The ulceration does not generally occur before the third or fourth month. The ulcer is painless and may be an inch or more in diameter. Healing comes on in about seven to ten months, the yellowish unhealthy granulations giving place to healthy pink ones. The sore tends to run a course of about one year, hence the French designation bouton d’un an.
According to Weber’s statistics about 85% of the sores were located on the upper or lower extremities and about 10% on the face, while the trunk served as the location for only about 5% of the sores. There are generally 2 or 3 sores.
According to Déperet and Boinet the number of sores to a case was one sore in 30%, 2 to 4 sores in 50% and from 4 to 20 in about 20% of cases.
Fig. 56.—Oriental sore. (Ruge and zur Verth after Cardamatis.)
American Leishmaniasis.—Under a number of names such as espundia, uta, bubas and forest yaws there has been found in many parts of Central and South America an ulcerating sore, more or less resembling oriental sore, but often associated with ulcerating granulomatous lesions of nasal and buccal mucosae. Da Silveira states that in Brazil about 20% of cases develop the mucous membrane lesions. He notes an incubation period of two to three months. In Venezuela the mucous membrane lesions are more rare.
The lymphatic glands and lymphatics are commonly affected.
Just as with oriental sore one or more pruriginous papular lesions appear on the uncovered parts of the body. In a few days it develops a pustular summit. This undergoes ulceration and after several months or even after the primary lesions have healed nodules may make their appearance in nose and mouth.
These ulcerate and form fungoid granulations. Even the larynx may be involved. The nasal septum and other cartilaginous portions of the nose are often destroyed and the overlying tissues become swollen and often eroded by ulceration, so that the patients present the appearance of similar cases where syphilis, tuberculosis or leprosy may be the cause.
A point of distinction between syphilitic and leishmaniasis lesions of the nasal mucosa is that the latter do not involve the bony structures.