-30- 



1982 (Fig. 2-3). When the lesion persisted, an excisional biopsy was 

 performed which showed amastigotes in large vesicles within 

 macrophages by both light and electron microscopy. The patient had 

 never traveled outside the USA. He frequently spent the week ends at 

 the ranch of his paternal grandparents in Devine, Texas. The family 

 had one pet dog, and the boy's grandparents had three hunting dogs. 



Patient D . The patient was a 10-year-old white male from the 

 rural farming community of D'Hanis, Texas, who developed a lesion near 

 his right eye brow and another on his right cheek in December, 1982 

 (Fig. 2-4). When the lesions persisted, an excisional biopsy was 

 performed which showed amastigotes in large vesicles within 

 macrophages by light microscopy. Presence of kinetoplasts was 

 confirmed by electron microscopy. Promastigotes were recovered from 

 an aspirate of the eyebrow lesion, but these died before further 

 identification could be performed. The patient had never traveled 

 outside of Texas and had lived all of his life in Medina County with 

 only occasional trips to Uvalde, San Antonio, and Seguin, Texas. He 

 regularly accompanied his father on coyote hunting trips near his 

 home. The family had ten hunting dogs. The patient's mother recalled 

 seeing tiny hopping flies in the house, around the light fixture, and 

 members of the family reported being bitten by tiny gnats. When shown 

 a live female Lu. diabolica the mother said that it was the same as 

 those she had seen in the house. 



A suspected case, with history very similar to the others, was 

 reported from Hondo, Medina County, Texas, within 12 miles of the home 

 of Patient D. The patient was a 4-year-old white male who first 

 noticed a lesion on the bridge of his nose beginning in January, 1983. 



