📟 14 YO boy from Ghana with 🤒 & malaise reports a 5 week history of mulriple skin lesions, which are show below. The lesions on his legs are painful & pruritic. He says multiple kids from his school have them too
🧪- VDRL & FTA-ABS +
❓What organism most likely caused this?
Answer: Treponema pallidum subsp pertenue
🎙Endemic Treponematoes:
🚨Yaws:
🦠- Treponema pallidum subsp pertenue
🗺- Africa, Asia, Latin America, Pacific Islands
Incubation ⏲- 3 wks
Transmission - auto inoculation, close contact with infected lesion
🔎- 🧒🏻👧🏻
Primary Stage -
😣, pruritic ulcer that looks like raspberries. These are highly contagious. 🩹 in several mo.
Secondary Stage - appear as primary lesion is healing. Wks- mo. Associated with 🤒 & malaise.
1️⃣Daughter Yaws: lesions are raised
2️⃣🦀 Yaws: plantar or palmer hyperkeratosis causing a painful 🦀like gait
3️⃣ Condyloma lata
4️⃣ Periostitis, osteitis, & dactylitis
🚨Pinta:
🦠- T pallidum subsp carateum
🗺- Central & South America, Caribbean
Incubation ⏲- 3 wks
Transmission - direct contact with skin lesions
🔎- at any age
Primary Stage - small erythematous papules that coalesce & become hyperpigmented over mo.
Secondary Stage - pintids
scaly papules that get darker
Tertiary Stage - lesions become depigmented
🔬- dark field microscopy or immunofluroscence
🧪- nontreponemal (RPR and VDRL) and treponemal (FTA-ABS and TPPPA serology
👇🏼
Won’t be able to differentiate between the 3 and Syphilis
💊- IM benzathine pen G
‼️Leishmaniasis is a protozoal infection caused by the sandfly vector.
It can cause visceral (Old World, Kala-azar) or cutaneous (New World, mucocutaneous, Espundia) disease depending on the species and location
L major cause CL but the ulcer, which develops wks-mo. after inoculation are usually painless with induration borders. Think 🍕
I should mention that CL wouldn’t be VDRL & FTA-ABS + either. 🙏🏼
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📟 A farmer from the Dominican Republic is here in the US visiting family & presents with a swollen foot that has been progressing over the past 8 years
📸 of his R foot along with biopsy of lesion
❓What is the mostly likely organism?
Answer: Madurella mycetomatis
🎙Cutaneous Fungal/Mold Infections:
🚨Madurella mycetomatis: Eumycetoma or “Madura foot”
🔎- traumatic inoculation ➡️ chronic nodular lesions w/ sinus tracts w/ macroscopic grains ➡️ 🦴 Evolve over yrs
🔬- grain w/ numerous hyphae
👇🏼
This is fungal
Derm… ☠️ Let’s break it down starting with viral exanthems. Follow the 🧶
🚨Coxsackievirus:
1️⃣✋🏼,🦶🏼, & mouth disease - Coxsackie A > Coxsackie B or EV71
🔎 - 😣 ulcerative lesions on hard palate, 👅, buccal mucosa ➡️ vesicular rash on 🤲🏼 &🦶🏼
2️⃣ Atypical HFMD
🔎- vesiculobullous rash or crusted papules (Gianotti-Crosti syndrome). Associated with skin and 💅🏼 peeling. At sites of atopic eczema (eczema coxsackium)
Post-exposure prophylaxis. As with all things, timing maters 😷
1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease
or Hep B/C infection
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠
2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days