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