The document discusses various parasitic infections affecting the skin, soft tissue, and musculoskeletal system, detailing their lifecycle, clinical features, diagnosis, treatment, and prevention. Key infections covered include cutaneous leishmaniasis, filariasis, dracunculiasis, and others, each with distinct causative agents and manifestations. The document aims to educate students about these infections to enhance their understanding and management in medical practice.

1. Parasitic Infections of Skin, Soft
Tissue and Musculoskeletal
System
Dr Bhavika patel
MBBS,MD Microbiology,DIPC
Assistant Professor
Department of microbiology
GMERS MC, Valsad.

2. Learning objectives
2
At the end of the session, the students will be able to understand:
▰ Life cycle, pathogenesis, clinical features, lab diagnosis, treatment and
prevention of cutaneous leishmaniasis, cutaneous filariasis, Dracunculiasis,
trichinellosis, cutaneous larva migrans.

3. Parasitic infections of skin, soft tissue and
musculoskeletal system
3
Protozoan infections
 Cutaneous leishmaniasis
 Cutaneous amoebiasis
 Acanthamoeba skin lesions
 Trypanosoma chancre and chagoma
 Sarcocystosis
Cestode infections
 Muscular cysticercosis
 Sparganosis (Spirometra)
Trematode infections
 Cercarial dermatitis
 Cutaneous paragonimiasis
Nematode infections
 Cutaneous filariasis
 Dracunculiasis
 Trichinellosis
 Cutaneous larva migrans

4. The Major cutaneous parasites
▰ 1. CUTANEOUS LEISHMANIASIS
▰ 2. CUTANEOUS FILARIASIS
▰ 3. DRACUNCULIASIS
▰ 4.TRICHINELLOSIS
▰ 5.CUTANEOUS LARVA MIGRANS
4

5. CUTANEOUS
LEISHMANIASIS
(oriental sore,aleppo avil,Delhi boil,Baghdad
sore,Rose of jericho,uta,Espundia,Kala
azar,Black fever) 5

6. 6
a 36-year-old lady, presented with a large disfiguring lesion on her left arm
expanding during the last three months. Systemic examination was
unremarkable. Examination of her arm showed a 6x6cm erythematous
crusted plaque covering her medial aspect of the distal forearm.

7. Resolution of the original plaques leaving scar and hyperpigmentation
after cryotherapy
7
A
B
C
D

8. CUTANEOUS LEISHMANIASIS
8
▰ CL: Cutaneous leishmaniasis (CL) - most common form of leishmaniasis.
▰ Global annual incidence of 6-10 lakh new cases.
▰ About 95% of CL cases - America, the Mediterranean basin, the Middle East
and Central Asia

9. CUTANEOUS LEISHMANIASIS (Cont..)
9
▰ MCL: Over 90% of mucocutaneous leishmaniasis (MCL) cases - Bolivia, Brazil,
Ethiopia and Peru.
▰ Post kala-azar dermal leishmaniasis (PKDL) - another cutaneous
manifestation - occurs few months to years following VL

10. 10
• L.tropica,
• L.aethiopica
• L. major
Old World
Cutaneous
Leishmaniasis
(CL)
• Leishmania Leishmania (L.L.)
mexicana complex
• Leishmania Viannia (L.V.)
braziliensis complex
• Leishmania Leishmania (L.L.)
chagasi:
New World
cutaneous
leishmaniasis

11. Various agents of cutaneous leishmaniasis
11
Species Geographical
distribution
Clinicalsyndrome Vector (sandfly) Reservoir Transmission
L. L. tropica
(Oriental sore)
Western India, North
Africa, and Middle
East
CL, LR Phlebotomus
sergenti
Humans Anthroponotic
(human)
L. L. aethiopica Ethiopia, Uganda,
and Kenya
CL, DCL P. longipes Hyraxes Zoonotic
L. L. major Middle East, India,
China, Africa, Central
and Western Asia
CL P. papatasi Rodents Zoonotic

12. Old World Cutaneous Leishmaniasis (CL)
12
▰ Old world CL is caused by Leishmania tropica complex - comprises of three
species—L. tropica, L. aethiopica and L. major.

13. Life Cycle
13
Life cycle of the L. tropica complex is same
as L. donovani , except that:
 Vector: Sandfly, but different species of
Phlebotomus.
 Habitat: In humans, the amastigote forms
reside in reticuloendothelial cells of skin
(they do not migrate to viscera).

