boards’ fodder Tropical dermatology: Bacterial and viral infections by Kristen Whitney, DO

Disease Organism Clinical Findings Treatment/Misc.

Bacterial Infections Yaws Treponema pallidum (sub- Primary: Erythematous papule at site of Benzathine Penicillin G species pertenue) inoculation (“mother yaw).” Secondary: Numerous smaller “daughter yaws” often near orifical sites. Tertiary: Skin abscesses that ulcerate; bone, joint and soft tissue deformities. Pinta Treponema carateum Skin only involvement. Benzathine Penicillin G Primary: Enlarging papule that progesses to infiltrative plaque. Secondary: Small scaly papules that pro- gesses to psoriasiform plaques. Teritary: Depigmented patches.

Endemic syphilis Treponema pallidum (sub- Primary: Skin lesions rare. Benzathine Penicillin G (Bejel) species endemicum) Secondary: Mucous membrane patches, papular skin eruptions, condyloma lata, lymphadenopathy. Tertiary: Gumma formation of skin, bones, cartilage, mucous membrane.

Buruli ulcer Mycobacterium ulcerans Nontender nodule that progresses to ulcer- Excision, heat, streptomy- ation. cin and rifampin.

Tropical ulcer Polymicrobial Painful, rapidly growing ulcer, often on leg. Tetracycline and metroni- Fusobacterium, Bacillus dazole. fusiformis, Treponema vincenti Cutaneous tubercu- Mycobacterium tubercu- Deep abscesses in skin resulting from Rifampin, Isoniazid, losis-scrofuloderma losis contiguous spread from underlying tuber- Pyrazinamide, Ethambutol. culosis lymphadenitis (lymph nodes) or infection of bones/joints.

Tropical pyomyositis Staphylococcus aureus Abscesses in muscles on limbs and Surgical drainage, IV anti- extremities. biotics.

Typhoid fever Salmonella typhi “Rose spots” often on abdomen. Ciprofloxacin or Amoxicillin.

Brucellosis Brucella spp. Malodorous perspiration, skin lesions in Doxycycline and Rifampin. less than 10% (violaceous papulonodules, erythema nodosum, cutaneous vasculitis), fevers, arthralgias, hepatospenomegaly. Granuloma inguinale Klebsiella granulomatosis Painless ulceration with beefy red granula- Streptomycin, tion tissue in the genital region. Chloramphenicol, Azithromycin, Bactrim or Tetracyclines.

Donovan bodies on histol- ogy. Chancroid Haemophilus ducreyi Painful, non-indurated ulcer and buboes. Azithromycin, Ceftriaxone Kristen Whitney, DO, or Ciprofloxacin. recently graduated from residency and School of fish pattern on will be an attending gram staining. physician at a private Leprosy Mycobacterium leprae Tuberculoid: Hypopigmented, anesthetic, Pauibacillary: Dapsone and practice in Pittsburgh, anhidrotic plaque. Rifampin. Pennsylvania Lepromatous: Symmetric, skin-colored to erythematous macules/papules/nodules, Multibacillary: Dapsone, leonine facies, madarosis, enlarged periph- Rifampin, and Clofazamine. eral nerves.

irinections D­Residency p. 1 • Fall 2016 boards’ fodder Tropical dermatology: Bacterial and viral infections (cont.) by Kristen Whitney, DO

Disease Organism Clinical Findings Treatment/Misc. Bacterial Infections (cont.) Actinomycotic Nocardia spp, Granulomatous infection of dermal and Actinomycotic- mycetoma Actinomadura spp and subcutaneous tissue; draining sinuses Streptomycin or Amikacin Streptomyces somaliensis containing grains, local edema. plus Bactrim or Dapsone.

Splendore-Hoeppli phe- nomenon on histology.

Vibrio infection Vibrio vulnificus Painful, hemorrhagic bullae with underlying Oral tetracyclines or 3rd cellulitis, fever, chills, abdominanl pain. generation cephalosporins.

Rhinoscleroma Klebsiella rhinoscleromatis Granulomatous nodule, often intranasal Long-term antibiotics, that can grow into a large tumor. surgery.

