title: Diffuse and disseminated cutaneous leishmaniasis: clinical cases experienced in Ecuador and a brief review.
abstract: BACKGROUND
  In Ecuador, cutaneous leishmaniasis (CL) is prevalent countrywide, but only one case of diffuse-CL and two cases of disseminated-CL were experienced during our research activities more than 30 years from 1982 to date. These three patients suffered from multiple lesions distributed at a wide range of the body surface, revealing difficulty to clinically differentiate each other.
  
  
  METHODS
  There is a considerable confusion of the use and/or differentiation of the terminologies (terms) between the two disease forms, diffuse-CL and disseminated-CL. One of the aims of the present study is to clarify the difference between the two disease forms, mainly based on the cases experienced in Ecuador.
  
  
  RESULTS
  The disseminated-CL case newly reported here was clinically very similar to the diffuse-CL case, but the former showed the following marked differences from the latter: (1) the organisms isolated were identified as the parasites of Leishmania (Viannia) guyanensis/panamensis, which are also known as the causative agents of disseminated-CL in different endemic countries of the New World; (2) the patient was sensitive against antimonials; and (3) mucosal involvement was observed, which is never observed in diffuse-CL.
  
  
  CONCLUSIONS
  In the text, three clinical cases, one diffuse-CL and two disseminated-CL, were presented. Furthermore, a bibliographic comparison of the features between the two disease forms was made, and a brief comment was also given.
authors.affiliation: Facultad de Medicina, Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuador ; Proyecto Prometeo, Secretaría Nacional de Educación Superior, Ciencia, Tecnología e Innovación (SENESCYT), Quito, Ecuador ; Department of Parasitology, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Hashiguchi
authors.affiliation: Departamento de Medicina Tropical, Facultad de Medicina, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador ; Servicio Nacional de Erradicacion de la Malaria (SNEM), Ministerio de Salud, Guayaquil, Ecuador.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Gomez
authors.affiliation: Laboratory of Parasitology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Hirotomo
authors.initials: H
authors.lastname: Kato
authors.affiliation: Departamento de Parasitología, Instituto Nacional de Investigación de la Salud Pública, Guayaquil, Ecuador.
authors.forename: Luiggi R
authors.initials: LR
authors.lastname: Martini
authors.affiliation: Departamento de Medicina Tropical, Facultad de Medicina, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador ; Servicio Nacional de Erradicacion de la Malaria (SNEM), Ministerio de Salud, Guayaquil, Ecuador.
authors.forename: Lenin N
authors.initials: LN
authors.lastname: Velez
authors.affiliation: Department of Dermatology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uezato
keywords: Cutaneous leishmaniasis; Differentiation; Diffuse; Disseminated; Ecuador; Old and New Worlds