History and Geography

Leishmaniasis is an ancient disease of both the Old and the New Worlds. Old World cutaneous leishmaniasis was first described in English by Alexander Russell in the mid-eighteenth century. Designs on Indian pottery of the New World clearly show the disfiguring disease. The pre-Columbian Incas knew of the dangers of the disease in the lowlands east of the Andes where coca grew and thus used captives to cultivate it. The Spaniards who later took over the coca trade were less aware of the problem, and consequently, their labor policies resulted in much disfigurement and death.

Visceral leishmaniasis was known to nineteenth-century British doctors in India as kala-azar or Dumdum fever with its symptoms attributed vari

Figure VIII.79.1. The uta form of leishmaniasis.

ously to malaria, Malta fever, and other diseases. It was in 1900 that W. B. Leishman, working at Net-tley, noticed the similarity of the parasite to that of trypanosomiasis, and shortly thereafter Leishman's bodies were discovered to be the cause of kala-azar. Leishman published his findings in 1903, yet his work was duplicated independently by Charles Donovan. Leishman's name was given to the entire genus, but the agent of kala-azar got its specific name from Donovan.

Old World leishmaniasis or oriental sore had long been in northern Africa and India, where it was known geographically as the Delhi boil, Aleppo boil, and so forth. Its agent, L. tropica, was probably seen as early as 1885, but the first clear description was not published until 1898, by Peter Fokitsch Borov-sky in a Russian military journal. However, the paper did not become known to the West, and thus credit for the discovery of the organism is often given to James Homer Wright of Baltimore, who in 1903 found it in an ulcer of a child from Armenia.

The first cases of cutaneous disease in the Americas were described by A. Carini and V. Paranhos in southern Brazil in 1909 - the same year that mucocutaneous leishmaniasis was described as a distinct disease, this also in Brazil. Gasper Oliveira de Vianna named the etiologic agent Leishmania braziliensis in 1911. The visceral form in the Americas was first seen in Paraguay in 1913. Phlebotomus was suspected of being the vector as early as 1911, but this was not proven until 1941.

The cutaneous and mucocutaneous form of the disease are relatively common problems among people working in heavily forested areas, such as the original area of Amazonia in Brazil. In Peru the uta form is seen on the lower eastern slopes of the Andes. In the Arica area of northern Chile there is an interesting case of what is probably the uta form (Figure VIII.79.1) of this disease dating back about 1,000 years. It is known that contacts were common with the jungle area for trade purposes, and this case is probably an example of an imported exotic disease to the Pacific coast.

Marvin J. Allison

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