Skin conditions in the returned traveler

Noreen A. Hynes, M.D., M.P.H., D.T.M.&H.

Skin conditions in the returned traveler is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

Papular eruptions: Sarcoptes scabiei, Onchocerca volvulus, non-human schistosomes (e.g., avian), Edwardsiella lineata larva (sea anemone), Linuche unguinculata (jellyfish), bedbugs, flea bites.
Nodules/subcutaneous swellings: myiasis due to Cordylobia anthropophaga larvae, Dermatobia hominis larvae or Tunga penetrans; Loa loa; Trypanosoma brucei gambiense and T.b. rhodesiense (more common to see nodule in this form).
Ulcers: Staphylococcus aureus, Group A streptococci; Leishmania (Viannia) braziliensis complex; Mycobacterium marinum; Boutonnese fever (Rickettsia conorii group); Orientalis tsutsugamushi; Haemophilus ducreyi; Chlamydia trachomatis L serovars; Klebsiella granulomatis; Treponema pallidum; Herpes simplex virus.
Geographic migratory and linear lesions: examples
1. Non-human nematode larvae: Ancylostoma braziliense, A. caninum, Gnathostoma spp, zoonotic Strongyloides, Spururina spp.
2. Human nematode larvae: Strongyloides stercoralis.
3. Migratory maggots.
4. Adult nematodes: Loa loa; Dracunculus medinensis.
5. Trematode larvae: Fasciola giganta.
6. Mites: Sarcoptes scabei.

Exanthema: dengue virus serotypes 1, 2, 3 and 4; chikungunya virus; Rickettsia africae; R. conorii; other location-specific arthropod-borne rickettsioses.
Animal bites: Capnocytophaga spp, Corynebacterium spp, Neisseria spp, Pasturella spp; Staphylococcus aureus, streptococci, anaerobes, rabies virus, herpes B virus
Additional systemic infections of travelers associated with skin lesions: (not a comprehensive list)
- Bartonella bacilliformis (Oroya fever, Verruga peruana, Carrion disease)
- Brucella spp.
- Ehrlichia spp.
- Enteroviruses
- Neisseria gonorrheae
- Acute HIV infection
- Leishmania major (visceral leishmaniasis)
- Leptospira spp.
- Borrelia burgdorferi (Lyme disease)
- Measles
- Burkholderia pseudomallei
- Neisseria meningitidis
- Parvovirus
- Streptobacillus moniliformis (Rat-bite fever)
- Spirillum minus(Rat-bite fever)
- Borrelia recurrentis(louse-borne relapsing fever)
- Borrelia hermsii(or other species, Ttck-borne relapsing fever)
- Trypanosoma cruzi (Chagas disease)
- Coccidioides spp.
- Paracoccidioides brasiliensis
- Agents of dermatophytoses (fungal infections of the superficial keratinized areas of the body)
- Rickettsial spp. (15 species in the spotted fever group, 2 species in the typhus group, 3 serogroups in the scrub typhus/Orientalis biogroup)
- Tick-borne lymphadenopathy (TIBOLA)
- Dermacentor-borne necrosis eschar lymphadenopathy (DEBONEL)

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PATHOGENS

Papular eruptions: Sarcoptes scabiei, Onchocerca volvulus, non-human schistosomes (e.g., avian), Edwardsiella lineata larva (sea anemone), Linuche unguinculata (jellyfish), bedbugs, flea bites.
Nodules/subcutaneous swellings: myiasis due to Cordylobia anthropophaga larvae, Dermatobia hominis larvae or Tunga penetrans; Loa loa; Trypanosoma brucei gambiense and T.b. rhodesiense (more common to see nodule in this form).
Ulcers: Staphylococcus aureus, Group A streptococci; Leishmania (Viannia) braziliensis complex; Mycobacterium marinum; Boutonnese fever (Rickettsia conorii group); Orientalis tsutsugamushi; Haemophilus ducreyi; Chlamydia trachomatis L serovars; Klebsiella granulomatis; Treponema pallidum; Herpes simplex virus.
Geographic migratory and linear lesions: examples
1. Non-human nematode larvae: Ancylostoma braziliense, A. caninum, Gnathostoma spp, zoonotic Strongyloides, Spururina spp.
2. Human nematode larvae: Strongyloides stercoralis.
3. Migratory maggots.
4. Adult nematodes: Loa loa; Dracunculus medinensis.
5. Trematode larvae: Fasciola giganta.
6. Mites: Sarcoptes scabei.

Exanthema: dengue virus serotypes 1, 2, 3 and 4; chikungunya virus; Rickettsia africae; R. conorii; other location-specific arthropod-borne rickettsioses.
Animal bites: Capnocytophaga spp, Corynebacterium spp, Neisseria spp, Pasturella spp; Staphylococcus aureus, streptococci, anaerobes, rabies virus, herpes B virus
Additional systemic infections of travelers associated with skin lesions: (not a comprehensive list)
- Bartonella bacilliformis (Oroya fever, Verruga peruana, Carrion disease)
- Brucella spp.
- Ehrlichia spp.
- Enteroviruses
- Neisseria gonorrheae
- Acute HIV infection
- Leishmania major (visceral leishmaniasis)
- Leptospira spp.
- Borrelia burgdorferi (Lyme disease)
- Measles
- Burkholderia pseudomallei
- Neisseria meningitidis
- Parvovirus
- Streptobacillus moniliformis (Rat-bite fever)
- Spirillum minus(Rat-bite fever)
- Borrelia recurrentis(louse-borne relapsing fever)
- Borrelia hermsii(or other species, Ttck-borne relapsing fever)
- Trypanosoma cruzi (Chagas disease)
- Coccidioides spp.
- Paracoccidioides brasiliensis
- Agents of dermatophytoses (fungal infections of the superficial keratinized areas of the body)
- Rickettsial spp. (15 species in the spotted fever group, 2 species in the typhus group, 3 serogroups in the scrub typhus/Orientalis biogroup)
- Tick-borne lymphadenopathy (TIBOLA)
- Dermacentor-borne necrosis eschar lymphadenopathy (DEBONEL)

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