Not-knowing and the proliferation of assumptions: local explanations of Cutaneous Leishmaniasis in Suriname.

Why do patients and others confronted with cutaneous leishmaniasis (CL) - a parasitic skin disease - in the hinterland of Suriname, South America, provide a dazzling variety of aetiological explanations for one single illness? And how do these explanations reflect local knowledge of and interest in the origin of illness? In this article, we explore these questions using the concept of 'not-knowing', as introduced by Murray Last in 1981. One of Last's conclusions is that 'don't knows' or 'don't cares' reflect people's disinterest in medicine. The aim of this article, however, is to draw attention to another aspect of not-knowing: it may lead to a proliferation of explanatory assumptions, unhindered by precise knowledge. In other words, multiple explanations mask not-knowing, which is from a methodological point of view a rarely observed element in social science research and constitutes an important addition to Murray Last's well known argument. The paper describes findings based on anthropological fieldwork carried out between September 2009 and December 2010 at the Dermatology Service in Suriname's capital Paramaribo and among 205 CL patients and 321 inhabitants in various communities in the hinterland. As this article shows, both knowing and not-knowing are rooted in the various contexts of people's daily lives and reflect their historical, socio-cultural, occupational, educational, biological, environmental, and public health-related conditions. Public health authorities should explore not-knowing more seriously in their efforts to prevent illness, since knowing about not-knowing is valuable in the design of health education and prevention programmes.

Refugees at the Crossroads of Continents: A Molecular Approach for Cutaneous Leishmaniasis Among Refugees in Turkey.

PURPOSE: Due to mass population movements driven by internal conflicts and wars, cutaneous leishmaniasis (CL) is becoming increasingly important in Turkey. This study is aimed at determining the clinical aspects, diagnosis and genotyping of CL patients coming to Turkey from abroad. METHODS: In our study, the clinical materials obtained from the patients or sent for diagnostic purposes from other centers to our laboratory between years 2012 and 2016 were assessed retrospectively. In total, there were 38 patients from Syria, Iraq, Afghanistan, Iran, and Turkmenistan. RESULTS: 29 (76%), 28 (73%) and 33 (87%) samples were positive by light microscopy, Novy-McNeal-Nicolle(NNN), and enriched medium, respectively. By ITS-1 gene region PCR, 31 (81%) of the cases were positive. 35 of the patients were tested positive by at least one of the diagnostic methods. By genotyping, 21 Leishmania tropica, 8 Leishmania major, 3 Leismania infantum, 2 Leishmania donovani, and 1 Leishmania aethopica were detected. CONCLUSION: This study is aimed at informing the clinicians working in the field for the import CL cases and recording the changing epidemiological features of CL in the region as well as discussing the possible focus for L. aethiopica infection which has not been shown in the region before.

The new situation of cutaneous leishmaniasis after Syrian civil war in Gaziantep city, Southeastern region of Turkey.

Cutaneous leishmaniasis (CL) is an important public health problem with around 2.000 autochthonous reported cases each year in Turkey. Due to the civil war in Syria, Turkey received around three million refugees and they are mainly located at either camps or homes in south/southeastern part of Turkey. In the present study, we aimed to collect samples from CL suspected patients admitting to State Hospital in Gaziantep City and perform parasitological and DNA-based techniques for diagnosis as well as species identification of the parasite for better understanding the prevalence of each species among Turkish and Syrian patients in the region. The collection of samples was carried out between January 2009 and July 2015. The lesion aspiration samples were taken and stained with Giemsa stain followed by microscopical examination for parasitological diagnosis. After the DNA extraction from Giemsa stained slides, real time and semi-nested PCRs both targeting ITS1 region were performed for molecular diagnosis and species identification. A total of 567 people were admitted to the hospital with the suspicion of CL and 263 (46.4%) of them were found to be positive by parasitological examination. One hundred seventy-four (66.15%), 88 (33.46%) and 1 (0.38%) of them were Turkish, Syrians and Afghan, respectively. Slide samples obtained from 34 CL suspected patients were analyzed by PCR and 20 of them were found positive. Eighteen (13 Turkish and 13 Syrians) of the positive samples were identified as L. tropica, while two (1 Turkish and 1 Syrian) of them were L. infantum. In conclusion, the effects of Syrian civil war on the epidemiology of CL in Gaziantep city is demonstrated in the present study. The use of molecular tool in the diagnosis of leishmaniasis is effective, sensitive and time saving which will enable the species typing. Species typing of the causative agent in endemic areas will bring valuable data to epidemiological knowledge.