14. Clinical Features
14
▰ 1.Cutaneous leishmaniasis: Also known as “Oriental
sore”, Delhi boil, Aleppo boil and Baghdad Button, etc.
▰ Occurs on face and hands – painless papule, becomes
nodular and finally it ulcerates.
▰ Heals spontaneously or - leaves behind disfigurement
or scar.

15. Clinical Features (Cont..)
15
▰ 2.Leishmaniasis recidivans (LR): Granulomatous
response producing new lesions - occur years after
healing of primary sore due to L. tropica. It is
▰ Characterized by scaly, erythematous papules and
nodules - develop in center or periphery of a
previously healed sore.

16. Clinical Features (Cont..)
16
▰ 3.Diffuse cutaneous leishmaniasis (DCL): Caused by L.
aethiopica. It is
▰ Characterized by - lack of CMI response to the parasite,
resulting in widespread cutaneous lesions
▰ Rare -100 cases have been reported so far - Kenya and
Ethiopia
▰ Responds poorly to treatment; disease may last long.

17. Laboratory Diagnosis of CL
17
▰ Microscopy: Amastigotes - demonstrated from punch biopsies
- from the edge of the active lesion and touch preparation
(impression smear) stained with Giemsa.

18. Laboratory Diagnosis of CL
18
▰ Culture: Aspiration from the ulcers - cultured in NNN medium and Schneider’s
Drosophila medium - isolation of promastigote forms

19. Laboratory Diagnosis of CL (Cont..)
19
▰ Montenegro test: Positive leishmanin
skin test - delayed hypersensitivity
reaction to the parasite.
▰ Negative in diffuse CL.

20. Treatment of Cutaneous Leishmaniasis (Old
World)
20
▰ Local therapy - usually recommended. Options available are:
 (i) paromomycin (15%) or methyl benzethonium (12%) ointment - 20 days
 (ii) intralesional antimonials
 (iii) cryotherapy
 (iv) thermotherapy.

21. Treatment of Cutaneous Leishmaniasis (Old
World) (Cont..)
21
▰ Systemic therapy: Only for disfiguring or scarring lesions.
 L. major—(i) fluconazole for 6 weeks, (ii) pentavalent antimonials with or
without pentoxifylline for 10–20 days
 L. tropica—pentavalent antimonials for 10–20 days. In LR cases -
combined with oral allopurinol
 L. aethiopica—pentavalent antimonials + paramomycin for 60 days or
longer.

22. New World Cutaneous Leishmaniasis
22
▰ Mainly caused by:
 Leishmania Leishmania (L.L.) mexicana complex
 Leishmania Viannia (L.V.) braziliensis complex
 Leishmania Leishmania (L.L.) chagasi - Causes atypical CL and American
VL.

23. New World Cutaneous Leishmaniasis (Cont..)
23
▰ Morphology and life cycle - identical to L.
donovani, except:
▰ Vector: Lutzomyia species
▰ Reservoir of infection: Dogs, foxes (zoonotic)
▰ Amastigote forms - reside in reticuloendothelial
cells of skin and mucous membrane (do not
invade viscera).

24. Leishmania Leishmania mexicana complex and
Leishmania Viannia braziliensis complex
24
Leishmania Leishmania mexicana complex Leishmania Viannia braziliensis complex
Species Geographical
distribution
Clinical syndrome Species Geographical
distribution
Clinical syndrome
L. L. mexicana Central America
and
northern parts of
South
America (the
Amazon
basin)
CL (chiclero ulcer)
DCL
L. V. braziliensis Brazil CL, MCL (espundia),
LR (rare)
L. L. amazonensis CL, DCL and VL
(rare)
L. V. panamensis Panama,
Colombia
CL, MCL
L. L. venezuelensis
L. L.garnhami
CL L.V. guyanensis Guyana CL(forest yaws),
MCL
L. L. pifanoi CL, DCL L. V. peruviana Peru CL(Uta), MCL
Reservoir: Forest rodents, marsupial and humans Reservoir: Dogs, foxes, forest rodents and humans
Vector: Lutzomyia species and Transmission: Zoonotic (for both complexes)

25. Chiclero ulcer
25
▰ L. mexicana causes - specific form of CL - chiclero
ulcer (or bay sore).
▰ Characterized by persistent ulcerations in pinna.
▰ Seen in Central America - workers living in forests
harvesting chicle plants to collect chewing gum
latex.

