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Respiratory Pharyngitis, Cough, Hemoptysis, Pneumonia, Lesions Visible on CXR
Diphtheria (Worldwide): Diphtheria is an acute upper respiratory infection caused by virulent strains of the toxin-producing gram positive bacillus, Cornybacterium diphtheriae. Symptoms include fever, serosanguinous nasal discharge, sore throat, and gray pseudomembrane in the pharynx, nasopharynx, and/or trachea. Complications include respiratory tract obstruction, pneumonia, peripheral neuritis, and/or myocarditis. Immunization is essentially universal among younger people in the U.S., but some refugees and immigrants may not be immunized. Treatment includes (1) diptheria antitoxin within 48 hours of onset (after testing for sensitivity to antitoxin); (2) procaine penicillin G 600,000 units IM bid for 14 days (150,000 units/kg/day IV for 10 days for pediatric patients) or erythromycin 500 mg parenterally or po qid; (3) bedrest and supportive care; and (4) isolation until secretions are noncontagious. With some differences in regime, carriers are also treated.
HIV/AIDS: HIV/AIDS is found world-wide, and is especially common in sub-Saharan Africa, Southeast Asia, and India. Heterosexual transmission is common in these areas. Readers are referred to the CDC and other current sources of information (See links).
Other more common upper respiratory infections
Ascariasis: See full discussion (Worldwide): Ascariasis is a nematode or roundworm infection with Ascaris lumbricoides causing transient respiratory symptoms initially and chronic gastrointestinal symptoms. The adult worms are more than 20 cm. in length, hence are easily seen in stool and may also emerge from the nose or mouth as a result of coughing or vomiting. Treatment is with albendazole single dose of 400 mg po (not FDA approved) or mebendazole or pyrantel pamoate.
Common bacterial and chlamydial respiratory infections
Lassa hemorrhagic fever: See full discussion of HFs (West Africa, including Nigeria): Lassa fever is caused by hantavirus. The incubation period ranges from 7-21 days. Presentation of Lassa fever varies. Common early symptoms are gradual onset of fever, malaise, headache, and abdominal pain. Other symptoms are conjunctivitis, facial swelling, sore throat, non-productive cough, retrosternal pain, nausea, vomiting, diarrhea, back pain, and myalgia. Respiratory rate, temperature, pulse rate are increased and blood pressure decreased. Neurological symptoms may also occur, including hearing loss, tremors, and encephalitis. Hemorrhagic manifestations (not usually evident) may include mucosal bleeding and, less frequently, conjunctival, gastrointestinal, or vaginal bleeding. Severe infections produce hemorrhagic manifestations, pleural effusions, and shock. Pregnant women are more likely to die than are others. Some degree of deafness occurs in about 30% of patients. Treatment is supportive and also includes ribavirin as discussed in the full discussion of hemorrhagic fevers.
Leptospirosis: See full discussion (Worldwide, especially tropical areas of Latin America and Southeast Asia): Leptospirosis is a spirochette (Leptospira interrogans) infection transmitted primarily through exposure to water contaminated with urine from infected animals. Leptospirosis varies from asymptomatic to a severe or fatal illness. There are two common forms (anicteric and icteric or Weil's syndrome). Anicteric leptospirosis is the more common and milder form, and often is biphasic, with the first phase characterized by sudden onset high fever with chills, headache, conjunctival suffusion, cough and pulmonary chest pain, abdominal pain, nausea and vomiting, and myalgia. The illness may resolve after about one week with no further manifestations; or, after one to three days, recur with milder and more varied symptoms than in the first phase - except that aseptic meningitis may occur. Icteric leptospirosis or Weil's syndrome is the more severe form and is characterized by symptoms as described above (except not usually biphasic); and after about one week, the development of decreased renal function, pulmonary complications, jaundice, and/or hemorrhagic manifestations. Treatment includes antibiotics (doxycycline, penicillin, or others) and support.
