Leishmaniasis in the Caribbean Islands. A review

A review is presented of the current knowledge relating to leishmaniasis in the West Indies. The only country where an autochthonous focus of cutaneous leishmaniasis has been discovered within the last 20 years is the Dominican Republic. Most of the cases are of the diffuse clinical type, which tend to be anergic to the Montenegro skin test, but subclinical or mild cases are apparently common. The responsible agent is a new species of Leishmania and the suspected vector is Lutzomyia cristophei, the only anthropophilic sandfly on the island; the black rat could be a wild reservoir for the parasite. Sporadic indigenous cases have also been reported in Martinique and in Trinidad. On the latter island, no new cases have been found in the last 60 years, and only an enzootic cycle between rodents and marsupials and Lu. flaviscutellata exists there at present; the responsible parasite in this cycle is L. amazonensis or a closely related species. An apparently indigenous case of visceral leishmaniasis has been reported in Guadeloupe but new studies are needed to confirm if this form of the disease is endemic on the island. The sandfly fauna in some of the larger islands is discussed in relation to the existence of possible vectors and the establishment of the disease. In the case of Haiti, there is no reason for human leishmaniasis not to be present as it is in the neighboring Dominican Republic. In Trinidad, the conditions are present for leishmaniasis to become a true zoonosis at any time, produced by L. amazonensis. In Cuba, conditions seem to be favorable for the introduction of cutaneous leishmaniasis in the near future. No predictions can be made at this time for other islands because of lack of information about the existence of the factors required.