-29- 



remaining information was obtained through personal interviews with 

 patients or their family members. A complete discussion of the case 

 histories and results of serologic tests are provided by Gustafson et 

 aj_. (1984). 



Patient A . The patient was an 11-year-old white male from Uvalde, 

 Texas, who noticed an ulcerating lesion on his left cheek beginning 

 February, 1980. In May, 1980, a biopsy was performed which showed 

 amastigotes in dermal macrophages. Leishmania mexicana was cultured 

 from biopsy material that was sent to Walter Reed Army Institute of 

 Research. Patient A had never traveled outside the USA except for 

 occasional one-day trips to the border city of Ciudad Acuna, Mexico. 

 In the month prior to onset, he had participated in a camping trip at 

 Fawcett Boy Scout Camp in Edwards County. The family had no pets. 



Patient B. The patient was a 56-year-old white female from a 

 suburban neighborhood in southeast San Antonio, Texas, who first 

 noticed a small lesion on her left ear in November 1982 (Fig. 2-2). 

 She distinctly remembered waking one morning with an itching ear and 

 noticed a drop of blood on her ear lobe and on her pillow. She 

 suspected that she had been bitten by an insect. Her bed was located 

 next to an open, screened window. A biopsy performed in February, 

 1983, showed amastigotes in dermal macrophages by light and electron 

 microscopy. Patient B had traveled out of the USA as a military 

 dependent more than ten years previously and had visited Chihuahua in 

 northern Mexico in June, 1982. She had one pet dog. 



Patient C . The patient was a 5-year-old white male from a 

 suburban neighborhood in northeast San Antonio, Texas, who first 

 noticed an enlarging papule on his left thigh beginning in November 



