Mainland Middle America This section includes general information about health hazards as reported by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The region includes Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. It ranges from the deserts of the north to the tropical rain forests of the southeast. Of the arthropod-borne diseases, malaria and cutaneous and mucocutaneous leishmaniasis occur in all eight countries. Visceral leishmaniasis occurs in El Salvador, Guatemala, Honduras, and Mexico. Onchocerciasis (river blindness) is found in two small foci in the south of Mexico and four dispersed foci in Guatemala. American trypanosomiasis (Chagas' disease) has been reported to occur in localized foci in rural areas in all eight countries. Bancroftian filariasis is present in Costa Rica. Dengue fever and Venezuelan equine encephalitis may occur in all countries. The foodborne and waterborne diseases, including amebic and bacillary dysenteries and other diarrheal diseases and typhoid fever are very common throughout the area. All countries except Panama reported cases of cholera in 1996. Hepatitis A occurs throughout the area, and hepatitis E has been reported in Mexico. Helminthic infections are common. Paragoniasis (oriental lung fluke) has been reported in Costa Rica, Honduras, and Panama. Brucellosis occurs in the northern part of the area. Many Salmonella typhi infections from Mexico and Shigella dysenterteriae type 1 infections from mainland Middle America as a whole have been caused by drug-resistant enterobacteria. Rabies in animals (usually dogs and bats) is widespread throughout the area. Snakes may be a hazard in some areas.