overall, it's estimated up to 1 in every 10 cases of bacterial meningitis is fatal.
Find out more about the complications of meningitis

Page last reviewed: 25 October 2022
Next review due: 25 October 2025

# data[].attributes.attachment_link.description
Read about meningitis, an infection of the protective membranes that surround the brain and spinal cord. Find out about the symptoms, vaccines and treatments.

# data[].attributes.attachment_link.keywords[]
travelling outside the european economic area

# data[].attributes.attachment_link.description
Find out about the symptoms of tuberculosis (TB). General symptoms include lack of appetite, weight loss, fever, night sweats and extreme tiredness.

# data[].attributes.attachment_link.description
This page outlines black Sigatoka, an exotic fungal disease of banana plants.

# data[].attributes.attachment_link.description
Potato and tomato blight, properly called late blight, is a disease of the foliage and fruit or tubers of tomatoes and potatoes, causing rotting. It is most common in wet weather.

# data[].attributes.attachment_link.readable_text
Ring rot of potatoes is caused by the bacterium Clavibacter michiganensis subsp. sepedonicus.

Description

Ring rot causes a vascular wilt in the above ground parts of the potato plant, with discolouration and loss of texture/consistency noted in infected tubers. Losses of up to 50% of the crop have been noted in severe infections.

Threat

Ring rot is a major threat to the potato growers and potato seed producers in Northern Ireland and the rest of Western Europe. It is listed as a notifiable quarantine pathogen in the EU plant health legislation 93/85/EC (as amended), and national legislation is in place in Northern Ireland to prevent its entry (The Plant Health Order (Northern Ireland) 2006 (as amended)). The major yield loss caused by ring rot is through rotting of tubers. If the pathogen was to become established in Northern Ireland, not only would our potato industry suffer direct yield losses but the knock-on effect on exports from our seed-potato industry could be substantial. Once established, the costs of control could be very high.

Control of this disease requires vigilance by all sectors of the industry; from growers through to merchants, packers and retailers.

Northern Ireland Risk register rating

Susceptible species

Ring rot mainly only affects potato, although asymptomatic infection of sugarbeet has been recorded. Other subspecies of Clavibacter michiganensis affect other crops, such as Clavibacter michiganensis subsp. michiganensis causing 'birds eye' in tomatoes.

Spread

Important means of spread are the planting of infected seed potatoes and the use of contaminated containers, equipment and premises. Planters and graders which have been contaminated by the pathogen from a few badly diseased potatoes are also a potent infection source. Spread in the field from plant to plant is usually very low, but there is experimental evidence that some insects can transmit the disease.

Outbreak stage and national plans

Ring rot is not present in Northern Ireland or Ireland. The first finding of Ring rot in Britain was in November, 2003 in a Welsh seed potato crop planted with seed produced in the Netherlands. The pathogen is now considered eradicated and absent from Britain. Ring rot could easily become established under our conditions because it favours cool climates.

Symptoms

The disease can cause plants to wilt, but you are more likely to come across symptoms in tubers. The initial symptom is a soft cheese-like rotting of the vascular ring, hence the name "ring" rot. In severe cases this completely rots and the skin of the potato may crack. Disease spread is largely by vascular infection of daughter tubers derived from infected seed. The bacterium is thought to be unable to overwinter in the soil but will do so in groundkeepers and debris from infected crops.

Infected groundkeepers lifted at the same time as an otherwise clean seed crop, can infect that crop. Bacteria can also survive and remain infectious on potato bags, barn walls, machinery and other equipment that have been contaminated by rotting ooze and, although this is not the main means of disease transmission, it can make eradication of the disease very difficult. The return of contaminated potato waste to fields is a possible source of infection.

Symptoms on potato tubers may be confused with those caused by brown rot (causal agent Ralstonia solanacearum). The two may be distinguished by a bacterial ooze that often emerges from the eyes and stem-end attachment of R. solanacearum-infected tubers. When this bacterial exudate dries, soil may adhere to the tubers at the eyes.

Reporting suspect cases

If you think you have spotted the disease, please check our symptoms section before reporting it using one of the Further Information contact points below.

Management, grants, treatment

Ring rot is a notifiable plant disease in Northern Ireland under national legislation (Plant Health (Northern Ireland) Order 2006 (as amended)), and as such suspected cases should be reported to DAERA using the Further Information contact points below.

