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A Cluster of Cutaneous Leishmaniasis Associated with Human Smuggling
Cutaneous leishmaniasis (CL) is rarely seen in the United States, and the social and geographic context of the infection can be a key to its diagnosis and management. Four Somali and one Ethiopian, in U.S. Border Patrol custody, came to the United States by the same human trafficking route: Djibouti to Dubai to Moscow to Havana to Quito; and then by ground by Columbia/Panama to the United States - Mexico border where they were detained. Although traveling at different times, all five patients simultaneously presented to our institution with chronic ulcerative skin lesions at different sites and stages of evolution. Culture of biopsy specimens grew Leishmania panamensis. Soon thereafter, three individuals from East Africa traveling the identical route presented with L. panamensis CL to physicians in Tacoma, WA. We document here the association of a human trafficking route and new world CL. Clinicians and public health officials should be aware of this emerging infectious disease risk.
Author Notes
Financial support: This work was partially supported by grant K24AI068903, 3U01AI075420, AI087164-01, T32AI007036, and P30 AI036214 from the United States Public Health Service, National Institutes of Health.
Authors' addresses: Anthony P. Cannella and Joseph M. Vinetz, Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, E-mails: acannella@ucsd.edu and jvinetz@ucsd.edu. Bichchau M. Nguyen, Caroline D. Piggott, and Robert A. Lee, Division of Dermatology, Department of Medicine, University of California, San Diego, San Diego, CA, E-mails: nguyenbt81@gmail.com, carolinepiggott@gmail.com, and ral002@ucsd.edu. Sanjay R. Mehta, Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, E-mail: srmehta@ucsd.edu.