DISTRIBUTION

  • widespread in areas where ticks are present

  • majority of cases are from northeastern United States

  • also reported from France and other European countries

INCUBATION PERIOD

  • variable; 1 week to 12 months reported

TREATMENT

  • a combination of antiparasitic agents (clindamycin and quinine) has been effective in most patients

  • exchange blood transfusion may be required in patients with very high-grade parasitemia

PREVENTION AND CONTROL

  • avoidance of tick exposure in endemic areas (protective clothing, tick repellant)

  • control of rodents around human habitations

FACTORS FACILITATING EMERGENCE

  • reforestation and subsequent increase in deer population

  • housing development in wooded areas

Candida

DISEASE(S) AND SYMPTOMS

Candidiasis

  • fungal infections usually confined to the superficial layers of skin or mucous membranes: oral thrush, intertrigo, vulvovaginitis, paronychia, or onychomycosis

  • ulcers may be formed in the esophagus, gastrointestinal tract, or bladder

  • dissemination in the blood may produce lesions in other organs (kidney, spleen, liver, lung, endocardium, eye, or brain)

DIAGNOSIS

  • microscopic demonstration of yeast cells in infected tissue or body fluid

  • fungal culture



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