Paragonimiasis (lung-dwelling trematode infection) (Asia, Latin America, Africa): Paragonimus sp. are lung-dwelling (as well as other sites) trematodes. Infection is most frequently linked with ingestion of incompletely cooked or pickled shellfish. Paragonimiasis may persist for many years and thus present as acute or chronic illness - though chronic is the more common. Acute illness may include fever, cough, pleural effusion, and hepatosplenomegaly. Chronic paragonimiasis is characterized by cough, dyspnea, hemoptysis, brown-flecked sputum, and pleuritic chest pain. X-ray shows (depending on length of illness) diffuse or segmented infiltrates, nodules, cavities, ring cysts, and/or pleural effusions. Extrapulmonary infections may manifest with abdominal pain, diarrhea, and CNS symptoms. Treatment is with praziquantel 25 mg/kg tid for two days.
Pertussis or whooping cough (Worldwide): Most refugees and immigrants arrive in the U.S. with at least the first series of immunizations. However, not all records are accurate and some small risk exists for pertussis and other such illnesses. The infectious agent is Bordetella pertussis. Pertussis occurs in three stages: (1) The catarrhal stage is manifested by gradual onset of slight fever, dry cough, coryza, sneezing, malaise, and anorexia. (2) The paroxysmal stage begins 10-14 days after onset of symptoms and lasts 4-6 weeks. This stage includes the characteristic whooping cough (paroxysmal violent coughing spells with respiratory distress and without intervening inhalation and then a high-pitched inspiratory crowing whoop). Mucous is copious, clear, and tenacious; and vomiting may follow coughing. Coughing is most severe for the first 10-14 days of the paroxysmal stage and then severity gradually decreases. Paroxysms of coughing and the whoop are not always present in older children or adults. (3) The convalescent stage is marked by a chronic cough lasting as long as two years. Treatment includes respiratory isolation until the patient has received at least five days of a 14 day course of antibiotics; erythromycin (estolate form preferred) 50 mg/kg/day in 2-4 divided doses with a maximum of 2 gm/day for 14 days; supportive care is given in the hospital for younger and older patients. Cough suppressants are ineffective.
Pneumonia: See anthrax, ascariasis, blastomycosis, coccidioidomycosis, histoplasmosis, HIV/AIDS, legionellosis, paragonimiasis, plague, psittacosis, Q fever, typhus, strongyloidiasis, tuberculosis. Note other, more common causes.
Psittacosis (Worldwide): Psittacosis is Chlamydia psittaci infection contracted from infected birds. Psittacosis is characterized by rapid onset of fever, chills, headache, dry cough, myalgia; and later development of dyspnea and atypical pneumonia. Complications include endocarditis, hepatitis, or neurologic complications. Except for contact with birds, psittacosis is indistinguishable from viral, mycoplasmic, or other atypical pneumonias. Treatment is with tetracycline or erythromycin.
Q fever (Worldwide): Q fever is a rickettsial zoonosis (infection with gram negative Coxiella burnetii) contracted primarily from inhalation of dust contaminated by infected animals, especially sheep, cattle, and goats; and also other mammals. Other routes of infection include contact with milk and tissue from infected animals. Manifestations of acute Q fever include fever, fatigue, headache, cough, abdominal pain, nausea, diarrhea, and myalgia. Pneumonia develops in a small number of patients. Other complications are hepatitis, pericarditis, myocarditis, and meningoencephalitis. Hepato/splenomegaly and endocarditis are common in chronic Q fever. Endocarditis is frequently associated with purpuric rash, renal insufficiency, stroke, and heart failure. Treatment of acute Q fever is with doxycycline or a quinolone. Chronic Q fever requires combination therapy such as rifampin and doxycycline.
Toxocariasis (Worldwide): Toxocariasis is the most common visceral larva migrans and is due to infection with the tissue nematode (roundworm) toxocara canis or T. cati. Toxocariasis is most common among children who eat feces-contaminated dirt. Most infections are small load and asymptomatic except for mild eosinophilia. Heavy worm loads, decreased immune competence, and other factors may lead to malaise, fever, cough and wheezing, hepatomegaly, anorexia, and weight loss. Ocular toxocariasis also occurs and usually leads to decreased vision. For symptomatic infections, the treatment of choice is diethylcarbamazine 6 mg/kg/day po tid for 10 days. Asymptomatic infections are not necessary to treat.
