This may be encountered in travellers and servicemen and servicewomen returning from the Middle East, especially the Persian Gulf. The protozoa is transmitted by a sandfly and has an average incubation period of 9 weeks. The key clinical finding is an erythematous papule. Diagnosis is made by performing a punch biopsy and culturing tissue in a special medium. Treatment for extensive lesions is with high dosage ketoconazole for 1 month. Smaller lesions should be treated topically with 15% paromomycin and 12% methyl benzethonium chloride ointment applied bd for 10 days. 8 A special vaccine is available in some Middle Eastern countries, e.g. Israel.
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Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.