American cutaneous leishmaniasis in Guyana, South America

The 185 patients who presented at the dermatology clinic of Georgetown Publ ic Hospital, Guyana, between 1992 and 1998, with skin ulcers indicative of American cutaneous leishmaniasis (ACL) were retrospectively reviewed. The l aboratory-confirmed cases of ACL were identified and the corresponding data were analysed for risk factors such as age, gender, areas of residence and of possible exposure to the causative agent (Leishmania braziliensis guyan ensis), ethnic origin, longevity of the ulcers, and treatment regimes prior to the definitive diagnosis. Eighty-one (43%) of the 185 subjects were confirmed to be infected with Le. b. guyanensis. Although 53 (66%) of the cases lived in or close to the cap ital city, Georgetown, most of the cases had travelled to (and probably bee n infected in) region X in the interior of Guyana (32%) or regions VII (23% ), VIII (23%), IX (11%), VI (5%), I (3%) or III (3%), usually because they were involved in the mining (41%) or lumber (21%) industries, the army or h unting. Almost all (95%) of the cases were male and most (58%) were aged 20 -39 years. In general, the cases had had their skin lesions for many days b efore presenting for treatment: 46% for 1-5 weeks and 3% for > 6 months. Pr ior to presentation at the clinic, many of the cases had attempted to cure themselves, using local herbal remedies (37%), antibiotics and antifungal r emedies (39%), other creams (5%), household chemicals (9%) or miscellaneous remedies such as lead salts (especially lead sulphate) and battery acid, a ll without success. Recommendations are made for an epidemiological study of active ACL among f orest workers, eco-tourists and residents of high-risk areas. Diagnostic ce ntres need to be sited in the regions most at-risk, particularly in or near environments in which the main vectors-sandflies such as Lutzomyia umbrati lis, Lu. anduzei and Lu. whitmani-are known to be prevalent.