Reprinted, with additions, from the A. M. A. Archives of Otolaryngology 
November 1954, Vol. 60, pp. 601-611 
Copyright 1954, by American Medical Association 
NASAL LEISHMANIASIS AMERICANA IN PANAMA 
LUDWIG JAFFi, M.D. 
ALMIRANTE, PANAMA 
T EXTBOOKS of otolaryngology, as a rule, do not describe tropical conditions 
of the ear, nose, and throat. However, modern travel and war may bring 
patients suffering from such diseases to the temperate zone. In the United States, 
Fasal and Gradow 1 described a case of American leishmaniasis in the auricle of 
a laborer from El Salvador who had worked in Guatemala. Reipen 2 and Parten- 
heimer 3 reported from Germany involvement of the nasal mucosa in patients who 
had lived in Brazil. Thus, a short account of the condition, together with personal 
observation of eight cases, may be warranted. 
Affection of the nose has been reported from Panama in only one case, by Bates 4 
in 1913. Bates’s report concerned a patient from another region of the Republic 
of Panama (San Carlos, Los Santos Province). There is little doubt that Bates’s 
diagnosis of affection of the nasal mucosa was correct, even if rhinoscopy was not 
done. The term “Oriental sore” used by him is no longer applied to autochthonous 
leishmaniasis of the Western Hemisphere. 
ETIOLOGY 
The causal organism, Leishmania braziliensis, a protozoan parasite, is morpho¬ 
logically indistinguishable from Leishmania donovani and Leishmania tropica, the 
respective causal organisms of kala-azar (visceral leishmaniasis) and oriental sore 
(Aleppo boil, etc.). Sandflies of the genus Phlebotomus serve as transmitting 
vectors. 
GEOGRAPHICAL DISTRIBUTION 
The disease occurs in America from Yucatan, in Mexico, to Argentina, especially 
in the states of Sao Paulo and Bahia, in Brazil; in Peru and Paraguay, and in the 
West Indies. Local names for the disease in these areas are espundia, bubas brazili- 
ana, uta, pian bois, forest yaws, bosch yaws. However, these names are sometimes 
loosely applied. Stewart and co-workers * * reported one case of autochthonous 
American leishmaniasis in Texas. A few cases of mucosal involvement have been 
reported also from regions in which oriental sore is more or less endemic (Greece, 
Italy, Spain, and the Sudan). As a rule, however, the affection of the mucosa is 
found only in the New World. * 
PATHOLOGY 
The common lesions are in the skin and may consist in erythema, vesicle, papule, 
cauliflower-like growth, red plaque with raised edges, or ulcer. Ulcer of the auricle 
may result in the loss of a considerable part of the pinna (Fig. 1) ; it is known as 
From the hospital of the United Fruit Company (Chiriqui Land Company, Bocas Division). 
* Cited by Fasal and Gradow . 1 
