“Chiclero’s Ulcer” Due to Leishmania mexicana in Travelers Returning from Central America: A Case Report and Review of the Literature

Abstract

Cutaneous leishmaniasis (CL) due to a New World species of Leishmania is increasingly seen among returning international travelers, and most cases arise from travel to Mexico, Central and South America. We described a case of CL in a women presenting a nonhealing ulceration under her right ear with slight increase of size of the left parotid gland under the skin lesion, evolving for 4 months. In her history of travel, she reported a ten-day stay in Mexico during the Christmas vacation in the Yucatan region with only half a day walking in the tropical forest. Diagnosis of CL due to Leishmania mexicana was done via PCR detection and sequencing from swab sampling of the lesion. The patient recovered without antiparasitic treatment. Clinicians should consider diagnosing Chiclero’s ulcer in patients returning from endemic areas such as Central America and Texas who present with chronic ulceration. A noninvasive sampling is sufficient for the PCR-based diagnosis of this disease.

Amphotericin B resistance in Leishmania mexicana: Alterations to sterol metabolism and oxidative stress response

“…Extended use and the decision to use a single dose of the drug in monotherapy has great public health benefits [40,41,141,142] but that policy must consider the fact that selection of AmB resistance is clearly feasible in both CL and VL species, as we have shown here with L. mexicana (CL) and L. infantum (VL), and that resistance can be sustained in parasites that are virulent in mammals. Although CL is mainly treated with antileishmanials other than AmB, the Pan American Health Organisation has suggested its use in relapse cases for New World cutaneous species [143] although several reports indicate that liposomal AmB was unsatisfactory in treating CL caused by L. mexicana [144][145][146].…”

Non-Endemic Leishmaniases Reported Globally in Humans between 2000 and 2021—A Comprehensive Review

“…Most of the CL caused by NW Leishmania species were presented as single lesions (79.0%; n = 290) and was preferentially located in the upper (41.2%) and lower (34.5%) limbs (Table 5). The head and neck regions were affected in 28.1% of cases (especially the ears-11/31, [69,93,122,128,129,159,162,177,189,194,228]). Patients frequently presented ulcerated lesions (77.2% of cases).…”