Increased prevalence of human cutaneous leishmaniasis in Israel and the Palestinian Authority caused by the recent emergence of a population of genetically similar strains of Leishmania tropica.

Twelve unlinked microsatellite markers were used to determine the microsatellite profiles of 50 newly and 46 previously typed strains of L. tropica from various Israeli and Palestinian foci. Their microsatellite profiles were compared to those of 99 previously typed strains of L. tropica from 15 countries. Israeli and Palestinian strains of L. tropica fell into three different groups, one of which contained 75 of the 96 Israeli and Palestinian strains. This population separated from all the others at the first hierarchical level by Bayesian statistics and formed a distinct monophyletic group on applying genetic distance and allele frequency analyses. The second cluster contained ten Israeli strains from a specific focus north of the Sea of Galilee, which were previously shown to differ from all other strains of L. tropica in their serological, biochemical and molecular biological parameters. This cluster was closely related to clusters comprising strains of L. tropica from Africa. Four Israeli and five Palestinian strains fell into different genetic entities mostly related to strains from Asian foci of CL. Importation during numerous migrations of humans and, perhaps, infected reservoir animals in the past and, now, through modern travel is the most likely explanation for the existence of so many locally encountered genetic variants of L. tropica in the Israeli-Palestinian region. Geographical and ecological variation may play a role in expanding the genetic heterogeneity once given importations had become established in different foci. Currently, one population is expanding in the area comprising almost all of the Palestinian and Israeli strains of L. tropica isolated since 1996 and investigated in this study, which differ clearly from all other strains of whatsoever origin. This population seems to result from the re-emergence of a previously existing genotype owing to environmental changes and human activities.

Nuancing stigma through ethnography: the case of cutaneous leishmaniasis in Suriname.

Health-related stigma and its dramatic consequences for those stigmatized have long been a crucial concern for public health authorities globally. However, before concluding that stigma spoils the lives of people with a particular disease or disability and is a major obstacle to obtaining/providing adequate health care, it is necessary to first determine whether there is actual stigmatization related to the condition concerned. The purpose of this article is to nuance the concept of stigma through a detailed ethnographic exploration of the experiences and views of patients and others affected by the parasitic skin disease cutaneous leishmaniasis (CL) in Suriname, South America. Qualitative data on the perceptions, treatment and illness experiences of CL in Suriname was collected in 2009 and 2010 among 205 CL patients at the Dermatology Service in the capital city Paramaribo, and among 321 people in different rural hinterland villages. The exploration reveals the complex and sometimes confusing statements of patients and observers of social reactions to the disease. The authors conclude that--in contrast to other societies--CL is not generally a stigmatized disease in Suriname (though this is not to deny that stigmatization may occur occasionally). Over the past decades, the concepts of stigma and stigmatization have been abundantly theorized. But when theory drifts away from ethnographic evidence, it may turn into imprecise popular speech. In this article, we warn against inflation of the term stigma and show, through an in-depth qualitative description of reactions to symptoms of CL in Suriname, why negative reactions may not necessarily entail stigma.

LeishMan recommendations for treatment of cutaneous and mucosal leishmaniasis in travelers, 2014.

BACKGROUND: Treatment of cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML) in travelers is still controversial. Over the last decade, national and international consortia have published recommendations for treating CL in travelers. These guidelines harmonize many issues, but there are some discrepancies. METHODS: Leishmania parasites causing CL can now be genotyped by polymerase chain reaction techniques for detecting Leishmania DNA. Therefore, treatment recommendations can now be species based rather than based on geographical exposure. To review the evidence on which the recommendations were based, "LeishMan" (Leishmaniasis Management), a group of experts from 13 institutions in eight European countries, performed a PubMed MEDLINE) literature search and considered unpublished evidence and the experts' own personal experiences. The Oxford evidence grading system was used to evaluate the information. RESULTS AND CONCLUSION: In this article, the authors provide practical treatment recommendations for imported CL and ML in Europe, drawn up from the review by the European experts.

The impact of human immunodeficiency virus-related diseases on pigmented skin types.