Russell bodies and Mikulicz cells on histology. Glanders Burkholderia mallei Fever and one of the following: nodule Augmentin, Doxycycline, with lymphadenitis or mucous membrane TMP-SMX. ulceration, or septicemia with cutaneous papules/pustules, or pulmonary form.

Melioidosis Burkholderia pseudomallei Pustules or subcutaneous abscesses, high Supportive care, draining of fevers, rigors, diarrhea, jaundice. abscesses, and antibiotic therapy.

Bartonellosis Bartonella baciliformis Acute stage (Oroya fever): Fever, arthral- Chloramphenicol, penicil- (Carrion’s disease) gias and hemolytic anemia. lins, aminoglycosides Transmitted by Lutzomya (acute phase); rifampin, verrucarum sandfly Chronic stage: Erythematous papules/ streptomycin (chronic nodules phase).

Viral Infections Viral hemorrhagic Ebola, Marburg, Lassa, Non-specific cutaneous eruptions (petechi- Supportive care. fevers Hantavirus, Yellow fever, ae, purpura, mucosal hemorrhage), clini- Rift Valley fever, Crimean- cally ranges from mild, self-limited disease Hantavirus, Rift Valley fever Congo hemorrhagic to severe, fatal disease. and Lassa virus repond to fevers, viruses Ribavirin.

Yellow fever: Aedes aegypti mosquito RVF: Aedes mosquito, contact with infected tissue Ebola, Marburg: Bats and contact with infected human tissue Crimean-Congo: Tick- borne, contact with infect- ed human tissues Hanta, Lassa: Rodents Dengue fever Dengue virus Asymptomatic infection to life-threatening; Supportive care. fever, headaches, retroorbital pain, severe Transmitted by Aedes joint pains; morbilliform or scarlitiniform mosquito exanthem with islands of sparing in 50%, petechiae, gingival bleeding.

West nile virus West nile virus Fever, headaches, encephalitis, myalagias, Supportive care. nausea, vomiting, eye pain; exanthem in Transmitted by Culux up to 25%. mosquito

irinections D­Residency p. 2 • Fall 2016 boards’ fodder Tropical dermatology: Bacterial and viral infections (cont.) by Kristen Whitney, DO

Disease Organism Clinical Findings Treatment/Misc.

Viral Infections (cont.) Chikungunya fever Chikungunya virus Fever, headaches, nausea, vomiting, Supportive care. myalgias, several cutaneous presenta- Transmitted by tions (morbiliform, vesiculobullous, acral/ Aedes aegypti mosquito facial erythema and genital, intertriginous and oral ulcers), severe low back pain and arthralgias. Adult T-cell leuke- HTLV-1 (human Acute: leukemia, lymphadenopathy, Zidovudine and IFN-α, che- mia/lymphoma T-lymphotrophic virus organomegaly, skin lesions. motherapy. type 1) Chronic: patches/plaques/papular skin lesions (resembles mycosis fungoides). Transmitted person-to- person through blood or sexual contact Monkeypox Monkeypox virus Flu-like symptoms, diffuse papular eruption Supportive care. that progresses to vesiculopustules then Transmitted by contact crusts. with infected person or animal via body fluids

Zika virus Zika virus Exanthem in 90% (morbilliform/small Supportive care papules, descends from trunk to lower Transmitted by Aedes body) arthritis, conjunctivitis, and WHO named Zika a global mosquito headache. Fever is not prominent and health threat (2016) as in low-grade if present. utero infection can cause microcephaly in fetus

References 1. Bolognia J, Jorizzo J, Schaffer J, et al. Dermatology. Elsevier. 3rd edition. 2012. 2. Lupi O, Madkan V, Tyring SK. Tropical dermatology: bacterial tropical diseases. J Am Acad Dermatol. 2006;54(4):559-78. 3. Lupi O, Tyring SK. Tropical dermatology: viral tropical diseases. J Am Acad Dermatol. 2003;49(6):979-1000. 4. Derrington, SM, et al. “Mucocutaneous Findings and Course in an Adult With Zika Virus Infection.” JAMA Dermatol. 2016 Jun 1;152(6):691-3. 5. Farahnik, B, et al. “Cutaneous manifestations of the Zika virus.” J Am Acad Dermatol. 2016 Jun;74(6):1286-7.

irinections D­Residency p. 3 • Fall 2016