Table 7.
Tropical diseases associated with dermatologic symptoms
| Disease | Etiologic Pathogen | Geographic Regions | Vector or Exposure | Incubation Period | Presentation | Diagnosis | Management |
|---|---|---|---|---|---|---|---|
| B virus | Macacine herpesvirus I or B virus | Worldwide | Bites, scratches, body fluids of infected macaque | 3–30 d | Fever, headache, myalgias, vesicular lesions near exposure site with neuropathic pain, ascending encephalomyelitis | PCR, virus-specific antibodies | Supportive care, postexposure prophylaxis (valacyclovir), antimicrobial therapy (acyclovir, ganciclovir) |
| Cutaneous leishmaniasis | Leishmania species | Middle East, Southwest and Central Asia, North Africa, Southern Europe, Central and South America | Phlebotomine sand fly | Weeks–months | Papules that progress to ulcerated plaques, regional lymphadenopathy, and nodular lymphangitis | Light-microscopy evaluation of specimens, cultures, molecular methods | Antimicrobial therapy (miltefosine, amphotericin B) |
| Cutaneous larva migrans | Ancylostoma species (hookworms) | Caribbean, Africa, Asia, South America | Skin contact with contaminated sand | 1–5 d | Serpiginous track on skin with pruritus and edema | Clinical | Supportive care, antimicrobial therapy if desired (albendazole, ivermectin) |
| Loiasis (African eye worm) | Loa loa | Central and West Africa | Genus Chrysops (deerflies) | 7–12 d | Localized edema of extremities and joints (Calabar swelling), diffuse pruritus, eye pruritus and pain, and photophobia | Microscopic evaluation of adult worm from eye, microscopic evaluation of microfilariae on blood smear, serologies | Surgical excision of adult worms, antimicrobial therapy (diethylcarbamazine, albendazole) |
| Lymphatic filariasis | Wuchereria bancrofti, Brugia malayi, and Brugia timori | Sub-Saharan Africa, Southern Asia, Pacific Islands, South America, Caribbean | Aedes, Culex, Anopheles, Mansonia mosquitoes | Years | Lymphatic dysfunction with affected limb edema and pain | Microscopic evaluation of peripheral blood smear, serologies | Antimicrobial therapy (diethylcarbamazine, doxycycline) |
| Myiasis | Maggots of Dermatobia hominis (human bot fly), Cochliomyia hominivorax (screw worm), and others | Central and South America, Africa, Caribbean | Bites of infected flies or egg laying on open wounds | 1–2 wk | Localized skin nodule, pruritus, discharge from punctum | Clinical, serologies | Surgical excision of larvae |
| Rat-bite fever | Streptobacillus moniliformis and Streptobacillus minus | Worldwide | Bites, scratches, oral secretions of infected rats; unpasteurized milk or contaminated food or water | 7–21 d | Relapsing fever, maculopapular or purpuric rash, migratory polyarthritis, lymphadenopathy | Culture, darkfield microscopy, stained peripheral blood smear | Antimicrobial therapy (penicillin G) |
| River blindness (onchocerciasis) | Onchocerca volvulus | Sub-Saharan Africa, Middle East, South America |
Genus Simulium (blackflies) | Weeks –years | Pruritic, popular rash with subcutaneous nodules, lymphadenitis, ocular lesions, vision loss | Microscopic evaluation of skin shavings with microfilariae, histologic evaluation, serologies | Antimicrobial therapy (ivermectin + doxycycline) |
| Scabies | Sarcoptes scabiei var. Hominis | Worldwide | Prolonged skin-to-skin contact, fomites if crusted scabies | 2–6 wk | Nocturnal pruritus, papulovesicular rash, crusts and scales if crusted scabies | Microscopic evaluation of skin scraping | Antimicrobial therapy (permethrin, ivermectin creams) |
| Strongyloidiasis | Strongyloides stercoralis (roundworm) | Worldwide | Skin penetration with contaminated soil | Unknown | Localized, pruritic, erythematous popular rash, pulmonary symptoms (Löffler-like pneumonitis), diarrhea, abdominal pain, eosinophilia, serpiginous urticarial rash (larva currens) | Microscopic evaluation of stool, peripheral blood eosinophilia if disseminated, serologies | Antimicrobial therapy (ivermectin, albendazole) |
| Tungiasis | Tunga penetrans (chigoe flea, jigger, sand flea) | Africa, South America | Skin penetration (especially walking barefoot) | 1–2 d | Localized pruritus and pain with lesions and ulcerations with central black dot | Clinical | Extraction of flea using sterile needle |
Adapted from Beeching N, Beadsworth M. Fever on return from abroad. In: Acute medicine-A practical guide to the management of medical emergencies. 5th edition. 2017. p. 207–14; and Centers for Disease Control and Prevention. The yellow book: health information for international travel 2018. Philadelphia: Oxford University Press; 2017. p. 704. Available at: https://wwwnc.cdc.gov/travel/page/yellowbook-home. Accessed July 25, 2017; with permission.