A new case of cutaneous infection by a presumed monoxenous trypanosomatid in the island of Martinique (French West Indies)

TRANSACTIONSOFTHEROYALSOCIETYOFTROPICALMEDICINEANDHYGIENE(2000)94,463

1 Correspondence

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A new case of cutaneous infection by a presumed monoxenous trypanosomatid in the island of Martinique (French West Indies) BOW&W-GARSAUD and colleagues (2000: Trunsac-

tz’ons,94, 51-52) presented the second human case of cutaneous infection by a presumed monoxenous trypanosomatid in the island of Martinique. This immunocompetent patient had a single ulcerated lesion of the right eyebrow similar to a tvpical cutaneous leishmaniasii. The previous case was-reported by DEDET et al. (1995: Transactions. 89. 644-646) in a natient infected with human immu&d&ciency virus (HIV) who developed a diffuse cutaneous infection. The former authors draw attention to 3 other questionable casesof so-called autochthonous cutaneous leishmaniasis reported from Martinique by STEVENEL (19 17: Bulletin de la So&e de Pathologieexotique, 10, ~~~-~~~),FoucHB&MoNTEsTRUC (195 1: Archives de l’lnstitut Pasteur de Martinique, 4, 12-13) and MILLE cited by COURMES et al. (1966: Bulletin de la So&% de Pathologic exotsque, 59,2 17 - 22 5),

It seemsof interest to recall2 observations of leishmaniasis in Guadeloune. another French West Indies island near Martinique.’ The first case was reported by COURMES et al. (1966: Bulletin de la Societe de Pathologic exotique, 59,2 17-225). A 7-year-old girl was hospitalized with visceral leishmaniasis diagnosed by the presence of amastigotes in bone marrow and confirmed by culture in a diphisic rabbit blood-agar medium, promastigotes having: arown after onlv 3 davs of incubation. The second case, reported by us, was in’ a 39-year-old Haitian man living 11 years ago in Guadeloupe and HIV-positive (CNLJDDE et al., 1994: AIDS, 8, 559-560). He developed a diffuse cutaneous leishmaniasis with visceral dissemination: typical intracellular amastigotes were observed in biopsies of nodular skin, of the liver and of bone marrow. Promastigotes grew abundantly after 1 week’s culture on Schneider’s medium supplemented with 10% fetal calf serum. Unfortunately this trypanosomatid strain has been lost, preventing isoenzymatic identification. Yet, human leishmaniasis is considered uncommon or still unknown in the Caribbean, except in the Dominican Republic where leishmaniasis is characterized as autochthonous and endemic since 1975 (ZELEDON. 1992: Annals of the New York Academy of Sciences, 655, 154-

160). However the Dominican species is as yet still incompletely identified and seems to be a ‘completely new agent of cutaneous leishmaniasis’. The scarcity of human leishmaniasis in the Caribbean islands, the difficulties of specific identification of Caribbean strains, and the failure of comparative studies with reference human strains of Leishmaniu (SCHNLJR et al., 1983: Transactions, 77, 756-762) re-inforce the hypothesis of a presumed insect trypanosomid passaging to humans discussed by BOISSEAU-GARSAUD et al. (2000: Trunsuctions, 94, 5 l-52). Is this unusual passage favoured in the French West Indies because of the very high demographic densities (235 inhabitants/km* in Guadeloupe, 360 inhabitants/km2 in Martinique)? Those 2 original observations in Martinique bring a new light to the unsolved problem of leishmaniasis in the Caribbean islands. Christian P. Raccurt Centre hospitalier universitaire d’ Amiens Service de Parasitologic, Mycologic & Medecine des Voyages 800.54 Amiens, France 4 April 2000

HIV infection

in children

in developing

countries

We found the recent review of HIV infection in developing countries (TUDOR-WILLIAMS, 2000: Trunsactions,94,3-4) very useful, but readers should remember that death rates among infants and young children are much higher in developing countries than in developed countries, whether or not the children are HIV infected. For example, in sub-Saharan Africa as a whole, around 9% of newborns die before the age of 1 year, and an additional 6% before their fifth birthday. Thus, the higher probability of dying before 5 years in the African studies reviewed by Tudor-Williams will be partly due to the higher underlying mortality in Africa due to causes such aspneumonia, diarrhoea, malnutrition and malaria. Any conclusions regarding the relative rate of progression of HIV disease in develodng countries and in industrialized countries should be based on the deaths in HIV-infected infants or children that can be attributed to HIV. not iust the overall nrobabilitv of dvine in HIVinfected individuals. Such &alyses should*bebased on large prospective cohort studies of HIV-infected and HIV-uninfected infants, so that death rates in HIVinfected children can be compared with rates among HIV-uninfected children in the samepopulation. _ . Among adults, early reports that the rate of progression from infection to AIDS would be considerablv quicker in Africa than in the North (MULDER (1996j In: AZDSin the WorthIZ, MANN & TARANTOLA (editors). New York: Oxford University Press, pp. 15-16) have not been substantiated by longer-term prospective cohort studies in Uganda (MORGAN et al., 1997: AIDS, 11, 633-640). David A. Ross NIMRIAMREFLSHTM Collaborative Research Projects I? 0. Box 11936, Mwanza, Tanzania and Dtiartment of Infectious and Troaical Diseases L.oidon School ojHygiene and T;opical Medicine Richard J. Hayes Department of Infectious and Tropical Diseases London School of Hvgiene and Trobical Medicine Keppel St - -London WClE 7HT, UK 17 May 2000