Pain and tingling in the hand is typically present in CTS and absent from MMA; loss of function presents differently; with careful electrophysiological study and neurological exams the two are distinguished. In early stages, ALS, SCA, and MMA, presentation may be similar. Both CSA and ALS ultimately have more extensive symptoms. MMA is more prevalent in young people while ALS and CSA are more common in older populations. With ALS, hand symptoms usually more commonly both proximal and distal vs in MMA mostly distal only, and with ALS fasciculations (twitching) are often present in upper extremities, but rarely in MMA. MMA is usually eliminated from consideration if disability expresses itself in more than one extremity or in lower extremities (legs), but symptomatic absence may not rule out ALS for three to five years after initial onset. Electrophysiological texts and reflex tests tend to yield different results, but interpretation is at times subjective. Treatment
At present there is no cure for MMA. The impact on the affected individual ranges from minimal to significant depending on the extent of the weakness. Physical and occupational therapies include muscle strengthening exercises and training in hand coordination. Early use of a cervical collar is increasingly encouraged as therapeutic for arresting further compression of the cervical spinal cord. Spinal surgery on patients with more advanced symptoms has met with reported success, but is still regarded as experimental. Prognosis
The symptoms of MMA usually progress slowly for two to five years and then remain stable for many years.
African histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. duboisii, or Histoplama duboisii (Hcd). : 316  Disease has been most often reported in Uganda, Nigeria, Zaire (Democratic Republic of the Congo) and Senegal, as Hcd is exclusive to Africa. In human disease it manifests differently than histoplasmosis (caused by Histoplasma capsulatum, or Hcc), most often involving the skin and bones and rarely involving the lungs. Also unlike Hcc, Hcd has been reported to rarely present in those with HIV, likely due to underreporting. However, this along with the differences in Hcc and Hcd have been disputed.The favored locations of African histoplasmosis are "osteoarticular, ganglionic and pulmonary". Genitourinary skin damage is rare, occurring in only 4-11% patients and typically as a secondary skin invasion in those with disseminated infection.It presents as "localized with isolated skin, bone, or lymph node infections or disseminated with multiple cutaneous lesions present all over the body, subcutaneous abscesses, enlarged lymph nodes, liver and spleen, and visceral organ enlargement" Cutaneous manifestations can be isolated or present with nodules, papules, or ulcers. They may present with subcutaneous swelling, cold abscesses progressing to spontaneous fistulization, or ulcers that may bud. If left alone, lesions may turn into a large ulcer. See also
Histoplasmosis

References


== Further reading ==