26. Espundia (mucocutaneous leishmaniasis or MCL)
26
▰ L. braziliensis infects mucous membrane of the nose, oral
cavity, pharynx or larynx.
▰ Presents months to years after the CL.
▰ Ulcerative lesions - formed with erosion of the soft tissue and
the cartilages - loss of lips, soft part of nose and soft palate
▰ Gradually, the nasal septum - destroyed, resulting in nasal
collapse with hypertrophy of upper lip and nose leading to
development of “tapir nose”.

27. Treatment New World cutaneous leishmaniasis
(Cont..)
27
▰ The regimen for systemic therapy depends upon - causative agent.
 L. mexicana: Ketoconazole or miltefosine for 28 days
 L. guyanensis and L. panamensis: Pentamidine or pentavalent antimonials
or miltefosine for 28 days
 L. braziliensis: Pentavalent antimonials for 20 days; or amphotericin B

28. Treatment New World cutaneous leishmaniasis
(Cont..)
28
 L. amazonensis, L. peruviana and L. venezuelensis: Pentavalent
antimonials for 20 days
 Relapse treatment: Amphotericin B or pentavalent antimonials + topical
imiquimod.

29. Treatment New World cutaneous leishmaniasis
(Cont..)
29
▰ For MCL (all species):
 (i) pentavalent antimonials with or without oral pentoxifylline for 30 days
 (ii) amphotericin B
 (iii) Bolivia - miltefosine - agent of choice.

30. CUTANEOUS
FILARIASIS 30

31. CUTANEOUS FILARIASIS
31
▰ Filarial nematodes - Wuchereria and Brugia cause lymphatic filariasis
▰ Many other filarial nematodes - reside in skin and subcutaneous tissue -
several cutaneous manifestations—Loa loa, Onchocerca volvulus, and
Mansonella species.

32. 1.Loa loa
32
▰ Also called - African eye worm.
▰ Cause infection of subcutaneous tissue and eyes.
▰ Infection - restricted to West and Central Africa.

33. Life Cycle
33
▰ Similar to- W. bancrofti except for the vector - female Chrysops species (deer
flies, or tabanid flies).
▰ Following mosquito bite (during day time) - L3 larvae - transmitted to man and
transform into adult worms - migrate to subcutaneous tissues and eyes
▰ Microfilariae - from gravid female worms migrate to blood - exhibit diurnal
periodicity.

34. Clinical Features
34
▰ Calabar swellings: Most common form of loiasis
- called fugitive swelling - subcutaneous swelling
developing on the extremities (knee or wrist).

35. Clinical Features
35
▰ Ocular manifestations - conjunctival
granuloma, edema of the eye lid.
proptosis (bulging)
▰ Complications: Meningoencephalitis,
nephropathy and cardiomyopathy

36. Laboratory Diagnosis
36
▰ Peripheral blood smear examination reveals -
characteristic microfilariae.
 Microfilaria shows diurnal periodicity - blood
collected in day time between 10 am to 3 pm
 Sheathed, measure 275 (250–300) μm long and
bear a column of nuclei extending till the tail tip
 Adult worms - isolated from the eye or biopsy of
the subcutaneous swelling.

37. Laboratory Diagnosis (Cont..)
37
▰ Other methods include—
 (1) molecular method - nested PCR-based assays for the detection of specific
DNA, and
 (2) antibody detection: Lateral flow assay (ICT) - detects antibodies to Ll-SXP-
1 antigen.

38. Treatment of Loiasis
38
▰ Diethylcarbamazine (DEC) - drug of choice—multiple courses - necessary to resolve loiasis
completely
▰ Glucocorticoids: Required in heavy microfilaremia - reduce inflammatory reactions against
microfilariae - preventing neurological complicationsAlbendazole or ivermectin - effective in
reducing microfilarial loads – ivermectin- contraindicated in heavily infected patients with
loiasis
▰ Surgical removal of the adult worms - rarely required if they migrate through the bridge of the
nose or through the conjunctiva.

39. 2.Onchocerca volvulus
39
▰ Causative agent of “river blindness” in man.
▰ Endemic in West Africa and also in South and Central America.

