Pediatric emergency medicine trisk 582

Leishmaniasis is a parasitic disease caused by the protozoan flagellates of Leishmania genus that are transmitted to humans through the bite of the phlebotomine sandfly The annual incidence is 1.5 to million The disease is found worldwide in tropical zones, with most cases in South Asia and the Horn of Africa There are three major clinical manifestations including cutaneous, mucosal, and visceral forms Immunosuppression is a risk factor for the visceral form More than 90% of visceral leishmaniasis cases occur in the Middle East, where as 90% of mucosal leishmaniasis cases occur in Peru, Brazil, and Bolivia Cutaneous leishmaniasis is more widely distributed and occurs in Central America, northern South America, northern Africa, the Middle East, and scattered portions of southern Europe Cutaneous infection presents as painless skin lesions localized to exposed parts of the body that are accessible to sandflies (e.g., extremities, face) The incubation period is approximately month The skin lesions initially present as erythematous papules, which evolve into nodules and then to shallow volcano-like ulcerative lesions that are locally destructive and have associated localized lymphadenopathy Mucosal infection may occur simultaneously or months to years after a cutaneous lesion heals Parasites may extend into the nasopharyngeal mucosa and cause nasal congestion The infection may continue to spread to the buccal mucosa and laryngeal membrane Advanced stages of the disease can involve severe tissue necrosis and disfigurement The incubation period for visceral leishmaniasis is to months and the onset of symptoms may be acute or chronic In sudden-onset cases, patients develop a persistent high fever, anorexia, a protuberant abdomen, and wasting of the limbs Painless splenomegaly is an early finding; while hepatomegaly is less common, icterus is a marker of poor prognosis TABLE 94.21 DERMATOLOGIC CONDITIONS SEEN IN RETURNING TRAVELERS Morphology Disease Region Manifestations Burrows Central/South America Botfly embryo penetrates hair follicle and develops into a boil-like pocket Botfly (myiasis) Burrowing flea (tungiasis) Eschar Ulcers Caribbean, Latin After impregnation, America, Africa, female flea Indian subcontinent burrows under skin, releasing eggs from boillike orifice S aureus, group A Global Shallow, painful, streptococcus purulent lesions that are secondarily infected by pyogenic bacteria Rickettsial Africa, Asia Subcentimeter diseases painless lesion at the site of the tick bite Buruli ulcer Americas, Africa, Painless progressive disease Asia, eastern ulcers with cotton (Mycobacterium Mediterranean appearance and ulcerans ) surrounding skin hyperpigmentation Leishmaniasis Latin America Papules which (espundia ) become nodules then shallow Central Asia painless ulcers with raised borders Granulomatous inflammation can be destructive; most common on the face Urticarial Sporotrichosis (Sporothrix schenckii) Tropical/subtropical regions in western hemisphere Cutaneous larva migrans Caribbean, Africa, Migrating intensely Asia, Latin pruritic America, serpiginous tracks southeastern United most common on States buttocks and feet Onchocerca Sub-Saharan Africa volvulus (river blindness) Sea anemone Caribbean, Latin larvae America, (Edwardsiella Philippines, lineata ), Southeast Asia jellyfish larvae (Linuche unguiculata ) Scabies (Sarcoptes Worldwide scabiei ) Ulcerative, papular, or nodular lesions at site of minor trauma, usually from contact with soil Can spread in a lymphatic pattern Pruritic rash after contact with blackfly larvae Pruritic papular rash caused by larvae entrapped under the bathing suit Pruritic erythematous eruption most common in webspaces of digits and along areas where clothing fits tightly; in infants, diffuse rash can be seen