Leishmaniasis, Leprosy, Smallpox and Other Rare Skin Infections

Question 1

What is CUTANEOUS larva migrans?

Answer 1

• parasitic infection caused by the hookworm ankylostoma braziliensis.
• will see MIGRATORY PRURITIC, SERPINGINOUS rash (creeping eruption)

Question 2

With what syndrome is cutaneous larva migrans associated?

Answer 2

• Loeffler syndrome= dry cough and wheezing due to hypersensitivity reaction during the migration of parasites through lungs (pulmonary eosinophilia).

Question 3

How do you treat cutaneous larva migrans?

Answer 3

• Stibugluconate, Ivermectin, or miltefosine

Question 4

Where is cutaneous larva migrans and Leishmaniasis found?

Answer 4

• Mediterranian, Middle East, and Africa

Question 5

*** What is the vector for Leishmaniasis?

Answer 5

• SANDFLIES

Question 6

What is diagnostic of Leishmaniasis?

Answer 6

• AMASTIGOTES (intracellular form) seen within macrophages of aspirates from spleen, liver, or bone marrow.

Question 7

What is black fever or kala-azar Leishmaniasis?

Answer 7

• VISCERAL Leishmaniasis caused by Leishmania donovans.
• will see FEVER, scattered hyperpigmented spots, PANCYTOPENIA due to the bone marrow being affected, and HEPATOSPLENOMEGALY.

Question 8

How do you treat black fever or kala-azar Leishmaniasis?

Answer 8

• Amphotericin B

Question 9

What is Furuncular Myiasis?

Answer 9

• parasitic infestation of the body by fly larvae (maggots) in pts who have traveled to BELIZE.
• Ocular myiasis is larva in the eye.

Question 10

What is Tungiasis?

Answer 10

• infection with the female sand flea Tunga penetrans found in the tropical parts of Africa, the Caribbean, Central and South America, and India

Question 11

With what is reactivation leishmaniasis associated?

Answer 11

• HIV

Question 12

** What causes leprosy (Hanson’s disease)?

Answer 12

• Mycobacterium leprae carried by ARMADILLOS

Question 13

What is important to know about Mycobacterium leprae?

Answer 13

• thrives in cool temperatures (predilection for extremities).
• acid fast bacteria (mycolic acid) stained with CARBOL FUCHSIN.

Question 14

What are the 2 types of clinical presentation of leprosy (Hanson’s disease)?

Answer 14

1. TUBERCULIN response= Th1 response with cell mediated immunity (macrophages contain bacteria).
2. LEPROMATOUS response= Th2 mediated-humoral response (macrophages unable to contain bacteria). Human to Human transmission.

Question 15

What are the symptoms of the TUBERCULIN response of leprosy?

Answer 15

• demaracted hairless lesions on skin.

* positive Lepromin skin test deomonstrates good cell mediated response.

Question 16

What are the symptoms of the LEPROMATOUS response of leprosy?

Answer 16

• poorly demarcated raised lesions on extensor surfaces of extremities.
• facial deformity (LEONINE FACIES).

Question 17

How do you treat the TUBERCULIN form of Mycobacterium leporae (Hanson’s disease)?

Answer 17

• Dapsone + Rifampin

Question 18

How do you treat the LEPROMATOUS form of Mycobacterium leporae (Hanson’s disease)?

Answer 18

• Dapsone + Rifampin + Clofazimine (taken for 2 years)

Question 19

What is Smallpox?

Answer 19

• infectious disease caused by the virus Variola major.
• will see fever, headache, chills, and backache followed by eruption of papular rash that becomes pustular and then scabs.
• pt has lifelong immunity after scabs fall off.

Question 20

How can you distinguish smallpox from chickenpox (varicella)?

Answer 20

• you will see the same phase of evolution of rash throughout the entire body with smallpox.

Question 21

What is the leading infectious cause of blindness now worldwide?

Answer 21

• chlamydia trachomatis

Question 22

What is cowpox?

Answer 22

• infectious disease caused by the cowpox virus transmitted by cats.
• becomes an ulcerated nodule with black eschar.

Question 23

Is there a vaccine for smallpox?

Answer 23

YES

*will see Jennerian pustule if successful

Question 24

Is smallpox erradicated?

Answer 24

YES in 1980, but we learn it bc it can be used as bioterrorism weapon.