Tuberculosis (Worldwide): Tuberculosis (TB) is a chronic infection - most commonly pulmonary - caused by the acid-fast bacillus, Mycobacterium tuberculosis. Infection is usually acquired through inhalation of infected droplets expelled by cough from a person with active disease. Most cases (85%) of TB are pulmonary. Pulmonary symptoms include cough, chest pain, and hemoptysis. Constitutional symptoms are often present in pulmonary disease, and include fever, chills, night sweats, fatigue, decreased appetite, and weight loss. Symptoms of extrapulmonary TB depend on the site(s) of infection. Tuberculosis should always be ruled out in any person at-risk or with the above symptoms. Medical evaluation includes complete medical and family/close contacts/travel history, physical examination, Mantoux tuberculin skin test, chest x-ray, and appropriate bacteriologic or histologic examinations, e.g., smear and culture of sputum. Treatment is according to (1) classification of disease, e.g., exposure without infection, infection without disease, current TB disease, previous TB disease, or TB suspected; (2) whether disease is drug-resistant; (3) immune status of the patient; and (4) other factors. The treatment of TB is complex and is evolving at a rapid pace. Readers are referred to the U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/ for current standards of testing and treatment.
Ascariasis: See full discussion (Worldwide): Ascariasis is a nematode or roundworm infection with Ascaris lumbricoides causing transient respiratory symptoms initially and chronic gastrointestinal symptoms. The adult worms are more than 20 cm. in length, hence are easily seen in stool and may also emerge from the nose or mouth as a result of coughing or vomiting. Treatment is with albendazole single dose of 400 mg po (not FDA approved) or mebendazole or pyrantel pamoate.
Echinococcosis (Hydatid disease): See full discussion (Most of the world; endemic in South America, North Africa, Middle East, Southern Europe - especially in areas where sheep are raised). Echinococcosis or hydatid disease is a tapeworm infection that often is asymptomatic, especially in the lengthy early stages. Echinococcus embryos trapped in various organs (especially the liver or lung) develop into hydatid cyst(s), which grow and eventually cause dysfunction according to the function or area of the organ(s). Surgical excision of the cyst remains the treatment of choice. Albendazole is given pre and post-operatively. Drug treatment includes albendazole or mebendazole or praziquantel - all with poor cure rates.
Paragonimiasis (lung-dwelling trematode infection) (Asia, Latin America, Africa): Paragonimus sp. are lung-dwelling (as well as other sites) trematodes. Infection is most frequently linked with ingestion of incompletely cooked or pickled shellfish. Paragonimiasis may persist for many years and thus present as acute or chronic illness - though chronic is the more common. Acute illness may include fever, cough, pleural effusion, and hepatosplenomegaly. Chronic paragonimiasis is characterized by cough, dyspnea, hemoptysis, brown-flecked sputum, and pleuritic chest pain. X-ray shows (depending on length of illness) diffuse or segmented infiltrates, nodules, cavities, ring cysts, and/or pleural effusions. Extrapulmonary infections may manifest with abdominal pain, diarrhea, and CNS symptoms. Treatment is with praziquantel 25 mg/kg tid for two days.
Anthrax (Any temperate or tropical rural area where animal husbandry is common): Anthrax is a gram positive spore-forming aerobic rod (Bacillus anthracis) cutaneous or pulmonary infection. Cutaneous anthrax is characterized by a dark centered erythematous papule surrounded by edematous and vesicular tissue. The papule enlarges, ulcerates, forms eschar, which later sloughs. Lymphadenopathy, fever, malaise, headache, and nausea and vomiting may also occur. After the eschar sloughs, hematogenous spread and sepsis may occur, with resulting shock, collapse, and hemorrhagic meningitis. Pulmonary anthrax (a concern with respect to biological warfare) is characterized by fever, malaise, headache, respiratory congestion, and pneumonia or mediastinitis. Anthrax is treated with penicillin G or tetracycline. Mortality is high, especially in pulmonary anthrax.
