Dermatology in the tropics

Navigation Menu

General issues of Vaccine
Cold chain Correlates of Protection Vaccines for Asplenia Vaccines for Pregnant women Vaccines for Immunocompromised hosts Vaccine hesitancy Additional materials of vaccine

General issues of Tropical med.

Definition of Tropical Medicine Matrices of tropical infection General issues of Helminths Neglected Tropical Diseases Sexually-transmitted infections Non-Communicable Diseases Maternal health and contraception Child health Malnutrition and Micronutrient Eosinophilia Fever in the tropics Diarrhea in the tropics Anemia in the tropics Dermatology in the tropics Ophthalmology in the tropics Neurology in the tropics Mental health in the tropics Surgery in the tropics Humanitarian emergency Epidemiology in outbreak Antimicrobial resistance Pathology of infectious diseases

General issues of Travel med.
Epidemiology of Travel health Last minute traveler Time zone issue High altitude medicine Diving medicine Pregnancy and travel Children and travel Elderly and travel

Immunology
Principle of human immune system Innate immunity Cellular immunity Humoral immunity Neutralizing antibody and its assay Antigenic Cartography Additional materials of immunology

Epi & Stats
Basics & Definition Epidemiology Odds in statistics and Odds in a horse race Collider bias Data distribution Statistical test Regression model Multivariate analysis Marginal effects Prediction and decision Table-related commands in STATA Missing data and imputation

Virus
HIV HIV-TB co-infection HIV-STI interaction Viral Hemorrhagic Fever Ebola Crimean-Congo hemorrhagic fever SFTS Rabies Polio Dengue Yellow fever Chikungunya Zika Japanese encephalitis Tick-borne encephalitis Viral hepatitis Measles Smallpox and Monkeypox Respiratory Syncytial virus

COVID-19
Bivalent BA.1/BA.4-5 mRNA vaccines Monovalent XBB-1.5 mRNA vaccine Private archives of the initial phase of the pandemic Private archives of lecture materials of COVID vaccine as of March 2021 厚生労働省が発出する保健行政関連の文書の読み解き方

Bacteria
Bacteriological tests Tuberculosis Tuberculosis in Children HIV-TB co-infection Leprosy Dermatological mycobacterium infecions Syphilis and Yaws Plague Pneumococcus Meningococcus Typhoid Salmonellosis Melioidosis Leptospirosis Brucellosis Bartonellosis Lyme disease and Relapsing fever Tularaemia Tetanus Diphtheria Anthrax Coxiellosis

Rickettsia
Rickettsiosis Scrub typhus Spotted fevers Epidemic typhus Murine typhus

Protozoa
Overview of protozoa Overview of medicine for protozoa Malaria Chagas disease African trypanosomiasis Leishmaniasis Trichomoniasis Toxoplasmosis Amoebiasis Giardiasis Cryptosporidiosis Cyclosporiasis Isosporiasis Pentatrichomoniasis Microsporidiasis Babesiosis

Fungi
General issues of fungi Coccidioidomycosis Paracoccidioidomycosis Histoplasmosis Talaromycosis Blastomycosis Sporotrichosis

Nematode (roundworm)
Nematode principles Lympatic filariasis Onchocerciasis Loiasis Microscopic differentiation of microfilariae Strongyloidiasis Ascariasis Ancylostomiasis (hookworm) Trichuriasis (whipworm) Enterobiasis (pinworm) Angiostrongyliasis (rat lungworm) Dracunculiasis (Guinea worm) Anisakiasis Trichinellosis (Trichinosis) Gnathostomiasis Spirurinasis Soil-transmitted helminths

Trematode (fluke, distoma)
General issues of Helminths Trematode principles Schistosomiasis Clonorchiasis Fascioliasis Paragonimiasis Metagonimiasis

Cestode (tapeworm)
General issues of Helminths Cestode principles Diphyllobothriasis Sparganosis Taeniasis Echinococcosis

Medical Zoology
Zoonosis Insectology Mosquitology Acarology Batology Snake toxicology Scorpion and spider toxicology Marine toxicology

