case_images: PMC4934146_01
case_images: Map of Ecuador, showing the localities from which patients with diffuse-CL and disseminated-CL cases were reported. 1 Muisne, Esmeraldas province: one case of diffuse-CL; 2 Balao Chico, Guayas province: one case of disseminated-CL; 3 Cumanda, Chimborazo province: one case of disseminated-CL
case_images: 41182_2016_2_Fig1_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig1_HTML.jpg
case_images: Fig1
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)).
case_images: a, b Diffuse-CL case: a Rice-grain to thumb-sized reddish nodules and papules were observed on the ear lobes, auricles, face, and shoulders. b Various types of eruptions, such as papules, nodules, infiltrated erythemas, and brownish-colored freckles, were found on the lower extremities. Induration of the lesions was palpable. c, d Disseminated-CL case: c Superficial involvement of mucosae was recognized on the nose and lip, with partial ulceration. d Multiple and confluent lesions were observed on a wide range of the lower extremities with partial ulceration
case_images: 41182_2016_2_Fig2_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig2_HTML.jpg
case_images: Fig2
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)). Thus, the case was clinically very similar to diffuse-CL but showed the following marked differences: (1) the organisms isolated were identified as the subgenus Viannia, L. (V.) guyanensis, which is also known as one of the causative agents of disseminated-CL in different endemic countries of the New World; (2) the patient was sensitive against antimonials; and (3) the superficial involvement of mucosae was recognized as seen in Fig. 2c, such a mucosal sign is never seen in diffuse-CL cases.
case_images: Phylogenetic tree of cyt b gene sequences among species. Cyt b genes of the Leishmania parasites were amplified and sequenced from patients with diffuse-CL (DCL) and disseminated-CL (DSL). A phylogenetic analysis of cyt b gene sequences was performed by the neighbor-joining method together with sequences from 12 Leishmania species. The scale bar represents 0.01 % divergence. Bootstrap values are shown above or below branches
case_images: 41182_2016_2_Fig3_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig3_HTML.jpg
case_images: Fig3
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)). The parasites from the biopsy and FTA  card materials were identified as L. (V.) guyanensis by PCR analysis (Fig. 3).
case_images: PMC4934146_02
case_images: Map of Ecuador, showing the localities from which patients with diffuse-CL and disseminated-CL cases were reported. 1 Muisne, Esmeraldas province: one case of diffuse-CL; 2 Balao Chico, Guayas province: one case of disseminated-CL; 3 Cumanda, Chimborazo province: one case of disseminated-CL
case_images: 41182_2016_2_Fig1_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig1_HTML.jpg
case_images: Fig1
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)).
case_images: a, b Diffuse-CL case: a Rice-grain to thumb-sized reddish nodules and papules were observed on the ear lobes, auricles, face, and shoulders. b Various types of eruptions, such as papules, nodules, infiltrated erythemas, and brownish-colored freckles, were found on the lower extremities. Induration of the lesions was palpable. c, d Disseminated-CL case: c Superficial involvement of mucosae was recognized on the nose and lip, with partial ulceration. d Multiple and confluent lesions were observed on a wide range of the lower extremities with partial ulceration
case_images: 41182_2016_2_Fig2_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig2_HTML.jpg
case_images: Fig2
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)). Thus, the case was clinically very similar to diffuse-CL but showed the following marked differences: (1) the organisms isolated were identified as the subgenus Viannia, L. (V.) guyanensis, which is also known as one of the causative agents of disseminated-CL in different endemic countries of the New World; (2) the patient was sensitive against antimonials; and (3) the superficial involvement of mucosae was recognized as seen in Fig. 2c, such a mucosal sign is never seen in diffuse-CL cases.
case_images: PMC4934146_03
case_images: Map of Ecuador, showing the localities from which patients with diffuse-CL and disseminated-CL cases were reported. 1 Muisne, Esmeraldas province: one case of diffuse-CL; 2 Balao Chico, Guayas province: one case of disseminated-CL; 3 Cumanda, Chimborazo province: one case of disseminated-CL
case_images: 41182_2016_2_Fig1_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig1_HTML.jpg
case_images: Fig1
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)).
case_images: a, b Diffuse-CL case: a Rice-grain to thumb-sized reddish nodules and papules were observed on the ear lobes, auricles, face, and shoulders. b Various types of eruptions, such as papules, nodules, infiltrated erythemas, and brownish-colored freckles, were found on the lower extremities. Induration of the lesions was palpable. c, d Disseminated-CL case: c Superficial involvement of mucosae was recognized on the nose and lip, with partial ulceration. d Multiple and confluent lesions were observed on a wide range of the lower extremities with partial ulceration
case_images: 41182_2016_2_Fig2_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig2_HTML.jpg
case_images: Fig2
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)). Thus, the case was clinically very similar to diffuse-CL but showed the following marked differences: (1) the organisms isolated were identified as the subgenus Viannia, L. (V.) guyanensis, which is also known as one of the causative agents of disseminated-CL in different endemic countries of the New World; (2) the patient was sensitive against antimonials; and (3) the superficial involvement of mucosae was recognized as seen in Fig. 2c, such a mucosal sign is never seen in diffuse-CL cases.
case_images: Phylogenetic tree of cyt b gene sequences among species. Cyt b genes of the Leishmania parasites were amplified and sequenced from patients with diffuse-CL (DCL) and disseminated-CL (DSL). A phylogenetic analysis of cyt b gene sequences was performed by the neighbor-joining method together with sequences from 12 Leishmania species. The scale bar represents 0.01 % divergence. Bootstrap values are shown above or below branches
case_images: 41182_2016_2_Fig3_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig3_HTML.jpg
case_images: Fig3
case_images: The patient was a 43-year-old male, as of February 22, 2006 (Fig. 2c, d), and came from a small community "Barrio 28 de Enero," Chimborazo province, a subtropical mountainous area at the beginning of Andean slopes, located at 500 m a.s.l. (Fig. 1 (3)). The parasites from the biopsy and FTA  card materials were identified as L. (V.) guyanensis by PCR analysis (Fig. 3).
case_images: Disseminated-CL case, before and after the treatment. At the time of our examination, the patient already received injections of nine ampoules of trivalent antimonials (Repodral ) at the Cumanda health center. After finishing several courses of the treatment, he received another drug, pentavalent antimonials (Glucantime ) during about 5 months, responding well to the treatment. a, c Before the treatment, photographed on February 26, 2006. b, d After the treatment, photographed on August 17, 2006
case_images: 41182_2016_2_Fig4_HTML.jpg
case_images: PMC4934146_03_41182_2016_2_Fig4_HTML.jpg
case_images: Fig4
case_images: A superficial involvement of mucosae of the nose and upper lip was observed as seen in Fig. 4a.