e patient was a 58-year-old male with a 3-month history of a nonhealing ulcer on
ID: 218447 • Letter: E
Question
e patient was a 58-year-old male with a 3-month history of a nonhealing ulcer on his right thigh. It began as a pimple and progressed. He had no constitutional symptoms and no response to oral or topical antibacterials (agents not specified in the history). He had no lesions elsewhere, nor did he have trauma culation. His prior travel history was significant for his having the Amazon rain forest region of Peru 2 weeks prior to the onset returned from ptoms. In Peru, he stayed in an open-sided hut that did not have s ad countless insect bites and had no pretravel immunizations, nor malaria prophylaxis. In the United States, he lived in a rural commu- nity with three cats and one dog. Physical examination was essentially unremark cluding normal vital signs, except for the lesion on his right thigh (Fig. as described as a superficial ulcer surrounded by a large area of erythem- ous indurated plaques. The lesion was nontender, nonpurulent, and without discharge. He had a normal complete blood count, electrolytes, and liver function tests. He was referred to the dermatology department, where a punch biopsy was did he take able, in 43.1). It w performed (Fig. 43.2), 1. What was the organism causing his infection? Based on geography, you should be able to name the genus and species. Figure 43.1 Inial lesion in Peu Figure 43.2 Lesion 1 month later at time of punch biopsyExplanation / Answer
The organism is Leishmania maxicana. The person was infected by this organism when he was biten by the sand fly present in the Amazon forests. This fly act as the vector for this organism.
Genus- Leishmania
Species- L. mexicana
The infected person has elevated and hardened rim of the ulcer. This appearance of the ulcer help in the diagnosis. The biopsy can also help in the diagnosis of this organism. Diagnosis is necessary because this organism cause a fatal disease called as Kala-azar.
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