Ascariasis: See full discussion (Worldwide): Ascariasis is a nematode or roundworm infection with Ascaris lumbricoides causing transient respiratory symptoms initially and chronic gastrointestinal symptoms. The adult worms are more than 20 cm. in length, hence are easily seen in stool and may also emerge from the nose or mouth as a result of coughing or vomiting. Treatment is with albendazole single dose of 400 mg po (not FDA approved) or mebendazole or pyrantel pamoate.
Blastomycosis (Limited areas of south central and midwestern U.S. and Canada, Africa, Mexico ): Blastomycosis is a mycotic (Blastomyces dermatitidis) infection of lungs, skin, bones, or genitourinary system. The infection may be asymptomatic or may present with cough, fever, dyspnea, and chest pain that may resolve or progress to hemoptysis, fever, lymphadenopathy, weight loss, and collapse. Rough, warty skin lesions occur, as does destruction of bone (ribs and vertebrae) and GU problems among males. Blastomycosis must be differentiated from chromomycosis (see below). Treatment is with itraconazole or amphoteracin B. Also see paracoccidioidomycosis (South American Blastomycosis).
Coccidioidomycosis (United States, Mexico, and parts of Central and South America): Coccidioidomycosis is a fungal infection with Coccidioides immitis, usually pulmonary (cough, fever, chest pain, weight loss, malaise), but also of CNS, skin, lymph system, or liver. C. immitis occurs naturally in some soils (semi-arid with short rainy season) and is inhaled. Immunocompromised persons are at increased risk. Treatment is with amphotericin B or fluconazole or itraconazole. Maintenance therapy utilizes the same medications, especially fluconazole or itraconazole.
Filariasis: See full discussion (Distribution given below). The filarial parasites are tissue-dwelling roundworms whose microfilarial (mf) larvae are transmitted by several species of mosquitos or flies. The most problematic forms of filariasis are (1) Bancroftian filariasis and Malayan filariasis (much of the tropical and subtropical world between the Tropics of Cancer and Capricorn) which involve the lymphatic system and result in elephantiasisis; (2) loiasis or loa loa (tropical Africa) in which worms live in subcutaneous tissue; and (3) Onchocerciasis (tropical Africa and to a lesser extent Central and South America) which causes river blindness and skin disorders. Treatment in most cases is effective only against the mf, hence the infection continues and repeated treatment (with ivermectin and/or DEC) may be necessary.
Hantavirus pulmonary syndrome: See full discussion of HFs (North America, especially Southern; South America, especially Andes): Hantavirus infection is thought to occur through inhalation of infected rodent droppings. Incubation ranges from 7-28 days. In Latin America, hantaviruses cause HFs as described in the full discussion of HFs; and in the U.S., cause the hantavirus pulmonary syndrome (HPS). HPS is characterized by flu-like febrile illness that rapidly progresses to shock and adult respiratory distress syndrome with thrombocytopenia, hemoconcentration, and leukocytosis. Treatment is supportive as discussed in hemorrhagic fevers. Ventilation may be necessary within 24 hours of onset.
Histoplasmosis (Africa, Americas, East Asia, Australia): Best known in the West as an opportunistic infection of HIV, histoplasmosis is found among immigrants as the classic small-form histoplasmosis (primarily pulmonary) and as African histoplasmosis (primarily bone and cutaneous). Treatment is with amphotericin B initially, and itraconazole or fluconazole are used for maintenance therapy.
HIV/AIDS: HIV/AIDS is found world-wide, and is especially common in sub-Saharan Africa, Southeast Asia, and India. Heterosexual transmission is common in these areas. Readers are referred to the CDC and other current sources of information (See links).
