70 



THE HEMOFLAGEUATES 



Phlebotomus intermedins (syn. , Pllittzi), 

 and also probably P. iiiigonei, P. whit- 

 niani and P. pessoai. 



4. Uta occurs in the mountains of Peru. 

 It is a benign form of the disease, 

 with numerous small skin lesions. Its 

 reservoir hosts and vectors are ap- 

 parently unknown. 



5. American forest leishmaniosis, pian 

 bois or buba is found in Panama, Costa 

 Rica, the Guianas and other parts of 

 northern South America. It is caused 

 by L. Iropica gidaneiisis. The skin 

 lesions are moderately ulcerated, and 

 ordinarily heal spontaneously unless 

 they involve the nose. About 5% of the 

 patients have lesions of the mucous 

 membranes which have arisen by ex- 

 tension rather than by metastasis. 

 The lymph nodes are involved in about 

 10%. Dogs may be naturally infected, 

 but the wild reservoirs are unknown. 

 The vectors in Venezuela are believed 

 to be PlilebutoDius evansi, P. niigoiiei, 

 P. parasinensis and P. siiis. 



6. Chiclero ulcer or bay sore is found in 

 Guatemala, southeastern Mexico and 

 British Honduras. It gets its name 

 because it is common among chicle 

 and rubber hunters in rain forests. It 

 is caused by L. tropica mexicaiia. The 

 skin lesions are small. They heal 

 spontaneously in a few weeks to a few 

 months unless they involve the ear. In 

 this location they cause chronic, dis- 

 figuring nodular ulcers which may per- 

 sist many years. There is no metas- 

 tasis to the mucous membranes, and 

 cutaneous metastases are rare. The 

 lymph nodes are involved in about 2%. 

 Nothing is known of the wild reser- 

 voirs or of the vectors, altho the dis- 

 ease is clearly a zoonosis (Garnham 

 and Lewis, 1959). 



Both the Old World types of cutaneous 

 leishmaniosis are zoonoses, but their 

 epidemiology is quite different. The dry 

 type is an urban disease common to dogs 

 and man, while the moist type is a rural 

 disease of gerbils and other rodents which 

 affects man more or less incidentally. 



The American forms, too, occur primarily 

 in wild animals, mostly unknown, of the 

 tropical rain forests; both man and dogs 

 are secondary hosts. 



Pathogenesis : The ulcers or sores 

 of classical, dry Oriental sore are found 

 on exposed parts of the body in man. At 

 first they resemble mosquito bites, but 

 they do not go away. The lesion grows 

 slowly, becoming covered with thick brown 

 scales. It itches a great deal, and scratch- 

 ing produces a small ulcer which is covered 

 with a crust. This enlarges slowly, and 

 may finally be several centimeters in diam- 

 eter. After some months or a year, con- 

 nective tissue is formed, but a permanent 

 scar is left. The disease is very seldom 

 fatal. 



In the central Asian form of the dis- 

 ease, the lesions are moist. They develop 

 more rapidly, becoming ulcerative in one 

 or two weeks, and then heal spontaneously. 

 Relatively few parasites can be found in 

 them. 



In espundia, the ulcers are often worse 

 than those of Oriental sore and may last 

 much longer. They usually heal in 7 to 8 

 months, but sometimes last more than 20 

 years. In addition, in some cases they may 

 extend to the mucosa of the mouth or nose 

 either directly or by metastasis. When 

 they do this, they may cause a great deal of 

 disfigurement; in extreme cases the nose 

 may even be completely eaten away. 



The lesions in the dog are similar to 

 those in man. They are probably confined 

 to the skin. Visceral leishmaniosis due to 

 L. tropica has been reported in dogs, but 

 many observers believe that these are due 

 to concurrent infections with L. donovani. 

 In infected gerbils, cutaneous sores occur 

 on the ears. 



Immunity : Persons who have recov- 

 ered spontaneously from classical Oriental 

 sore have a solid immunity. This fact is 

 so well known among the natives that they 

 vaccinate themselves on the arm in order 

 to avoid natural, disfiguring ulcers on the 

 face. There is no cross-immunity between 

 the wet and dry Old World types of the 



