A child in North Dakota acquired cutaneous leishmaniasis from a different etiologic species than the Leishmania mexicana species that has been documented in the 10 cases of the disease in the south-central United States, according to a case report published in Clinical Infectious Diseases.
The otherwise healthy 27-month-old boy developed lesions on the right upper and lower eyelids in June 2012. The upper eyelid lesion healed in 18 months after multiple courses of topical and oral antibacterial treatments. The lower lesion persisted, increased in size and showed swelling and erythema. Neither the child nor his family had traveled outside of North Dakota.
Cutaneous leishmaniasis was considered in November 2013 by a physician-in-training. The boy underwent an excisional biopsy of the lesion, and histopathology showed granulomatous inflammation. The tissue sent to the CDC was culture negative, but L. donovani species complex DNA was detected by PCR testing.
“We believe this case is of interest for two reasons,” the researchers wrote. “First, human leishmaniasis acquired in the US has not been reported outside of Texas and Oklahoma. Second, this case also represents the first report of autochthonous human infection in the US caused by a member of the L. donovani species complex.”
The investigators said infections caused by this species are typically small, and patients present with one to three lesions, usually on the face. Also, there is no known information about the presence of sandflies in North Dakota, but there have been at least 14 species of Lutzomyia sandflies identified in North America.
“While it seems fair to conclude that [cutaneous leishmaniasis] in our patient was likely acquired via an infected sandfly, we can only speculate about the reservoir of infection since transmission may have been either zoonotic or possibly even anthroponotic,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.