Paragonimiasis (lung-dwelling trematode infection) (Asia, Latin America, Africa): Paragonimus sp. are lung-dwelling (as well as other sites) trematodes. Infection is most frequently linked with ingestion of incompletely cooked or pickled shellfish. Paragonimiasis may persist for many years and thus present as acute or chronic illness - though chronic is the more common. Acute illness may include fever, cough, pleural effusion, and hepatosplenomegaly. Chronic paragonimiasis is characterized by cough, dyspnea, hemoptysis, brown-flecked sputum, and pleuritic chest pain. X-ray shows (depending on length of illness) diffuse or segmented infiltrates, nodules, cavities, ring cysts, and/or pleural effusions. Extrapulmonary infections may manifest with abdominal pain, diarrhea, and CNS symptoms. Treatment is with praziquantel 25 mg/kg tid for two days.
Plague (Worldwide, but primarily rural and lightly populated areas in undeveloped countries): Plague is an acute febrile zoonotic disease caused by Yersinia pestis, a microaerophilic coccobacillus of the family Enterobacteriaceae. Plague is transmitted primarily by flea (from rodents) bite, but also from direct inoculation through handling infected mammal carcasses or via the respiratory route from infected droplets from a patient with pneumonic plague. The most recent pandemic was in the late 19th and early 20th centuries and resulted in estimated 12,000,000 deaths. In recent years (1970s-1990s), most cases have been reported in Africa, Asia, and the Americas. There are three common forms of plague: bubonic (most common), pneumonic (most rapid and most frequently fatal), and septicemic - with the latter two either primary or secondary to metastatic spread. Plague is manifested by abrupt onset of high fever, severe headache, severe myalgias, prostration, and in some cases, delirium. The incubation period is 2-10 days. An ulcer may develop at the inoculation site. Lymphadenitis is followed by painful, draining bubo(s). Pneumonic plague produces fulminant pneumonitis with frothy bloody sputum and sepsis. Hematogenous spread or septicemic plague is characterized by rapid decline, coma, and purpura - hence the term "black plague." Treatment must be quickly instituted in all cases. IM streptomycin is the first line treatment, though IM or IV gentamicin is frequently used. IV or po tetracycline or doxycycline are also used.
Psittacosis (Worldwide): Psittacosis is Chlamydia psittaci infection contracted from infected birds. Psittacosis is characterized by rapid onset of fever, chills, headache, dry cough, myalgia; and later development of dyspnea and atypical pneumonia. Complications include endocarditis, hepatitis, or neurologic complications. Except for contact with birds, psittacosis is indistinguishable from viral, mycoplasmic, or other atypical pneumonias. Treatment is with tetracycline or erythromycin.
Q fever (Worldwide): Q fever is a rickettsial zoonosis (infection with gram negative Coxiella burnetii) contracted primarily from inhalation of dust contaminated by infected animals, especially sheep, cattle, and goats; and also other mammals. Other routes of infection include contact with milk and tissue from infected animals. Manifestations of acute Q fever include fever, fatigue, headache, cough, abdominal pain, nausea, diarrhea, and myalgia. Pneumonia develops in a small number of patients. Other complications are hepatitis, pericarditis, myocarditis, and meningoencephalitis. Hepato/splenomegaly and endocarditis are common in chronic Q fever. Endocarditis is frequently associated with purpuric rash, renal insufficiency, stroke, and heart failure. Treatment of acute Q fever is with doxycycline or a quinolone. Chronic Q fever requires combination therapy such as rifampin and doxycycline.
Strongylodiasis (Most of the tropical world): Strongylodiasis is a nematode (roundworm) infection by Strongyloides stercoralis following larval penetration of the skin. A minority of infected persons are asymptomatic. Cutaneous manifestions may occur at the site of penetration (often feet), and include inflammation, serpiginous or urticarial tracts, and pruritis. Intestinal manifestations follow cutaneous, and include abdominal pain, nausea, flatulence, and diarrhea. Larval migration to lungs results in a variety of pulmonary symptoms, ranging from cough to pneumonia, pleural effusion, and miliary abscesses. Hyperinfection syndrome causes life-threatening CNS, cardiac, and wide-ranging gastrointestinal problems. Treatment is with ivermectin 200 mcg/kg/day po for two days. Albendazole and thiabendazole have also been used.