40. Life Cycle
40
▰ Life cycle - similar to - W. bancrofti, except the vector is Simulium (black flies).
▰ Following the bite of black flies - L3 larvae - transmitted to man and transform
into adult worms - migrate to subcutaneous tissues and eyes
▰ Gravid female worms release microfilariae - migrate to the blood - infective to
the black flies.

41. Clinical Features
41
▰ Skin (Dermatitis)
 Leopard skin
 Sowda
▰ Onchocercoma
▰ Ocular lesions
▰ Lymphadenopathy

42. Laboratory Diagnosis
42
Detection of the Parasite:
▰ In a skin snip smear - gold
standard method for diagnosis
of onchocerciasis.
▰ Microfilariae - found either in the
skin (90%) or in the nodules
(10%).

43. Laboratory Diagnosis (Cont..)
43
▰ Microfilariae: Measure 254 μm long, pointed tail tip without any nuclei -
unsheathed and nonperiodic.
▰ Adult worms - detected from the biopsy of the subcutaneous nodules - less
sensitive

44. Laboratory Diagnosis (Cont..)
44
▰ Other Methods:
 Serology
 Molecular methods
 Mazzotti skin test

45. Treatment of Onchocerciasis
45
▰ Ivermectin - drug of choice for onchocerciasis.
▰ Active against the microfilariae but not against the adult worms
▰ Given orally in a single dose of 150 μg/kg - yearly or biannually.
▰ Contraindicated - areas of Africa co-endemic for O. volvulus and L. loa.
▰ Surgical excision - recommended when nodules are located on the head.

46. 3.Mansonella Species
46
▰ Named after Patric Manson.
▰ Rarely infect humans - either nonpathogenic or asymptomatic in most of the
individuals.

47. Mansonella perstans
47
▰ Transmission: By Culicoides (midges).
▰ Adult worms reside in serous cavities, mesentery and perirenal tissues.
▰ Microfilariae circulate in – blood without periodicity
▰ Clinical features: Nonpathogenic – occasionally cause - angioedema, urticaria,
pruritus and calbar-like swelling - also produces acute periorbital
inflammation - bung-eye or bulge-eye

48. Mansonella perstans (Cont..)
48
▰ Laboratory diagnosis: Microfilariae in peripheral blood are nonperiodic,
nonsheathed, measures 195 μm long - straight tail and blunt end.
▰ Body nuclei - extended till the tail tip
▰ Treatment: DEC or albendazole.

49. Mansonella streptocerca
49
▰ Transmission: Biting midges (Culicoides grahami)
▰ Clinical feature: Asymptomatic - some people develop - inguinal
lymphadenopathy, pruritus, dermatitis with hypopigmented macule - no
sensory loss

50. Mansonella streptocerca (Cont..)
50
▰ Laboratory diagnosis: Detection of the characteristic microfilariae in skin
snips - nonperiodic, nonsheathed, measures 210 μm with a curved tail (looks
like Shepherd’s crook). Nuclei - extended till the blunt tail tip
▰ Treatment: DEC - effective for streptocerciasis.

51. 4.Dirofilaria Species
51
▰ Parasites of lower animals.
▰ Humans - unusual hosts.
▰ Parasite undergoes - incomplete development in humans either in the lungs,
eyes and or subcutaneous tissue, producing various lesions.
▰ Man acquires infection by the bite of mosquito (Aedes, Culex, Anopheles, or
Mansonia) containing L3 filariform larvae.

52. Prevention of Cutaneous Filariasis
52
▰ Vector control - useful in highly endemic areas.
▰ Insecticide spraying - destroy the breeding sites.
▰ Mass administration of ivermectin every 6–12 months is being used to
interrupt the transmission in endemic areas.

53. 3.DRACUNCULIASIS
53

54. DRACUNCULIASIS
54
▰ It is a parasitic infection by the somatic nematode - Dracunculus medinensis.
▰ Also called as Guinea worm disease or dracunculiasis, characterized by
cutaneous blisters.

55. Epidemiology
55
▰ Crippling parasitic disease on the verge of eradication,
▰ Currently endemic to only to 3-4 countries in Sub-Saharan Africa.
▰ About 187 countries including India - already declared free of transmission.
▰ In 2019, only 54 human cases reported in 2019.

