The Blood Flagellates 579 



Muco-cutaneous leishmaniasis 



Distribution. Muco-cutaneous leishmaniasis, generally more severe 

 than classical oriental sore, has been reported from Argentina, Bolivia, 

 Brazil, British Honduras, Colombia, Costa Rica, Ecuador, French Guiana, 

 Panama, Paraguay, Peru, Uruguay, and Venez.uela. 



The causative organism. L. brasiliensis is very similar to L. tropica in 

 morphology and likewise is found mainly in macrophages in man. The 

 insect phase of the cycle is similar to that in L. tropica. 



Symptoms and pathology. The skin lesion develops much as in oriental 

 sore. The non-ulcerating type grows from the primary papule into a 

 slightly elevated reddened area with a rough surface from which a liquid 

 oozes and dries into a crust. This liquid usually contains parasites and 

 thus may start a new sore on contact with a break in the skin. The ulcerat- 

 ing lesion becomes excavated centrally and secondary invasion by bacteria 

 often occurs. Neighboring lymph glands are often swollen, and general 

 symptoms may include fever, chronic headaches and aches in the joints. 

 The mucous membranes also are sometimes involved. Ulcers may develop 

 in the nose and mouth and, more rarely, in the vagina. An ulcer originat- 

 ing in the nose may spread downward over the upper lip into the oral 

 cavity, or the nostrils may become plugged and the nasal septum pro- 

 gressively destroyed. Depending upon their location, mucosal lesions may 

 eventually destroy the sense of smell or hearing, or may cause blindness. 



Transmission of leishmaniasis 



Transmission of oriental sore by direct contact has long been 

 known. In fact, natives of certain regions in India formerly made a prac- 

 tice of inoculating material from sores into the skin of young children. 

 This crude vaccination led to development of a sore on an unexposed 

 part of the body and, it was hoped, to prevention of more conspicuous 

 sores later in life. The general opinion is that L. tropica may invade a 

 sound mucous inembrane but cannot penetrate unbroken skin, and it is 

 likely that L. brasiliensis has similar abilities. Contact transfer of kala- 

 azar also may be possible, since the flagellates have been demonstrated 

 in nasal secretions of patients. 



Bedbugs, fleas, mosquitoes, lice, houseflies, and ticks have all been 

 suspected, at one tiine or another, of transmitting leishmaniasis to man. 

 There is no convincing evidence that any one of them normally serves 

 as a true host. However, occasional mechanical transfer may be possible, 

 as in the transmission of L. tropica by Stomoxys calcitrans in Lebanon. 

 Investigations on sandflies have been more successful. By 1924 it was 

 known that Phlebotomus argentipes develops a flagellate infection after 

 feeding on kala-azar patients. In 1927, hamsters were infected by inocula- 

 tion with flagellates from sandflies (29). In the same year, it was found 



