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;