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Papalomoyo
Gentlemen,
I was in Sepecue, Costa Rica this past June and had three patients with cutaneous lesions which I had not seen the likes of before. One was on the face, old scar, one nodular lesion (1 x 1.5 cm) on a fore arm and one on the ventral ankle midline which was actively being treated by the local "clinic". The treatment process was multiple intra lesional injections. The cure rate was abysmal. We were providing care for an indigineous indian tribe called the BriBri in very rural Costa Rica. A Costa Rican (new graduate) MD described the lesions being caused by a mosquito, Papalomoyo, that lives in the deep jungle areas on the under surface of the leaves of certain plants. Upon my return to the states, I did some research on this site, the net and a book or two. I think the lesions were more consistant with leishmaniasis. The sand fly is indicated as the vector which seems more consistant with what I saw. The locals live mostly in stilt houses with their live stock below (chickens, pigs) and some mangy looking mutts. Seems like the perfect set up for a host vector environment. My Spanish is lousy at best, and the young Costa Rican Dr.'s English was just as bad so maybe I misunderstood what he was describing to me. I plan to return to an even more remote area in April 2009 and I would like to be able diagnose and treat this disease. So my question is, is this some evil mosquito or misdiagnosed Leishmaniasis? If it is Leishmans, is IM Pentamidine the treatment of choice or is there a PO option? I can treat the secondary infections were needed. Sorry, I did not take any pictures.
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