American cutaneous leishmaniasis: presentation and problems of patient management.

We report our experience with the diagnosis and treatment o f 60 patients with American cutaneous leishmaniasis. They were infected in Panama (55), Brazil (4) or Colombia (I). Among 35 patients with a 3 week exposure in Panama, the mean maximum incubation period was 33 days (range 4-81 days). Diagnosis was delayed an average o f 93 days after onset o f skin lesions, due to the patient’s delay in seeking medical attention (31 days), medical personnel’s delay in considering the diagnosis (45 days), and the laboratory’s delay in confirming the diagnosis (17 days). Forty-four patients (73%) developed ulcers typical o f cutaneous leishmaniasis. Sixteen additional patients (27%) had atypical macular, papular, squamous, verrucous or acneiform skin lesions that were diagnosed only because leishmanial cultures were obtained. O f the 59 patients treated with pentavalent antimonial drugs, only 34 (58%) were cured after the first course o f treatment. Lesions which were at least 2 cm in diameter, ulcerated, or c a u se d by Leishmania braziliensis were less likely to be cured after a single course o f treatment than were lesions smaller than 2 cm, nonulcerated or caused by Leishmania mexicana or Leishmania donovani.