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and is a big enough problem that blood donations in en- Most think of “cocci,” also known as San Joaquin Valley
demic areas are screened for the disease. Treatment is prob- fever, as a West Coast disease and “histo” as a southeastern
lematic, requiring less available and more toxic medications United States problem. In fact, both may be acquired in our
than most physicians are used to. If you want to learn more area, with the last big Texas outbreak of histoplasmosis oc-
about Chagas disease, the Centers for Disease Control and curring in some spelunkers in Brackettville and a lurid recent
Prevention’s website, www.cdc.gov/parasites/chagas/, has the television report on this “new” and awful fungal infection
information you need on diagnosis and treatment. The first (coccidiomycosis) that had found its way to San Antonio.
thing that will strike you on visiting the website is pictures Clinically apparent infections with either of these are still un-
of the cone-nosed beetle vector and the thought, “I’ve seen common in our area, but very unusual skin eruptions may
that in my back yard!” be seen in patients who are immune-suppressed by way of
Dengue fever (“break bone fever”) is a common (100 mil- disease such as HIV/AIDS or by way of immune-suppressing
lion cases annually worldwide), potentially fatal, mosquito- medications. A rising concern is that many patients who have
borne illness which has been seen in northern Mexico for been exposed to these diseases in the past may be susceptible
quite a while but now seems to be making its move north- to reactivation when started on the newer injectable biologic
ward. Seven Texas counties have reported what is probably therapies for psoriasis, arthritis and inflammatory bowel dis-
locally acquired dengue fever, with Cameron and Hidalgo ease. It is standard to screen for tuberculosis before starting
counties being the “hottest” counties currently. Dengue is a patients on this class of medications but there is not yet a
multisystem disease which may include abnormal bleeding, standard approach to those at risk for reactivated histoplas-
abnormal fluid accumulation (pleural effusions or ascites), mosis or coccidiomycosis.
persistent vomiting, liver enlargement and a variety of other Needless to say, any of these diseases are potentially re-
systemic complaints. Diagnosis is made serologically, and portable illnesses. The Texas Department of State Health
treatment is supportive. Because of the variety of presenta- Services has requirements and mechanisms for disease report-
tions, any primary care practitioner and many specialists may ing at www.dshs.state.tx.us/idcu/investigation/conditions/.
have a dengue fever victim walk in (or more likely wheeled Various links on the site also offer other useful information,
in) to their clinic. The website www.cdc.gov/dengue/ has in- such as how to avoid West Nile Virus infections, how to get
formation for practitioner and patient alike. a birth or death certificate, obtaining or verifying professional
Some tropical diseases have been around for quite a while. licenses, and separate sites for health professionals, patients,
Cutaneous leishmaniasis has been reported in our area, with government officials and media. The requirements for report-
one of the former reservoirs for the intermediate host, the ing do not just include obvious entities such as bubonic
wood rat, being at Brooks City Base. Also nicknamed “High- plague and smallpox, but also much more common events
way 90 disease,” this sandfly-transmitted disease, fortunately, such as viral hepatitis of any type, invasive streptococcal dis-
is not the more disfiguring mucocutaneous type seen in ease and detectable lead levels in any child or adult. If you
South America, nor the potentially fatal systemic leishmani- think it might need to be reported, you are probably right.
asis seen in the Middle East. It is characterized by a chronic,
non-healing ulcer and is usually seen in children who play Jeffrey J. Meffert, MD, is an associate profes-
outside and less-mobile patients who spend time sitting out- sor of dermatology and cutaneous surgery at the
side in the evening. University of Texas Health Science Center at
Two diseases that are not tropical but still are not thought San Antonio and 2013 chair of the BCMS
of often enough are histoplasmosis and coccidiomycosis. Communications/Publications Committee.

18 San Antonio Medicine • February 2014