Edward C. Keystone MD

Skin problems in returned travellers; what’s eating U? Jay S. Keystone/Edward C. Keystone MD Thursday, 19 April, 12 Skin problems in returned trave...
Author: Evan Franklin
4 downloads 0 Views 6MB Size
Skin problems in returned travellers; what’s eating U? Jay S. Keystone/Edward C. Keystone MD

Thursday, 19 April, 12

Skin problems in returned travellers Disorder pyoderma

lederman Caumes n=4,594 ’08 n=269 ’95

Herbinger n=4,158 ’11

16 10

18 25

22 8

Insect bite

8

10

17

allergic reaction leishmaniasis

5 3

6 3

5 2.4

myiasis

3

9

cutaneous larva migrans

Thursday, 19 April, 12

2

0.8

Thursday, 19 April, 12

Thursday, 19 April, 12

Case i. A 35 year old female returns from C. America with a pruritic rash ! over the next 6 months she complains of recurrence of lesions, one or two at a time.

• 

•  •  •  •  • 

Insect bites: - pattern (clusters, linear) - fleas, bedbugs, mites, reduviid bugs - painful - tse tse, black fly, ants - recurrent, pruritic, papular urticaria - Rx: topical steroids, hydroxyzine 5

Thursday, 19 April, 12

6 Thursday, 19 April, 12

Fire ant bite 6 Thursday, 19 April, 12

Bed bug bite

Fire ant bite 6

Thursday, 19 April, 12

Flea bite

Bed bug bite

Fire ant bite 6

Thursday, 19 April, 12

Thursday, 19 April, 12

8 Thursday, 19 April, 12

Thursday, 19 April, 12

Ivermectin Thursday, 19 April, 12

Case v. A 6 months old immigrant child from Honduras presents with a 3 week history of a papular, pustular rash. Scabies

•  mite infection from direct contact papular, pustular, vesicular, very pruritic rash •  location: intertriginous, genitals, abdomen, axillae, extensor surfaces •  dx; clinical, scrape burrow and examine microscopically •  Rx: lindane (↑ resistance), 5% permethrin, ivermectin •  Norweigen scabes: no pruritus, 1000 s 10mites Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

16 Thursday, 19 April, 12

Thursday, 19 April, 12

Case vi. A 35 year old traveler returns from one month in rural Venezuela with a painful lesion on his great toe, present for two weeks

Tungiasis (chigoe, jigger, sand flea): •  Africa, South and Central America, India •  female flea burrows into foot •  painful nodule •  surgical: extract flea 18 Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Case vii. A 50 year old man returns from two weeks in Belize, urban and rural travel, complaining of lesions on his arms; sharp jabs of pain with a feeling that something is moving inside

Myiasis (Tumbu & Bot fly) •  egg deposition onto skin •  furunculoid lesion; central opening; usually painful; movement inside ugh! •  Rx : suffocate with paraffin (vaseline, bacon fat, crazy glue, nail polish) •  extraction by lateral pressure, rarely surgery 31 Thursday, 19 April, 12

Thursday, 19 April, 12

Case viii. A 35 year old fisherman presents with nodular lesions on his hand which move progressively up his arm.

Fish tank or swimming pool granuloma •  inoculation of Mycobacterium marinum found in fresh or brackish water •  Dx. Culture •  Tx: doxycycline; rifampin and ethambutol 33 Thursday, 19 April, 12

Lymphocutaneous disease • Sporotrichosis • M.marimum • Leishmaniasis • Nocardiosis • Bartonellosis • Tularemia 34 Thursday, 19 April, 12

Thursday, 19 April, 12

36 Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Case ix .A 30 year old man returns from Jamaica; one week after return complains of a severely pruritic, serpiginous, linear, progressing rash with bullae on his foot.

Cutaneous larva migrans: •  very pruritic linear, serpigenous lesions; occasionally bullous •  Rx: topical or oral thiabendazole, albendazole, ivermectin •  suspect strongyloidiasis (larva currens); - perianal larval track - rapid migration, up to 10 cm/hr - prolonged symptoms 40 Thursday, 19 April, 12

Thursday, 19 April, 12

42 Thursday, 19 April, 12

Case x An 18 year old woman returns from St. Lucia and notices (one the plane) a linear pigmented rash on her leg which seems to be darkening. No pruritus or pain.

Phytophotodermatitis: (Limes disease) •  psoralen containing compounds (lime juice) which cause UVA •  photosensitization •  painless, erythematous, pigmented, straight streaks or droplets 43 Thursday, 19 April, 12

Thursday, 19 April, 12

Case Xii .A 23 year old Vietnamese man, recently arrived in the U.S. complains of fever for 3 days. On examination you note a rash on his back.

Indigenous medicine: •  scratching the wind or coining •  linear bruises from rubbing with a coin to increase circulation and cure the fever •  common among Vietnamese of Chinese origin 45 Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

51 Thursday, 19 April, 12

52 Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Leishmaniasis: immunological spectrum Normal Low High

Thursday, 19 April, 12

Leishmaniasis: immunological spectrum Normal Low High MCL

Thursday, 19 April, 12

Leishmaniasis: immunological spectrum Normal Low High MCL

Thursday, 19 April, 12

LR

Leishmaniasis: immunological spectrum Normal Low High MCL

Thursday, 19 April, 12

LR

CL

Leishmaniasis: immunological spectrum Normal Low High MCL

Thursday, 19 April, 12

LR

CL

DCL

Chronic ulcers or nodules

• leishmaniasis • TB • atypical mycobacteria • fungus 58 Thursday, 19 April, 12

Thursday, 19 April, 12

Case xxi. A 35 year old returns three days ago from four weeks in South Africa, both urban and rural stay, complains of fever, inguinal discomfort and a lesion on his leg. Eschar: •  Mediterranean, Indian, African tick typhus (R. conorii) or S.E. Asian scrub (mites) typhus (R. tsutsugamushi) •  febrile illness + rash •  DDx: anthrax, (edematous margins), spider bite (Brown recluse; loxesceles, herpes zoster, trypanosoma chancre •  Dx: serology •  Rx: tetracycline 60 Thursday, 19 April, 12

Tropical Dermatology Summary • Epidemiology is everything! (travel and exposure history, in particular) • When in doubt, cut it out..and culture it! • chronic nodules,plaques or ulcers: usually leishmaniasis,fungus or mycobacteria • If it moves ,it is probably alive…and a parasite! Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Thursday, 19 April, 12

Suggest Documents