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Case Reports and Literature Review

Pascal del Giudice, MD; Pierre Marty, MD; Jean Philippe Lacour, MD; Christophe Perrin, MD; Francine Pratlong, MD; Hervé Haas, MD; Pierre Dellamonica, MD; Yves Le Fichoux, MD

Arch Dermatol. 1998;134:193-198.

Background  Leishmania infantum recently has been identified as a possible agent of cutaneous leishmaniasis (CL). This species has been isolated from cutaneous lesions of patients from the Mediterranean Basin. However, little is known about the clinical, biological, or therapeutic features of this newly recognized CL.

Observations  Six patients aged 9 months to 85 years in southeastern France were found to have autochthonous leishmaniasis. Parasitological identification showed that the agent was L infantum, zymodemes Montpellier-1 for 2 patients and Montpellier-24 for 1 patient. Five patients who underwent testing with a Western blot assay were found to have antibodies against 4 antigens with molecular masses of 18, 21, 23, and 31 kd. Five patients were successfully treated with local injections of N-methylglucamine, and 1 patient was successfully treated with topical paromomycin sulfate. No patient had visceral disease at diagnosis or after follow-up.

Conclusions  Recent data provide increasing evidence that L infantum is an important agent of CL. In southwestern Europe, this species is the only agent that has long been identified from autochthonous CL. Leishmania infantum should be considered an agent of CL in areas in which visceral leishmaniasis is endemic. Western blot assay could be a useful test for the diagnosis, but precise parasitological identification is important to having a better knowledge of the disease. The relationships between CL and the visceral disease have to be explored.

From the Departments of Infectious Diseases (Dr del Giudice), Parasitology-Mycology (Drs Marty and Le Fichoux), Dermatology (Dr Lacour), and Pathology (Dr Perrin), Centre Hospitalier Universitaire de Nice; Centre Hospitalier Inter Communal de Fréjus-Saint Raphaël (Drs del Giudice, Haas, and Dellamonica); and Laboratoire d'Ecologie Médicale et Pathologie Parasitaire (Dr Pratlong), Montpellier, France.

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