Cutaneous Leishmaniasis in a Recreational Cave Diver After Travel to México.

Alfredo Siller Jr,Benjamin A Garcia,Evan J Kipp,Michael Lee,Stephen Tyring

doi:10.7759/cureus.16896

Abstract

Cutaneous Leishmaniasis due to Leishmania mexicana is a common cause of New World protozoal infections endemic to southern Mexico and now the United States (US). We present a case of a 72-year-old male who became infected with cutaneous L. mexicana while participating in numerous diving excursions in the flooded limestone caves, commonly referred to as cenotes, in the Yucatán Peninsula. This unique case of adventure tourism highlights cave diving in endemic regions of leishmaniasis as a possible new risk factor for the acquisition of this disease. We also discuss increasing autochthonous cases of cutaneous leishmaniasis and the different barriers to treatment that occur with this disease.

Highlights

Transmitted by phlebotomine sand fly vectors, leishmaniases are a group of globally distributed protozoal diseases capable of presenting with a broad range of clinical syndromes [1]
Cutaneous Leishmaniasis due to Leishmania mexicana is a common cause of New World protozoal infections endemic to southern Mexico and the United States (US)
We present a case of a 72-year-old male who became infected with cutaneous L. mexicana while participating in numerous diving excursions in the flooded limestone caves, commonly referred to as cenotes, in the Yucatán Peninsula

Summary

Introduction

Transmitted by phlebotomine sand fly vectors, leishmaniases are a group of globally distributed protozoal diseases capable of presenting with a broad range of clinical syndromes [1]. Conventionally viewed in the United States (US) as a travel-associated disease, it has become increasingly apparent that autochthonous transmission of CL caused by Leishmania mexicana does occur across portions of the southern US [3,4]. A 72-year-old male was referred to a dermatology clinic in San Diego, CA, for treatment of a solitary crusted ulceration on his right forearm present for three months. The patient was referred to an infectious disease specialist who recommended only symptomatic care with TheraHoney®, as cutaneous lesions caused by L. mexicana are frequently self-limiting and known to resolve spontaneously, generally within three to nine months [2]. At follow-up, 14 months from the onset of his lesion, the patient reported his ulceration had completely healed after symptomatic care with TheraHoney®, albeit with a distinct scar (Figure 3). A timeline of the patient's infection is shown below (Figure 4)

Discussion

Conclusions

Disclosures

Herwaldt BL