56. Life Cycle
56

57. 57
▰ Signs and symptoms appear - 1 year after the
infection - when gravid adult female worm emerges
near the surface of the skin.
▰ Characterized by painful blister  female worm
emerges  local erythema, fever, nausea and
pruritus.
▰ Most common sites  lower leg, ankle and foot
▰ Secondary bacterial infections may occur at the
blister site.
A B
Pathogenesis and Clinical Features

58. Laboratory Diagnosis
58
Detection of adult worm:
▰ Possible when the gravid female worms
appear in the blisters.
▰ Calcified adult worms from the deeper
tissue - detected by X-ray
A B

59. Laboratory Diagnosis (Cont..)
59
▰ Detection of L1 larvae: When the leg with
ulcer is placed in a container with cold water
- large number of motile larvae - discharged
- examined under the microscope
▰ Antibody detection: Antibodies to D.
medinensis - detected by ELISA
▰ Peripheral blood Eosinophilia.

60. Treatment of Dracunculiasis
60
Worm removal:
▰ Slowly and gently extracted over a period
of 15–20 days using a small stick and
wounding out daily with small traction.
▰ Heavy pressure – avoided because
breaking the worm - lead to allergic
reactions and secondary bacterial
infection.

61. Treatment of Dracunculiasis (Cont..)
61
Symptomatic treatment:
▰ Application of wet compresses to the affected skin, administration of
analgesics and prevention of secondary bacterial infection by the use of
topical antibiotics.
▰ No anti-helminthic drugs known to be effective against D. medinensis.

62. Reasons for Eradication from India
62
▰ The national Guinea worm eradication program - launched in 1984 with
technical assistance from World Health Organization (WHO).
▰ Provision of safe drinking water
▰ Cyclops control: Killing copepods in sources of drinking water by application
of abate (temephos) larvicide

63. Reasons for Eradication from India (Cont..)
63
▰ Provision of clean drinking water from boreholes or wells (was a major source
of infection)
▰ Health education about boiling or filtering of drinking water
▰ Treatment of cases.

64. 4.TRICHINELLOSIS
64

65. TRICHINELLOSIS
65
▰ Trichinella spiralis causes trichinellosis (or trichinosis) - zoonotic infection
acquired from domestic pigs or other carnivores.

66. Morphology
66
▰ Like other somatic nematodes, it has an adult worm (1.5– 3 mm long), and
four stages of larvae.
▰ No egg stage.
▰ L1 larva - infective form - forms cysts in muscles.

67. Life Cycle
67

68. Larva of Trichinella liberated from bear meat
68

69. Pathogenicity and Clinical Features
69
▰ Clinical symptoms - depend on the phase of parasitic invasion.
▰ Intestinal stage: Most of the infections – asymptomatic - heavy load of
parasite - provoke watery diarrhea (most common feature) during the first
week after infection.

70. Pathogenicity and Clinical Features (Cont..)
70
▰ Larval migration: Symptoms appear in the second
week after infection
 Periorbital and facial edema is common
 Hemorrhages in the subconjunctiva, retina and
nail beds (“splinter” hemorrhages)
 Maculopapular rash
 Migration to heart, CNS and lungs - rare.

71. Pathogenicity and Clinical Features (Cont..)
71
▰ Muscle encystment: Occurs 2–3 weeks after infection.
▰ Common symptoms - myositis with myalgia, muscle edema, and weakness.
▰ Extraocular muscles - common to be involved, followed by biceps, muscles of the jaw, neck,
lower back, and diaphragm.

72. Laboratory Diagnosis - Demonstration of Larvae
72
▰ Definite diagnosis - demonstration of larvae in muscle biopsy - from
gastrocnemius, deltoid, and biceps.
▰ Direct slide technique: Fresh muscle tissue - compressed between glass
slides and examined under low power microscope

73. Laboratory Diagnosis - Demonstration of Larvae
(Cont..)
73
▰ Histopathologic examination:
Performed either on fresh muscle
tissues directly or after artificial
digestion of muscle mass by pepsin
Trichinella cysts in the human muscle
biopsy (hemotoxylin and eosin stain).

74. Laboratory Diagnosis - Antibody Detection
74
▰ ELISA - detecting parasite specific IgG antibody against excretory secretory
antigen of muscle larvae.
▰ Confirms the diagnosis but cannot differentiate past and present infection.
▰ Also cross reacts with other nematodes.