Trichinosis (trichinella) (Worldwide): Trichinosis is a nematode (roundworm) infection with Trichinella sp. from ingestion of meat that contains cysts, especially undercooked pork or meat from a carnivore. Infection ranges from light and asymptomatic to heavy and life-threatening. Manifestations vary according to the life cycle of the worms: Initially there is malaise, nausea, cramping abdominal pain, and diarrhea. Gastrointestinal symptoms are followed in 1-6 weeks by fever, eosinophilia, periorbital and facial edema, conjunctivitis, dysphagia, dyspnea, cough, myalgia, and muscle spasms. Complications include meningitis and other neurological disorders, myocarditis, pneumonia, and nephritis. The current treatment of choice is mebendazole 300 mg po tid for 10 days (sometimes with prednisone to control symptoms).
Tuberculosis (Worldwide): Tuberculosis (TB) is a chronic infection - most commonly pulmonary - caused by the acid-fast bacillus, Mycobacterium tuberculosis. Infection is usually acquired through inhalation of infected droplets expelled by cough from a person with active disease. Most cases (85%) of TB are pulmonary. Pulmonary symptoms include cough, chest pain, and hemoptysis. Constitutional symptoms are often present in pulmonary disease, and include fever, chills, night sweats, fatigue, decreased appetite, and weight loss. Symptoms of extrapulmonary TB depend on the site(s) of infection. Tuberculosis should always be ruled out in any person at-risk or with the above symptoms. Medical evaluation includes complete medical and family/close contacts/travel history, physical examination, Mantoux tuberculin skin test, chest x-ray, and appropriate bacteriologic or histologic examinations, e.g., smear and culture of sputum. Treatment is according to (1) classification of disease, e.g., exposure without infection, infection without disease, current TB disease, previous TB disease, or TB suspected; (2) whether disease is drug-resistant; (3) immune status of the patient; and (4) other factors. The treatment of TB is complex and is evolving at a rapid pace. Readers are referred to the U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/ for current standards of testing and treatment.
Typhus: See full discussion (numerous areas of the world as noted in discussion below): The typhus group of illnesses are one of several rickettsioses or febrile exanthematous illnesses caused by bites of rickettsial-infected arthropods or exposure to their feces. The three most important typhus group diseases are: epidemic louse-borne typhus, scrub typhus, and endemic (murine) typhus. (1) Epidemic louse-borne typhus is caused by Rickettsia prowazekii, with infection favored by crowded, unsanitary living conditions such as in concentration or the more primitive refugee camps - especially those in cold areas. Epidemic louse-borne typhus is currently most prevalent in mountainous areas of Africa, Asia, and Latin America. It is characterized by a prodrome of headache and constitutional symptoms; then the abrupt onset of high fever, chills, and prostration; then a macular rash progressing to maculopapular and petechial. Other common manifestations are delirium, conjunctival injection, photophobia, eye pain, flushed facies, hearing loss, hypotension, pulmonary involvement, renal insufficiency, and splenomegaly. Recovery may be spontaneous, or complications, including pneumonia, circulatory collapse, myocarditis, and uremia may lead to death. Treatment is with doxycycline 200 mg in a single dose or until the patient is afebrile for 24 hours. (2) Scrub typhus is transmitted by the bite of infected mites or chiggers, and is found in most areas of Asia. Scrub typhus illness ranges from mild to severe, and is characterized by gradual onset of fever, chills, headache, myalgia (backache), cough, nausea and abdominal pain, eschar at the site of the infecting bite, regional lymphadenopathy and a maculopapular rash. Severe scrub typhus is characterized by encephalitis and pneumonia. Scrub typhus is treated with doxycycline 100 mg bid po for 7-14 days; or chloramphenicol 500 mg qid po for 7-14 days. Azithromycin is also effective. (3) Endemic (murine) typhus is transmitted by the bite of infected fleas and is found worldwide. Endemic typhus is characterized by several days of prodromal constitutional symptoms, followed by the abrupt onset of fever, chills, and nausea and vomiting. Pulmonary involvement is common and may include interstitial pneumonia, pleural effusion, and/or pulmonary edema. Treatment is with doxycycline 100 mg bid po for 7-14 days; or chloramphenicol 500 mg qid po for 7-14 days.
