Pediatric emergency medicine trisk 2329 2329
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Schistosomiasis— Sub-Saharan Africa
Katayama fever
Schistosoma—
Sub-Saharan Africa
swimmer’s itch
(freshwater),
digger’s itch
(saltwater)
High fever, urticaria,
eosinophilia
weeks after
contact with
freshwater in
endemic areas
Pruritic rash after
skin is penetrated
by schistosomal
cercaria
Laboratory findings include anemia, thrombocytopenia, hypoalbuminemia,
and hypergammaglobulinemia. Untreated visceral infection is nearly always
fatal. Diagnosis of the cutaneous form is through identification of leishmanial
organisms via Wright or Giemsa stain of tissue samples. Visceral disease is
diagnosed via bone marrow (iliac crest in children), spleen, or less commonly,
liver aspirations. Treatment is always indicated for the mucosal and visceral
cases. The drug of choice for visceral and mucosal disease is liposomal
amphotericin B. Miltefosine can be used to treat all three forms and is FDA
approved for patients ≥12 years old. Sodium stibogluconate, an antimonial, has
also been used in the treatment of leishmaniasis, but has multiple potential
adverse events including cardiotoxicity (EKG changes findings include STelevation or depression, T-wave inversion, and QT-interval prolongation),
hepatitis,
pancreatitis,
nephrotoxicity
with
proteinuria,
phlebitis,
myelosuppression, and optic atrophy. Treatment of localized cutaneous disease
depends on the type and characteristics of the lesion. Those that are rapidly selfhealing can remain untreated. Systemic treatment is recommended for large or
multiple cutaneous lesions. Diffuse cutaneous disease is resistant to treatment.
Expert consultation through the CDC Division of Parasitic Diseases and Malaria:
(404) 718-4745 or (770) 488-7100 is strongly suggested. Standard isolation
precautions are recommended.
Cutaneous Larva Migrans
CLM is caused by the larval form of canine and feline hookworms (Ancylostoma
species), found in fecal material in soil or sand. These nematodes can penetrate
intact skin; infection is most common in tropical regions, especially on beaches.
While most common in travelers returning from the Caribbean, Latin America,
