Tropical dermatology: Tropical diseases caused by protozoa - 08/08/11

Doi : 10.1016/j.jaad.2009.03.004

Omar Lupi, MD, PhD ^a, Brenda L. Bartlett, MD ^b, Reshma Nair Haugen, MD ^c, Lady C. Dy, MD ^c, Aisha Sethi, MD ^d, Sidney N. Klaus, MD ^e, Jackson Machado Pinto, MD, PhD ^f, Francisco Bravo, MD ^g, Stephen K. Tyring, MD, PhD ^b,^h,^⁎
^a Department of Dermatology at Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
^c Department of Dermatology, Rush University Medical Center, Chicago, Illinois
^f Department of Dermatology, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
^g Department of Dermatology, Alberto Hurtado Faculty of Medicine, Alexander von Humboldt Institute of Tropical Medicine, Peruvian University Cayetano Heredia, Lima, Peru
^h Department of Dermatology, University of Texas Health Science Center, Houston, Texas
^b Center for Clinical Studies, Houston, Texas
^d Section of Dermatology, Department of Medicine, University of Chicago, Chicago, Illinois
^e Department of Medicine (Dermatology), Dartmouth Medical School, Hanover, New Hampshire

Reprint requests: Stephen K. Tyring, MD, PhD, Clinical Professor of Dermatology, Microbiology/Molecular Genetics and Internal Medicine, University of Texas Health Science Center and Center for Clinical Studies, 6655 Travis, Ste 120, Houston, TX 77030.

Abstract

Protozoan infections are very common among tropical countries and have an important impact on public health. Leishmaniasis is the most widely disseminated protozoan infection in the world, while the trypanosomiases are widespread in both Africa and South America. Amebiasis, a less common protozoal infection, is a cause of significant morbidity in some regions. Toxoplasmosis and pneumocystosis (formerly thought to be caused by a protozoan) are worldwide parasitic infections with a very high incidence in immunocompromised patients but are not restricted to them. In the past, most protozoan infections were restricted to specific geographic areas and natural reservoirs. There are cases in which people from other regions may have come in contact with these pathogens. A common situation involves an accidental contamination of a traveler, tourist, soldier, or worker that has contact with a reservoir that contains the infection. Protozoan infections can be transmitted by arthropods, such as sandflies in the case of leishmaniasis or bugs in the case of trypanosomiases. Vertebrates also serve as vectors as in the case of toxoplasmosis and its transmission by domestic cats. The recognition of the clinical symptoms and the dermatologic findings of these diseases, and a knowledge of the geographic distribution of the pathogen, can be critical in making the diagnosis of a protozoan infection.

Learning objectives

After completing this learning activity, participants should be able to recognize the significance of protozoan infections worldwide, identify the dermatologic manifestations of protozoan infections, and select the best treatment for the patient with a protozoan infection.

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Key words : amebiasis, Chagas disease, leishmaniasis, pneumocystosis, protozoa, toxoplasmosis, trypanosomiasis

Abbreviations : CA, CDC, CL, CNS, CSF, DCL, ELISA, IFN-γ, MCL, PCP, PCR, TNF-⍺, TORCH, VL, WHO