Infection with human immunodeficiency virus (HIV) remains a significant problem globally. Early diagnosis and treatment with antiretroviral drugs has considerably improved health outcomes and decreased disease-related morbidity. HIV infection is associated with a wide range of skin disorders enabling dermatologists to diagnose HIV as well as associated opportunistic infections early in the course of disease. Despite concerted efforts by international health organizations to limit disease incidence, the prevalence of HIV infection remains high and is highest in sub-Saharan Africa. The diagnosis of HIV-related skin diseases is challenging as immunosuppression often results in atypical disease presentation. In addition, the clinical presentation will vary in pigmented skin types. The aim of this article is to describe disease variation in pigmented skin types.

Cluster of zoonotic cutaneous leishmaniasis (Leishmania major) in European travelers returning from Turkmenistan.

We report a cluster of cutaneous leishmaniasis due to Leishmania major in four immunocompetent travelers returning from Western Turkmenistan and having atypical and/or multiple lesions. Treatments with pentamidine or fluconazole were effective. Physicians should be aware that some virulent strains of L major currently circulate in Central Asia.

Estudo das características epidemiológicas da leishmaniose tegumentar americana no estado de Giás, Brasil, 2007-2009 / Study of the epidemiological characteristics of cutaneous leishmaniasis in the state of Gias, Brazil, 2007-2009

A leishmaniose tegumentar americana é um grave problema de saúde pública em vários países do mundo. O presente trabalho visou realizar o levantamento descritivo das características epidemiológicas da doença no estado de Goiás entre os anos de 2007 e 2009. Este trabalho consistiu em uma pesquisa retrospectiva descritiva com base nos dados notificados e cadastrados no Sistema de Informação de Agravos de Notificação (SINAN). O estudo mostrou a distribuição dos casos autóctones por município, evidenciando a expansão da doença no estado. Assim, foram notificados 1.285 casos confirmados de leishmaniose tegumentar americana, dos quais 848 eram autóctones em 130 municípios. Em 2007, foram notificados 233 casos autóctones em 75 municípios; em 2008, 276 casos em 81 municípios e, em 2009, 349 casos em 85 municípios. Estes dados sugerem uma leve tendência de aumento de casos e uma ampla distribuição geográfica. Houve predominância de casos que envolviam indivíduos habitantes da área urbana, do sexo masculino, de raça parda e escolaridade inferior ao ensino médio. O resultado da pesquisa sugere a necessidade de uma investigação mais profunda das causas dessas infecções, o que demonstra a importância deste estudo, uma vez que oferece dados que podem subsidiar programas voltados à informação e profilaxia deste tipo de infecção...

The American cutaneous leishmaniasis is a serious public health problem in many countries. This study aimed to survey descriptive epidemiological characteristics of the disease in the State of Goias between the years 2007 and 2009. This study consisted of retrospective descriptive research based on data reported to and registered in the Information System for Notifiable Diseases. The study showed the distribution of autochthonous cases by municipality, showing the spread of the disease in the state, thus, 1,285 confirmed cases of cutaneous leishmaniasis were reported, from which 848 cases were autochthonous, in 130 municipalities. In 2007, 233 cases were reported in 75 municipalities, in 2008 there were 276 cases in 81 municipalities and in 2009 there were 349 cases in 85 municipalities. These data suggest a slight upward trend of cases and a wide geographical distribution. There was a predominance of cases involving individuals who inhabited urban areas, were male, of mixed race and with less than high school education. The results of this search suggest further investigation of the causes of these infections, thus justifying the importance of this study, since it provides data that may support programs aimed at prevention of this type of infection...

Cutaneous leishmaniasis in Royal Marines from Oruzgan, Afghanistan.

Leishmaniasis is an infectious disease caused by Leishmania protozoa and occurs as a spectrum of clinical syndromes ranging from various forms of cutaneous leishmaniasis (CL) to mucosal leishmaniasis (ML) and visceral leishmaniasis (VL). CL in Afghanistan is either zoonotic (ZCL) due to L. major or anthroponotic (ACL) due to L. tropica and there has been a prolonged epidemic of ACL in eastern Afghanistan since 1987. However, there have been remarkably few reports of CL due to L. tropica amongst foreign troops serving in Afghanistan since 2001. We describe two such cases in Royal Marines deployed to Oruzgan Province in Afghanistan from 2008-9. These patients illustrate important issues regarding the clinical features, referral, diagnosis, treatment and epidemiology of CL amongst foreign troops in Afghanistan. This disease has the potential to cause significant disruption to military personnel and units and so requires efficient management in order to maintain operational effectiveness.

