South America

climate and vegitation

• tropical to temperate
• much rain to dry
• rain forest to desert
• low to high altitude
• mosquito to snake bite

HTLV-1 population offspring of Japanese immigrants

• related to stronglyoides

Bartonella

• Bartonella henselae
  • cat flea
  • cat scratch disease
• B. quintana
  • body lice
  • trench fever
• B. bacilliformis
  • sandfly (female) - Lutzomyia spp.
  • Carrion's disease, Oroya fever
  • Colombia, Ecuador, Peru
  • obligate intracellular (intra RBC)
  • acute phase vs chronic phase
    • CFR in acute phase >80%
    • chronic: angioprolific cutaneous disease (warts)
      • veruga peruana

Chagas disease

pathogen

Trypanosoma cruzi

transmission

• Triatomine insect (reduvid bug) borne
  • food contaminated with triatomine faeces
  • skin wound contamination with triatomine faeces, including sucking by triatomine
• blood transfusion, organ transplant from chronic career

disease

• acute disease only in 1% of infected
  • Romaña sign
  • chagoma
• chronic
  • 30-40% after 10-20 years
  • megacolon
  • RBBB in heart
  • cardiac aneurysm

diagnosis

• serology IgM/IgG
• culture in NNN media
• blood smear

treatment

• benznidazole
• nifurtomox
• cardiac treatment

prevention

• insecticide spraying
• bed net
• blood screening
• improving construction

Leishmaniasis

pathogen

• Leischmania braziliensis
• L. venezuelensis
• L. amazonesis
• L. peruviana
• L. guyanensis
• L. panamensis

vector

• sandfly

disease

• mucocutaneous leishmaniasis
  • severe deformation of nose, lips and mouth
• cutaneous lieshmaniasis
  • chiclero's ulcer
    • chiclero = a person who extracts gum from wild or cultivated trees

Paracoccidiodomycosis

pathogen

• Paracoccidioides brasiliensis
• soil-transmitted fungus
• dimorphic fungus
  • mould <28℃
  • yeast >37℃

epidemiology

• confined to Latin America, esp. Brazil 80%
• male vs female 14:1
  • most patients from tobacco/coffee crops
  • female hormone inhibit the transformation to yeast

disease

• pneumonia
  • cough, sputum, hemoptysis, fever, weight loss
• mimic pulmonary tuberculosis not only in history but also in imaging
• skin and mucous membrane lesion
  • ulcer, painful
  • teeth loss
• bone erosion

diagnosis

• KOH microscopy of oral mucosa, skin lesion, sputum
  • Mickey Mouse or ship pilot wheel appearance of yeast form
• histopathology
  • epithelioid granulomas
  • microabscess

treatment

• co-trimoxazole
• itraconazole

Histoplasmosis

pathogen

• Histoplasma capsulatum var. capsulatum
• soil habitant fungus
• dimorphic fungi

transmission

• inhalation of fungus containing soil, bird excreta, bat guano

risk

• occupational, building cleaning
• cave exploration (spelunking)
• cell-mediated immunocompromised
  • HIV
  • anti-TNF inhibitors
  • other immunosupression

distribution

• Latin America
• eastern part of north America
• sub-Saharan Africa
• Nepal - Bangradesh - Indochina peninsula

disease

• acute pneumonia
  • disseminated consolidations in both lungs
• mediastinal lymphadenopathy
  • DDx: TB, sarcoidosis, lymphoma
• chronic lung cavity
  • associated with smoking/COPD
  • DDx: TB, aspergillosis
• progressive disseminated histoplasmosis
  • risk at HIV CD4<150

diagnosis

• culture on Sabouraud's agar
  • 4-8 weeks
• serology
• antigen test in urine

treatment

• liposomal amphotericin B
• itraconazole