-33- 



When the lesion persisted the boy was seen by a physician who biopsied 

 it before a positive diagnosis could be rendered. Tissue samples and 

 saline aspirates taken from the biopsied lesion contained no 

 parasites. The boy had not traveled outside the USA, nor outside the 

 region during the previous year. The family had three pet dogs. 



Serologic tests performed for each patient included indirect 

 fluorescent antibody test (IFA) and dot enzyme- 1 inked immunosorbent 

 assays (ELISA) at Walter Reed Army Institute of Research, Wash., DC, 

 and fluorescent immunosorbent assays (FIAX) at Oklahoma State 

 University, Stillwater, Oklahoma (Gustafson et aj_., 1984). These tests, 

 performed between three and six months after onset, showed that all 

 four confirmed patients had detectable antibody titers to Leishmania . 

 The sister of Patient C and the mother of Patient D had detectable 

 titers by at least two serologic tests. One dog belonging to Patient 

 C and three dogs belonging to Patient D had detectable Leishmania 

 titers by at least two tests. However, all four dogs had antibody 

 titers to Trypanosoma cruzi , and the Leishmania titers may represent 

 cross-reactions (Gustafson et aj_., 1984). 



Description of Study Sites 



Eight study sites were selected based on previous collection 

 records of Lutzomyia from south central Texas (Eads e_t a]_., 1965; Easton, 

 et al_., 1968; Young, 1972; Eads, 1978; Endris, 1982; Perkins, 1982) and 

 on their association with confirmed Leishmania patients (Fig. 2-1). 

 Three of the sites, A, B, and D, were close to the home environs of 

 patient A and he had camped at or near the sites three months prior to 

 onset of symptoms. Lutzomyia species were also known to occur at site 