As with the management of all potato diseases, there are a number of steps that can be taken to reduce the chance of infection and spread.

1. Only plant classified seed
All classified seed potatoes produced in the EC are derived from material tested and found free from these diseases. Using home-saved seed does not provide the same guarantee of health.

2. Control groundkeepers
Groundkeepers are a key factor in the long-term survival of both diseases. Their control removes an important source of disease inoculum.

3. Practice good hygiene
Regularly clean and disinfect all machinery, equipment, containers, vehicles and storage facilities used during potato production. Dirty machinery spreads infection between stocks.

4. Keep potatoes for planting away from ware grading lines
Do not plant any potatoes that have passed over machinery handling imported ware potatoes. Bacteria from rotten potatoes can easily transfer to the next stock to be graded. Prepackers and processors should never return "seed" to growers.

5. Don't dump waste on agricultural land
Discarded potatoes and waste from potato processing could both harbour these diseases and should not be dumped back onto fields. If possible, dispose of all potato waste at an approved tip or by incineration.

6. Feeding potatoes to livestock
If feeding raw potatoes to animals, spread the slurry produced on fields for grazing rather than on ground to be planted with potatoes.

The science

Clavibacter michiganensis is a short, non-motile, Gram-positive rod bacterium. The species comprises of five defined subspecies, Clavibacter michiganensis subsp. insidiosus, Clavibacter michiganensis subsp. michiganensis, Clavibacter michiganensis subsp. nebraskensis, Clavibacter michiganensis subsp. sepedonicus and Clavibacter michiganensis subsp. tesselarius. The diagnostic tests for the pathogen include isolation onto selective media, consideration of the type of host infected, and the use of specific PCR primers are used to distinguish the subspecies.

Origins

The origin of this pathogen is unknown. Ring rot disease of potato was first described in Germany in 1905. In 1932 the disease was reported in Norway and was known to be present in Sweden prior to 1956 when it was widespread in seed and ware potatoes. It was reported to be present in France by 1934 but may have been present for a longer period of time, having been misidentified as a fungal wilt (i.e. Verticillium wilt). In 1940 it was noted that the disease was present in Russia. It was first detected in Britain in 2003, but has since been eradicated.

In 1931 the disease occurred in Canada, in the province of Quebec, and in 1937-1938 was known to exist in the provinces of Alberta, Manitoba, Nova Scotia, Ontario, Prince Edward Island and Saskatchewan; and in 1943 it was reported in British Columbia. In the USA it was first reported from Maine in 1932, and by 1939 the disease had been reported from 27 states and by 1948 from 45 states of the USA.

Pest risk analysis

There is currently no Pest Risk Analysis (PRA) available for the ring rot pathogen.

Import & movement restrictions

The Department of Agriculture, Environment and Rural Affairs (DAERA) carry out an annual survey of potato stocks from seed producers and from a random selection of ware producers. Stocks grown from both local and imported seed are also surveyed annually to look for latent infection. These samples are tested for both Ring Rot and another bacterial disease of potatoes (Brown Rot) at Agri-Food and Biosciences Institute (AFBI) Potato Diseases Laboratory, Applied Plant Science Division.

Recent legislation requires growers and merchants to notify DAERA in advance of imports of seed potatoes from outside Northern Ireland. This includes imports from Scotland and the Republic of Ireland as well as imports of seed from England and mainland Europe. DAERA will try to sample all imported seed stocks which are from areas with a history of Brown Rot and Ring Rot outbreaks. A test in advance of planting could detect these diseases and prevent growers from planting infected stocks.

Consignments of imported ware potatoes are monitored by DAERA inspectors. Imports at processors premises are inspected and sampled with special attention given to stocks originating in areas known to have a history of these diseases.

Further information

Questions and answers

Contact:
Plant Health Inspection Branch
DAERA Northern Ireland
Tel: 0300 200 7847
Email: planthealth@daera-ni.gov.uk

# data[].attributes.attachment_link.description
Ring rot of potatoes is caused by the bacterium Clavibacter michiganensis subsp. sepedonicus. Ring rot causes a vascular wilt in the above ground parts of the potato plant, with discolouration and loss of texture/consistency noted in infected tubers. Losses of up to 50% of the crop have been noted in severe infections.

# data[].attributes.attachment_link.title
acute oak decline - tree pests and diseases

# data[].attributes.attachment_link.description
Description of Acute oak decline, its spread and symptoms, and the threat it poses to trees.