*preventative chemoTx and transmission control (PCT) ones
*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
#edema - develops pain
#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
*''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==
==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
**black dots are seen on lesions, clusters of fungi
*Txs differ depending on #medical for 3-6 months##itraconazole#surgical bulk reducion#medical for 6 months again*mainly in 20-40 y/o males*triad#painless subcutaneous mass#multiple sinuses#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