Noting those details about the ulcer, Lockwood suspected cutaneous leishmaniasis, a parasite transmitted by sandflies. She did a punch skin biopsy, using a circular tool to remove a very small, tube-shaped piece of skin and underlying tissue, and sent the sample off to the lab. Two weeks later, her diagnosis was confirmed by a lab technician who could see the parasite under the microscope. Another lab test was able to identify the bug’s DNA in the tissue sample.
“I see this type of infection quite regularly when I examine ulcers,” Lockwood says, adding that there are many species of the parasite, which fall into two categories: those found in the Old World (Asia, Africa, southern Europe and the Middle East) and those found in the New World (Mexico, Central America and South America). There are up to 1 million new cases of cutaneous leishmaniasis worldwide annually, originally caused by an insect bite.
Infections caused by Old World leishmaniasis typically resolve on their own, although it may take up to a year. Those caused by New World species, meanwhile, can make their way through the bloodstream and destroy tissue in the nose and larynx, potentially leading to scarring or disfigurement (this usually takes several months). Georgia had the latter. An avid birdwatcher, she was likely bitten while hiking. The sandfly is found in wooded areas (not beaches), and the risk of a bite is highest from dusk to dawn because the flies typically feed at night and during twilight hours. Georgia doesn’t recall being bitten. Sandflies are just one-third the size of mosquitoes, and don’t make any noise.