75. Laboratory Diagnosis - Coproantigen Detection
75
▰ Modified double sandwich ELISA – developed using polyclonal antibodies
raised in rabbit to detect larval somatic antigens in stool.
▰ Detectable from first day of infection up to third week.

76. Laboratory Diagnosis - Bachman Intradermal Test
76
▰ Intradermal injection of Bachman antigen (prepared from Trichinella larvae) -
immediate induration and erythema.
▰ Becomes positive in 2–3 weeks of infection and persists for life - cannot
differentiate past infection present infection.

77. Laboratory Diagnosis - Other Tests
77
▰ Blood eosinophilia: Elevated in more than 90% symptomatic patients
▰ Elevated muscle enzymes: Elevated serum creatine phosphokinase
▰ X-ray to detect the calcified muscle cyst.

78. Treatment of Trichinellosis
78
▰ Mild infection: Symptomatic treatment – with bed rest, antipyretics, and
analgesics.
▰ Moderate infection: Mebendazole and albendazole - active against enteric
stages of the parasite.
▰ Severe infection: Glucocorticoid is added - beneficial for severe myositis and
myocarditis.

79. Prevention
79
▰ Direct inspection of pork and microscopic examination of small tissue
samples of pig diaphragm before use.
▰ Maintenance of strict standards for freezing, cooking, and curing of pork and
pork products.
▰ All parts of pork muscle tissue - heated to >58.3°C.
▰ Microwaving might not kill the parasite.

80. 5.CUTANEOUS LARVA
MIGRANS 80

81. Cutaneous larvae migrans
▰ CLM  skin lesions  produced by nematodes of lower animals 
infect man accidently.
▰ Agents
▻ Mainly by nonhuman hookworm species (A. brasiliensis, A.
caninum and A. ceylanicum)
▻ Rarely by strongyloides stercoralis, Ancylostoma duodenale and
Nector americanus.
▰ Another form of larvae migrans occurs called as “visceral larva
migrans”  life cycle arrested when larvae migrate to various
viscera.

82. Cutaneous larvae migrans
▰ In lower animals: nematodes inf lower animals  larvae into various
organs (intestine) develop in adult worms  lay eggs  cycle
continues
▰ In humans: larvae of lower animal nematodes  accidently infect
man  not able to complete normal development (because of
unsulal host for them)  life cycle get arrested larvae wander 
skin & subcutaneous tissue producing a condition  called
cutaneous larva migrans (CLM) or creeping eruption.
▰ Another form of larvae migrans occurs called as “visceral larva
migrans”  life cycle arrested when larvae migrate to various
viscera.

83. ▰ Clinical Features
▻ Ground itch:- Pruritic maculopapular dermatitis and rashes (ground itch) at the site of skin penetration of
hookworm larvae.
▻ Larva currens:- Migrating strongyloides larvae produce the pathognomic serpiginous urticarial rash called as
larva currens near the legs.
▰ Lab Diagnosis
▻ Larvae are usually not detected in skin biopsy.
▻ PCR
▻ Elevated Eosinophilia in PBS or sputum.
▻ Charcot-leyden crystals in sputum may be seen.

84. CUTANEOUS LARVA MIGRANS
84
▰ Cutaneous larva migrans - skin lesions produced by nematodes of lower
animals, when they accidentally infect man.

85. Laboratory Diagnosis
85
▰ Diagnosis - made by clinical feature (presence of the linear tracks) and history
of exposure.
▰ Larvae - not detected in skin biopsy.
▰ PCR - detection of larval DNA in human tissues
▰ Elevated eosinophilia - seen in peripheral blood or sputum - Charcot-Leyden
crystals in sputum.

86. Treatment of Cutaneous larva migrans
86
▰ Oral and topical thiabendazole is effective
▰ Freezing the advancing end of creeping eruption in ethyl chloride is useful.

87. PARASITIC AGENTS THAT
RARELY CAUSE SSTI
87

88. PARASITIC AGENTS THAT RARELY CAUSE SSTI
88
▰ Cutaneous amoebiasis
▰ Acanthamoeba skin lesions
▰ Trypanosoma chancre
▰ Chagoma
▰ Muscular sarcocystosis

89. PARASITIC AGENTS THAT RARELY CAUSE SSTI
(Cont..)
89
▰ Cysticercosis
▰ Sparganosis
▰ Cercarial dermatitis
▰ Cutaneous paragonimiasis

90. 90