What Is Your Diagnosis? New World Cutaneous Leishmaniasis
A 40-year-old man presented with a nonhealing ulcer on the right hand of 2 months’ duration. The lesion had started as a pruritic papule while he was visiting Guyana 2 months prior. The area had slowly enlarged with progressive ulceration. He denied any systemic signs including fever, chills, or weight loss, and his medical history was unremarkable. Physical examination revealed a 4-cm fungating ulceration with heaped-up borders on the dorsal aspect of the right hand.
There currently are no vaccines or drugs available to prevent against leishmaniasis. Preventive measures such as avoiding outdoor activities from dusk to dawn when sandflies are the most active, wearing protective clothing, and applying insect repellent that contains DEET (diethyltoluamide) can help reduce a traveler’s risk for becoming infected. Mosquito nets also should be treated with permethrin, which acts as an insect repellent, as sandflies are so small that they can penetrate mosquito nets.1,3,11
Acknowledgements—We would like to thank Francis Steurer, MS, and Barbara Herwaldt, MD, MPH, at the CDC in Atlanta, Georgia, for their help with the identification of the Leishmania species.
