|
AF,
Thank you. The facial lesion I saw was old, scarred and healed. It had an irregular border as if it had been an ulcerated area at one time. The nodule was about 1x1.5 cm raised about .5cm. It was hard but not fixed to deep tissue. This lesion was a bit atypical from the other two. The lesion on the ventral ankle was in a healing ulcerated state, still a bit moist at it's center like a healing scab, no secondary infection. No lyphs on any of these pt.s. I appologize but I do not know what the lesions were being injected with but I don't think it was truly effective. I think the lesions/process was just running it's course. None of them had any systemic complaints, no mucosal lesions, no abdominal pain or organomegally appreciated. The onset seemed to be about a week give or take. And this is very unclear to me. The pt.s denied having any lesions prior to these specific lesions/eruptions yet they all seemed to have various cuts, scratches etc from working in the plantations. In my opinion the locals think it is a mosquito more out of lore than anything. Ie, any bad skin lesion is blamed. What I understood the locals to say about the lesions is that they start with a bump that grows and then opens. They believe the mosquito lays eggs in the skin which hatch, grow and open the skin. Sounds "Alienoid". There is no mention of the infestation going systemic, only local. The lesions are painful, oozey or itchey depending on its stage. The Costa Rican Dr. that was with us for two days was convinced that all three lesions were from the mosquito. I did not have access to an ID man in country but when I got home I did speak with an ID guy from the CDC who told me all about Leishmans and that is what is sounded like to him. I have to agree. What is confusing to me is that the Costa Rican Dr. believes it was a mosquito. I gotta assume he knows what he is talking about. After all I've read, pictures I've seen, and folks I've spoken with I'd have to go with Leishmans. I started this thread to a. see if my suspicions are correct, b. provide information about this so the next time a team hears the term "papalomoyo" they'll know what they're dealing with.
Thanks again.
Boomer
|