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→disease
*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
