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Mediterranean, the possibility cannot be ruled out that she might have 

 contracted the disease outside the USA. 



Only three cases of mucocutaneous leishmaniasis had been reported 

 in the USA prior to 1943, one of which was presumed to be 

 autochthonous (Stewart and Pilcher, 1943). Benedek (1940) reported a 

 case of mucocutaneous leishmaniasis in a man from Chicago, which he 

 considered the first autochthonous case of leishmaniasis in the USA. 

 However, there is some question as to the extent of the patient's 

 travel, and thus there is room for doubt. 



Stewart and Pilcher (1943) reported on a case of cutaneous 

 leishmaniasis in a 6-year-old Mexican-American boy who lived on a 

 ranch near Alice, Texas and had never traveled more than 60 miles from 

 his home. The authors, obviously aware of the recent incrimination of 

 sand flies as the vectors of both visceral and cutaneous leishmaniasis 

 in the Old World, mentioned that three species of " Phlebotomus " 

 ( Lutzomyia ) had been identified in the USA, all of which were found 

 within or near Texas. They astutely concluded that the apparent 

 rarity of the disease in the United States was probably not real and 

 that the return of military and civilian personnel from endemic 

 centers was further reason for keeping American leishmaniasis in mind. 

 This was probably the first truly autochthonous case of leishmaniasis 

 reported in this country, although Wenyon disputed the identity of the 

 parasite stating: "The microphotograph illustrating the paper is a 

 good one, but though suggestive of Leishmania , it is not absolutely 

 convincing" (1945, p. 712). 



Addis (1945a) described a new species of sand fly from Texas, 

 " Phlebotomus anthophorus " ( Lu . anthophora) , from specimens collected 



