「South America」の版間の差分

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*acute pneumonia
 
*acute pneumonia
 
**disseminated consolidations in both lungs
 
**disseminated consolidations in both lungs
**mid-sternal lymphadenopathy
+
*mediastinal lymphadenopathy
 
**DDx: TB, sarcoidosis, lymphoma
 
**DDx: TB, sarcoidosis, lymphoma
 
*chronic lung cavity
 
*chronic lung cavity

2021年4月16日 (金) 16:02時点における最新版

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