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==LeischmaniasisLeishmaniasis=====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
