(CS-075) Cutaneous New World Leishmaniasis (L. panamensis) in a previously healthy 48 year old male after travel to Costa Rica presenting to a Southeastern US Wound Center.

Emily Culpepper, RN, MSN, ANP – Staff Nurse Practitioner, Wound Care Hyperbaric and Vascular Medicine & Limb Preservation Program, Roper St Francis Bon Secours Mercy Healthcare; Brandy Price, PA-C – Staff Physician Assistant, Wound Care Hyperbaric and Vascular Medicine & Limb Preservation Program, Roper St Francis Bon Secours Mercy Healthcare

Introduction:

A 48-year-old previously healthy male presented to our Wound Center on referral of his General Surgeon for a nonhealing surgical wound to the left medial distal calf.  Pt first noted the wound in May of 2023.  He noted a small papule which quickly became ulcerated.  

Methods:

 

 

This is a case report of a rare case of a tropical disease found in an otherwise healthy patient returning from a trip to Costa Rica. The chart and medical records were extensively reviewed as were consultant notes, test results, CDC reports and literature review was undertaken. Serial photos are available on request. 


Results:

 

The patient remains under the care of a multidisciplinary team including the Wound Center, Infectious Disease, and Dermatology. His case has been reported to the Center for Disease Control for tracking. He is making slow progress toward healing these chronic wounds.

Discussion:

  Leishmaniasis is divided into 2 categories: Old World and New World.  The Old World form is considered to be mostly benign and self-limited, whereas the New World form is able to cause a wide variety of symptoms from benign to life threatening disease. As it is spread through the host via the blood, lymph and local extension, New World Leishmania can cause visceral and systemic involvement.  Leishmania panamensis is found in Central and South America. Of the  3  forms, the most common is Cutaneous leishmaniasis (CL). The ulcers caused by CL can leave lifelong scars and serious disability. Approximately 95% of CL cases occur in the Americas, the Mediterrranean basin, the Middle East and Central Asia. Poverty increases the risk for leishmaniasis. Poor, unsanitary housing and lack of wastewater management and sewage can increase sandfly breeding as well and increase their access to humans. Camping in endemic areas or sleeping outdoors on the ground increases the risk of sandfly bites. Diagnosis is often delayed or not made at all when patients present to their healthcare providers in nonendemic areas, as many Physicians and practitioners are not familiar with the symptoms. It is vital to get a detailed travel history from any patient presenting with an atypical or unusual skin ulcer or lesion.  We must keep our differential diagnoses broad to avoid missing these rare causes of atypical wounds. References available on request.