Outbreak of zoonotic cutaneous leishmaniasis with local dissemination in Balkh, Afghanistan.

OBJECTIVES: In Afghanistan zoonotic cutaneous leishmaniasis (CL) due to Leishmania major has been less widely reported than anthroponotic CL due to L. tropica. However, an outbreak of zoonotic CL occurred amongst a group of British soldiers at a military camp near Mazar-e-Sharif in the Balkh province of northern Afghanistan in 2004. METHODS: A study was performed to assess the epidemiology, clinical features, parasitology results, treatment outcomes and environmental health measures associated with this incident. RESULTS: Twenty (17%) of 120 soldiers developed CL due to L. major and the risk of infection increased with the proximity of their accommodation to an area of recently cleared scrub, where many wild rodents were observed. Most cases had features of local dissemination, including secondary lesions from the pseudo-Koebner phenomenon, sporotrichoid lymphatic spread, lymphadenopathy and satellite papules or milia formation around healing lesions. Several cases responded poorly to fluconazole and low dose (10 mg/kg) sodium stibogluconate, which were considered suitable treatments at the time. Environmental health measures at the military camp were found to be deficient. CONCLUSIONS: Zoonotic CL due to L. major is a significant threat for foreign troops based in Balkh, Afghanistan and may present with unusually severe clinical features and be resistant to previously recommended treatments.

Treatment of leishmaniasis in the Oyapock basin (French Guiana): A K.A.P. survey and analysis of the evolution of phytotherapy knowledge amongst Wayãpi Indians.

ETHNOPHARMACOLOGICAL RELEVANCE: Cutaneous leishmaniasis is a neglected disease with a high incidence in French Guiana, mainly in the middle and upper Oyapock basin, where Amerindian and some Brazilian people live. The main goals of this work were (i) to assess the knowledge about leishmaniasis in the different populations of the middle and upper Oyapock basin, (ii) to study the therapeutic strategies adopted by people affected by leishmaniasis and (iii) to document the use of phytotherapeutic remedies for leishmaniasis. Knowledge, attitudes and practices (K.A.P.) related to this disease and its treatments have been studied according to cultural group and geographical settlement. Within the Wayãpi group, the evolution of the knowledge of phytoremedies over the last 20 years has been characterised by literature-based comparisons. MATERIALS AND METHODS: A total of 144 questionnaires were administered in all the villages of the upper Oyapock and Camopi basins. Correspondence analyses were used for multivariate analysis. Plant species were identified at the Cayenne Herbarium (CAY). RESULTS: The biomedical concept of leishmaniasis correlates well with the Teko and Wayãpi concepts of kalasapa and kalasapau. Although the vector of this disease was not correctly identified, the most commonly cited aetiology (74.5%) was vector-borne, and related epidemiological schemes correlate well with the one encountered in French Guiana. Theoretically and practically, health centres were the most commonly used resource for diagnostic in instances of leishmaniasis infection (65.9%), independently of the patient's cultural group, along with the use of pharmaceutical drugs (85.3%). Pharmaceuticals were commonly utilised despite the frequent (51.5%) use of phytotherapeutic remedies, alone or in combination with drugs. The most cited medicinal plant species for the treatment of leishmaniasis included Eleutherine bulbosa (Mill.) Urb. (Iridaceae, cited 14 times), Euterpe oleracea Mart. (Arecaceae, 9), Cecropia obtusa Trecul (Cecropiaceae, 8), Jatropha curcas L. (Euphorbiaceae, 7), Ceiba pentandra (L.) Gaertn. (Bombacaceae, 6) and Carica papaya L. (Caricaceae, 6). Multiple correspondence analyses demonstrated that the species used in leishmaniasis remedies are more prone to vary by the user's place of residence than by their cultural origin, which indicates that exchange of knowledge about leishmaniasis remedies has occurred across different cultural groups. Literature-based comparisons between the remedies for leishmaniasis used by the Wayãpi during the 1980s showed a striking evolution, both in terms of diversity of species and number of plants used. The large number of species shared with other Guianese groups argues for intercultural exchange and may explain the majority (57.1%) of the newly used species highlighted in our study. CONCLUSIONS: Leishmaniasis is a well-known disease in the studied area. Phytotherapeutic treatments are still in use, although they are not the main source of remedies, and should undergo pharmacological studies to evaluate their potential therapeutic value.

