American Cutaneous Leishmaniasis

American leishmaniasis, a disease limited to the American tropics and relatively unfamiliar to North American physicians, is seen in the United States with increasing frequency since the advent of air travel. In contrast to a recent report of successful treatment with metronidazole, our experience of failure in five of six cases indicates that this drug is ineffective. UnlikeLeishmania tropica, which causes the Old World form of cutaneous leishmaniasis,L braziliensiscan persist after disappearance of the primary ulcer and subsequently produce severely mutilating mucosal lesions. Because of this danger, complete eradication of the parasite is extremely important and, in spite of recognized disadvantages, pentavalent antimonial compounds remain the drugs of choice for this infection. (JAMA228:1256-1258, 1974)