Schistosomiasis— Sub-Saharan Africa Katayama fever Schistosoma— Sub-Saharan Africa swimmer’s itch (freshwater), digger’s itch (saltwater) High fever, urticaria, eosinophilia weeks after contact with freshwater in endemic areas Pruritic rash after skin is penetrated by schistosomal cercaria Laboratory findings include anemia, thrombocytopenia, hypoalbuminemia, and hypergammaglobulinemia Untreated visceral infection is nearly always fatal Diagnosis of the cutaneous form is through identification of leishmanial organisms via Wright or Giemsa stain of tissue samples Visceral disease is diagnosed via bone marrow (iliac crest in children), spleen, or less commonly, liver aspirations Treatment is always indicated for the mucosal and visceral cases The drug of choice for visceral and mucosal disease is liposomal amphotericin B Miltefosine can be used to treat all three forms and is FDA approved for patients ≥12 years old Sodium stibogluconate, an antimonial, has also been used in the treatment of leishmaniasis, but has multiple potential adverse events including cardiotoxicity (EKG changes findings include STelevation or depression, T-wave inversion, and QT-interval prolongation), hepatitis, pancreatitis, nephrotoxicity with proteinuria, phlebitis, myelosuppression, and optic atrophy Treatment of localized cutaneous disease depends on the type and characteristics of the lesion Those that are rapidly selfhealing can remain untreated Systemic treatment is recommended for large or multiple cutaneous lesions Diffuse cutaneous disease is resistant to treatment Expert consultation through the CDC Division of Parasitic Diseases and Malaria: (404) 718-4745 or (770) 488-7100 is strongly suggested Standard isolation precautions are recommended Cutaneous Larva Migrans CLM is caused by the larval form of canine and feline hookworms (Ancylostoma species), found in fecal material in soil or sand These nematodes can penetrate intact skin; infection is most common in tropical regions, especially on beaches While most common in travelers returning from the Caribbean, Latin America,