Case Report: Mucosal Leishmaniasis in New York City.

Area of Science:

• Infectious Diseases
• Parasitology
• Public Health

Background:

• Mucosal leishmaniasis (ML) is a neglected tropical disease caused by protozoan parasites of the genus Leishmania.
• Previous civilian cases of ML in the United States were exclusively imported New World leishmaniasis.
• Understanding the geographic distribution and species causing ML is crucial for diagnosis and treatment.

Observation:

• This report details two distinct cases of ML diagnosed in New York City.
• The first patient, a Syrian immigrant, presented with a nasal mass caused by Leishmania tropica, marking the first documented instance of Old World ML in the US.
• The second patient, an American ecologist with a history of cutaneous leishmaniasis in Bolivia, developed lesions in the uvula, soft palate, posterior pharynx, and larynx, attributed to Leishmania (Viannia) braziliensis.

Findings:

• The introduction of Old World Leishmania tropica into the United States represents a significant epidemiological finding.
• The case involving Leishmania (Viannia) braziliensis highlights the potential for late-onset mucosal disease years after initial cutaneous infection.
• These cases expand the known spectrum of ML presentations and geographic origins within the US.

Implications:

• These findings underscore the importance of considering diverse Leishmania species and geographic origins in ML diagnoses within non-endemic regions.
• Increased awareness and diagnostic capabilities are needed to identify both Old World and New World ML in the US.
• This emphasizes the need for robust public health surveillance for leishmaniasis in travelers and immigrants.