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| Trematode (fluke, distoma)
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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
- 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
- PB - paucibacillary 2-5 lesions
- multi-drug Tx for 6 months
- single lesion
- Rideley & Jpling classification
- 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
- subcutaneous nodules
- plaque
- 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
- 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
- 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
- Treponema pallidum subsp. pertenue
- more common in children
- direct contact transmission
- yellowish, raspberry-like nodule
- 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