NTDs

• preventative chemoTx and transmission control (PCT) ones
  • mass drug administration
    • onchocerciasis
    • lympahatic filariasis
    • schistosomiasis
    • soil-transmitted helminths
• innovative and intensified disease management (IDM) ones
  • individual care findings and case management
    • leishmaniasis
    • buruli ulcer
    • mycetoma
    • yaws
      • azithromycin is turning yaws to PCT
    • scabies
      • ivermectin is turning scabies to PCT
    • ...

skin NTDs

• new movement to integrate disease controls between NTDs that manifest with skin symptoms
  • led by WHO and community dermatologists

exanthematology

• morphology of each rash
• distribution
• sites on body

leprosy

• Mycobacterium leprae
• 20,000-25,000 new cases/year
  • mostly in India
• respiratory transmission? difficult to determine because of long incubation period
• skin + peripheral nerve manifestation
  • M. leprae has affinity to Schwann cells and destroy them
• clinical manifestation differs in wide range depending on amount of bacilli and host immune response
• WHO classification
  • MB - multibacillary > 5 lesions
    • multi-drug Tx for 1 year
  • PB - paucibacillary 2-5 lesions
    • multi-drug Tx for 6 months
  • single lesion
    • single dose
• Rideley & Jpling classification
  • TT
  • BT
  • BB
  • BL
  • LL
• delay of Dx and Tx leads to long term disability and deformity resulted in stigma and discrimination

Buruli ulcer

• Mycobacterium ulcerans
• 75% of worldwide patients are in Ivory Coast, Ghana and Benin
  • rarely found in Japan and Australia (esp. in Victoria)
• transmission route unknown
  • patients are often in proximity of stagnant water body
  • reservoir - snails, fish, water insects, aquatic plants, koala & opposum in Australia
• undermined wound edges, thick necrotic tissue, pain is liminited
• 3 months course

1. subcutaneous nodules
2. plaque
3. edema - develops pain
4. ulcer

• diagnosis - Ziehl-Neelsen stain and culture of ulcer base
• DDx - panniculitis, pyoderma gangreosum
• lipid toxin produced and secreted by M. ulcerans is pathogenetic
  • highly hydrophobic
  • M. ulcerans itself is not pathogenetic
• WHO treatment category
  • I lesions<5cm - 8 weeks antibiotics
  • II lesions 5-15cm - 4 weeks antibiotics -> surgery -> 4 weeks
  • III lesions >15cm

Lesishmaniasis

• Leischmania spp. > 20 species
  • intracellular protozoa
• transmitted by sandfly
• 3 clinical types
  • cutaneous
  • mucocutaneous
  • visceral (Kala-Azar)

Onchoceriasis

• Onchocera volvulus
• transmitted by blackfly
• mass drug administration in Central Africa region is dangerous because Loa loa is endemic, which may cause encephalitis by administration of ivermectin

Lyphmatic filariasis

• Wuchereria bancrofti, Brugia malayi, Brugia timori

Yaws

• イチゴ腫，フランベジア
  • 病変がフランボワーズ（ラズベリー）に似ているため
• Treponema pallidum subsp. pertenue
• more common in children
• direct contact transmission
• yellowish, raspberry-like nodule
  • often develop ulceration
• diagnosis
  • treponema pallidum rapid diagnostic test
  • dual path platform (DPP) test of skin swab
• just one dose of azithromycin 30mg/kg or 2 gram for adults is effective
  • resistant to azithromycin is rapidly increasing in yaws

Mycetoma

• syndrome, not a single etiology
• bacterial
  • Actionomadura madurae, Streptomyces somaliensis, Actinomadura pelletieri, Nocardia spp.
• fungal
  • Madurella mycetomatis, etc.
  • black dots are seen on lesions, clusters of fungi
• Txs differ depending on

Scabies

• Sarcoptes scabiei var. hominis
• ivermectin

Tungiasis (sand flea)

• Tunga penetrans
  • only female tunga invades human skin producing a large ovary

Guinea worm

• almost eliminated
  • human cases only in 4 countries
  • still exists as zoonosis
• Dracunculus medinensis