Inmunoterapia de la leishmaniasis cutánea: factores que influencian su efectividad / Immunotherapy of cutaneous leishmaniasis: factors that influence their effectiveness

En Venezuela se utiliza la inmunoterapia por su bondad terapéutica y operacional en el tratamiento de la leishmaniasis cutánea y se aprecian diferencias de su efectividad entre los servicios locales de salud que la emplean. En el estado Mérida, donde se tiene un bajo nivel de falla terapéutica, se desconocen los factores de riesgo ó de protección que la determinan. Por ello se planteó realizar un estudio epidemiológico de casos y controles para evaluar los factores individuales demográficos, clínicos, inmunológicos y adherencia terapéutica que influyen en dicha efectividad. El ajuste con regresión logística determinó según definición: a) Demográfica: como riesgo las edades extremas, tabaquismo y de oficio doméstico, con protección en el alfabeto educativamente, b) Clínica: como riesgo la forma intermedia, cinco o más lesiones, infección secundaria y ubicación en pié, con protección en la forma localizada y tamaño menor a 60 mm, c) Inmunológica: de riesgo las bajas respuestas a leishmánina y PPD, d) Adherencia terapéutica: son riesgo la aplicación tópica y aseo local inadecuados. Se concluye, hay factores de riesgo y protección que modelan la eficacia de la inmunoterapia, lo que en consecuencia demanda una dinámica vigilancia clínico-epidemiológica para potenciar dicha terapéutica.

Immunotherapy is used in Venezuela as treatment of cutaneous leishmaniasis and there are differences among the health services that use it. In Merida State there are a low proportion of failures, but the factors that are related to this failure are unknown. A case-control study was planned to evaluate the demographics, clinical, immunological factors and the treatment compliance that can be related to the effectiveness. Logistic regression showed that the factors related to failure were: a) demographics: lower and older ages, smoking, domestic labor and illiteracy; b) clinical: intermediate leishmaniasis, five or more lesions, aggregated infection, lesions in feet, and lesion size above 60 mm; c) Immunology: low reactivity to Montenegro and tuberculin tests; d) treatment compliance: use of incorrect topical substances and inadequate cleaning of ulcer. As a conclusion, there are several factors that influence treatment response, that require clinical and epidemiological surveillance to increase the effect of therapy.

Atención hospitalaria de la leishmaniosis tegumentaria americana en los miembros inferiores / Hospital care of American tegumentary leishmaniasis in the lower limbs

La leishmaniosis tegumentaria americana (LTA) como enfermedad endémica crónica continúa afectando a la población del medio rural venezolano, ocasionándole morbilidad y limitaciones laborales. Mediantes la descripción de casos clínicos se evaluaron 38 pacientes con LTA que recibieron atención hospitalaria por úlceras leishmánica en miembros inferiores. De los pacientes descriptos 63% eran niños, 84% procedía del Estado Miranda, 66% tenía una lesión ulcerosa única, 45% recibió cefadroxilo previo al tratamiento antiparasitario específico y el 24% había recibio inmunoterapia previa para la enfermedad. Treinta y siete pacientes (97%) recibieron antimoniato de meglumina en series terapéuticas de aiez días y uno anfoterecina B, por contraindicación cardiovascular para el uso del antimonial. Todos presentaron re-epitelización adecuada de sus lesiones, por lo que el antimoniato de meglumina demuestra una vez más su utilidad en la terapéutica de esta zoonosis parasitaria.

American tequmentary leishmaniasis (ATL) endemic chronic disease continues to affect the population of rural Venezuela, causing morbidity and labor constraints. By the description of clinical were evaluated 38 patients with ATL who received hospital care for leishmanial ulcers in lower limbs. Sixty-three percent of the patients were children, 84% came from Miranda state, 66% had a unique ulcerated lesion, 45% received cefadroxil prior to parasite specific treatment and 24% had received immunotherapy for the diseaes. Thirtyseven patients (97%) received meglumine antimoniate in series of ten days and one patient received anfotericine B, due to cardiovascular contraindication for the use of the antimonial. All ulcers healed. The antimoniate of meglumine demonstrates once again its usefulness in the treatment of this parasitic zoonosis.

