「Dermatology in the tropics」の版間の差分

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2023年9月10日 (日) 14:01時点における最新版

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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.
      • actinomycetoma
  • fungal
    • Madurella mycetomatis, etc.
      • eumaycetoma
    • black dots are seen on lesions, clusters of fungi
  • Txs differ depending on
  1. medical for 3-6 months
    1. itraconazole
  2. surgical bulk reducion
  3. medical for 6 months again
  • mainly in 20-40 y/o males
  • triad
  1. painless subcutaneous mass
  2. multiple sinuses
  3. discharge containing grains
  • in earlier stage, painless nodule
    • look like the first stage of buruli ulcer
  • can invade deeper tissues and bones, leading to amputation

Tinea imbricata

  • Trichophyton concentricum
  • rare form or recurrent itchy ringworm (tinea)
  • in tropical, esp. remote villages
  • terbinafine 4 weeks

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