Chiclero's ulcer

Chiclero's ulcer is a cutaneous condition primarily affecting individuals in Central and South America, particularly those involved in the extraction of sap from the sapodilla tree (Manilkara zapota) used in the production of chewing gum. The condition is named after the chicleros, the workers who harvest this sap. Chiclero's ulcer is characterized by a notable lesion or ulcer on the ear or surrounding areas, which results from the bite of certain species of sand fly carrying the parasite Leishmania.

Causes and Transmission

Chiclero's ulcer is caused by the protozoan parasites of the genus Leishmania, specifically those responsible for cutaneous leishmaniasis. Transmission occurs through the bite of infected female phlebotomine sand flies. These flies are prevalent in the forests of Central and South America, where chicleros work, making them particularly susceptible to the disease.

Symptoms

The primary symptom of Chiclero's ulcer is the development of skin ulcers, typically on the pinna of the ear, but it can also affect other parts of the body exposed to sand fly bites. The ulcers are often painless but can be prone to secondary infections, which can complicate the healing process. If left untreated, the ulcers can become chronic and cause significant tissue damage.

Diagnosis

Diagnosis of Chiclero's ulcer involves clinical examination of the lesions, along with laboratory tests to identify Leishmania parasites. Techniques such as microscopy, culture of the lesion samples, and molecular tests like polymerase chain reaction (PCR) are commonly used for diagnosis.

Treatment

Treatment for Chiclero's ulcer typically involves antimonial compounds or other anti-leishmanial drugs. The choice of treatment depends on the specific Leishmania species involved and the severity of the lesions. In some cases, local treatment of the ulcers, including cleaning and dressing of the wounds, may be necessary to prevent secondary infections.

Prevention

Preventive measures against Chiclero's ulcer focus on reducing sand fly bites. This includes the use of insect repellent, protective clothing, and bed nets, especially in areas where sand flies are prevalent. Public health efforts also aim at controlling sand fly populations and educating at-risk populations about the risks of Chiclero's ulcer.

Epidemiology

Chiclero's ulcer is endemic to the tropical and subtropical regions of Central and South America, closely associated with the habitats of the Leishmania-carrying sand flies. The disease primarily affects individuals who work in or near forests, such as chicleros, making it an occupational hazard.