Ezra Bado

Background: Neuropathic pain (NP), resulting from damage to the somatosensory nervous system, affects 7–10% of the global population and remains poorly managed despite available therapies. Smoking has been associated with increased pain severity and disease burden, yet its role in neuropathy/NP has not been systematically reviewed. This systematic review synthesizes the existing literature on smoking status and its relationship with neuropathy/NP incidence, prevalence, and severity. Methods: The review was conducted in accordance with PRISMA guidelines and included studies that assessed smoking consumption, dependency, quantity, and cessation in individuals with neuropathy/NP. Summary estimates were stratified by exposure type, and pooled odds ratios and relative risks were calculated. Results: Across 62 studies comprising cohort, case–control, and cross-sectional designs, smoking was consistently associated with greater NP prevalence and pain severity. Smoking dependency was linked to increased incidence, while cessation was associated with reduced risk of NP. Despite considerable heterogeneity and risk of bias, particularly from subjective exposure measurement and inconsistent classification, this relationship remained statistically significant. Conclusions: Findings support the role of smoking as a modifiable risk factor in various etiologies of neuropathy/NP. Cessation may represent a low-cost, low-risk, low-tech adjunctive therapy; however, further robust cessation interventional trials are needed, particularly for less common infectious causes of chronic NP such as leprosy.

Given the overlap of epidemiological and clinical presentations of both rickettsioses and malaria infections, diagnostic testing where malaria is confirmed or excluded, without subsequent rickettsial testing, specifically in the case of Plasmodium vivax or P. ovale infection, may mask the possibility of relapse. A lack of clinical suspicion of co-infections, absence of knowledge on the geographic distribution of diseases, and lack of availability of point-of-care diagnostic testing for other tropical diseases can often lead to missed diagnosis or misdiagnosis of common tropical infections, including rickettsioses. We herein describe a case of confirmed intercurrent rickettsial and P. vivax infection, with the former potentially triggering a relapse of the latter in a febrile traveler returning to Canada from South America, and review the literature on tropical coinfections in returning travelers.