Blastomycosis (Limited areas of south central and midwestern U.S. and Canada, Africa, Mexico ): Blastomycosis is a mycotic (Blastomyces dermatitidis) infection of lungs, skin, bones, or genitourinary system. The infection may be asymptomatic or may present with cough, fever, dyspnea, and chest pain that may resolve or progress to hemoptysis, fever, lymphadenopathy, weight loss, and collapse. Rough, warty skin lesions occur, as does destruction of bone (ribs and vertebrae) and GU problems among males. Blastomycosis must be differentiated from chromomycosis (see below). Treatment is with itraconazole or amphoteracin B. Also see paracoccidioidomycosis (South American Blastomycosis).
Echinococcosis (Hydatid disease): See full discussion (Most of the world; endemic in South America, North Africa, Middle East, Southern Europe - especially in areas where sheep are raised). Echinococcosis or hydatid disease is a tapeworm infection that often is asymptomatic, especially in the lengthy early stages. Echinococcus embryos trapped in various organs (especially the liver or lung) develop into hydatid cyst(s), which grow and eventually cause dysfunction according to the function or area of the organ(s). Surgical excision of the cyst remains the treatment of choice. Albendazole is given pre and post-operatively. Drug treatment includes albendazole or mebendazole or praziquantel - all with poor cure rates.
Histoplasmosis (Africa, Americas, East Asia, Australia): Best known in the West as an opportunistic infection of HIV, histoplasmosis is found among immigrants as the classic small-form histoplasmosis (primarily pulmonary) and as African histoplasmosis (primarily bone and cutaneous). Treatment is with amphotericin B initially, and itraconazole or fluconazole are used for maintenance therapy.
Melioidosis (Southeast Asia): Melioidosis is infection by Pseudomonas pseudomallei (gram negative bacillus) with symptoms of fever, pulmonary infection that may range from bronchitis to necrotizing pneumonia. Acute septicemic melioidosis is most common among debilitated persons. Focal suppuration (nodule, lymphangitis, lymphadenopathy) results from inoculation through a break in the skin. Chronic suppurative disease may involve virtually any body system. Recrudescence may occur many years after the initial infection. Treatment is according to susceptibility. Common antibiotics used are TMP-SMX (not in Thailand), Augmentin, doxycycline, and cephalosporins.
Psittacosis (Worldwide): Psittacosis is Chlamydia psittaci infection contracted from infected birds. Psittacosis is characterized by rapid onset of fever, chills, headache, dry cough, myalgia; and later development of dyspnea and atypical pneumonia. Complications include endocarditis, hepatitis, or neurologic complications. Except for contact with birds, psittacosis is indistinguishable from viral, mycoplasmic, or other atypical pneumonias. Treatment is with tetracycline or erythromycin.
Tuberculosis (Worldwide): Tuberculosis (TB) is a chronic infection - most commonly pulmonary - caused by the acid-fast bacillus, Mycobacterium tuberculosis. Infection is usually acquired through inhalation of infected droplets expelled by cough from a person with active disease. Most cases (85%) of TB are pulmonary. Pulmonary symptoms include cough, chest pain, and hemoptysis. Constitutional symptoms are often present in pulmonary disease, and include fever, chills, night sweats, fatigue, decreased appetite, and weight loss. Symptoms of extrapulmonary TB depend on the site(s) of infection. Tuberculosis should always be ruled out in any person at-risk or with the above symptoms. Medical evaluation includes complete medical and family/close contacts/travel history, physical examination, Mantoux tuberculin skin test, chest x-ray, and appropriate bacteriologic or histologic examinations, e.g., smear and culture of sputum. Treatment is according to (1) classification of disease, e.g., exposure without infection, infection without disease, current TB disease, previous TB disease, or TB suspected; (2) whether disease is drug-resistant; (3) immune status of the patient; and (4) other factors. The treatment of TB is complex and is evolving at a rapid pace. Readers are referred to the U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/ for current standards of testing and treatment.