Leishmaniosis cutánea en la Región Sanitaria No 3, República de Honduras, enero 1998-septiembre 2002 / Cutaneous leishmaniasis in Health Region No 3, Republic of Honduras, January, 1998 - September, 2002

Se realizó un estudio descriptivo retrospectivo en el área metropolitana de la Región Sanitaria No. 3 de Honduras, con el propósito de identificar características sociodemográficas, clínicas y epidemiológicas de la leishmaniosis. Los datos se obtuvieron de las fichas de vigilancia existentes en el área de salud. Para el análisis se utilizaron las distribuciones de frecuencias y el test de comparación de proporciones. El sexo masculino resultó ser el más afectado por esta enfermedad, así como los estudiantes. La forma clínica que predominó fue la úlcera, con lesiones únicas situadas fundamentalmente en piernas y brazos. La solicitud de servicios médicos se produjo entre 1 y 3 meses después de presentarse las lesiones. La entrada a zonas boscosas fue fundamental para la aparición de la enfermedad. No hubo recaídas en los pacientes que hicieron un tratamiento adecuado. La leishmaniosis es una enfermedad más que todo social en Honduras y nuestros médicos deben poder reconocerla.

A descriptive study was conducted in metropolitan area of Health Region No. 3 of Honduras to identify the sociodemographic, clinical and epidemiological features of leishmaniasis. Data were collected from surveillance record cards available in health area. In analysis frequencies distribution and ratio comparison test were used. The more affected sex was the male one as well as the students. Clinical form predominant was the ulcer with single lesions located mainly in legs and arms. Medical services request was between 1 and 3 months after lesions appearance. Entry to wooded zones was the main cause of disease appearance. There were not relapses between patients who fulfilled with the treatment parameters. In Honduras, leishmaniasis is a social disease and our physicians must to know it.

Leishmaniosis cutánea en la Región Sanitaria No 3, República de Honduras, enero 1998-septiembre 2002 / Cutaneous leishmaniasis in Health Region No 3, Republic of Honduras, January, 1998 - September, 2002

Se realizó un estudio descriptivo retrospectivo en el área metropolitana de la Región Sanitaria No. 3 de Honduras, con el propósito de identificar características sociodemográficas, clínicas y epidemiológicas de la leishmaniosis. Los datos se obtuvieron de las fichas de vigilancia existentes en el área de salud. Para el análisis se utilizaron las distribuciones de frecuencias y el test de comparación de proporciones. El sexo masculino resultó ser el más afectado por esta enfermedad, así como los estudiantes. La forma clínica que predominó fue la úlcera, con lesiones únicas situadas fundamentalmente en piernas y brazos. La solicitud de servicios médicos se produjo entre 1 y 3 meses después de presentarse las lesiones. La entrada a zonas boscosas fue fundamental para la aparición de la enfermedad. No hubo recaídas en los pacientes que hicieron un tratamiento adecuado. La leishmaniosis es una enfermedad más que todo social en Honduras y nuestros médicos deben poder reconocerla(AU)

A descriptive study was conducted in metropolitan area of Health Region No. 3 of Honduras to identify the sociodemographic, clinical and epidemiological features of leishmaniasis. Data were collected from surveillance record cards available in health area. In analysis frequencies distribution and ratio comparison test were used. The more affected sex was the male one as well as the students. Clinical form predominant was the ulcer with single lesions located mainly in legs and arms. Medical services request was between 1 and 3 months after lesions appearance. Entry to wooded zones was the main cause of disease appearance. There were not relapses between patients who fulfilled with the treatment parameters. In Honduras, leishmaniasis is a social disease and our physicians must to know it(AU)

Old world cutaneous leishmaniasis in Los Angeles: a case report, overview of the current literature, and guide for the treating dermatopathologist.

We describe a case of cutaneous leishmaniasis in a Spanish patient visiting Los Angeles. Leishmania species cause both cutaneous and visceral disease; the majority of infections with Leishmania are of the cutaneous form. Although leishmaniasis is a relatively rare occurrence in the United States, travel by United States' citizens to endemic regions and increased United States military operations in the Middle East raise the chances of encountering cutaneous leishmaniasis. The following case report and overview of the current literature outlines the major morphologic findings and current diagnostic modalities available to diagnose cutaneous leishmaniasis.