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some endemic areas. This is the first case reported in Mexico of coinfection by L. (L.) mexicana and HIV, which was manifested as VL. Our results agree with those found in Hernandez [26], who reported in Venezuelan patient displaying the symptoms of VL, a coinfection with HIV and a Leishmania variant strain sharing kDNA sequences with L. braziliensis and L.

Treatment of CL patients with Glucantime® was successful in 96% of cases, regardless of the number and location of lesions. To obtain complete healing of lesions, the doses needed were in children from 2 to 20 and in adults from 2 to 67 ampules, although some patients cure

In the endemic areas evaluated in the present studies, the risk factors associated with CL were identified as the human colonization of large areas of previously untouched rain forests, where CL is endemic. The urbanization and deforestation are important factors because the Leishmania transmission cycles are adapting to peridomestic environments and are spreading to previously no endemic areas with domestic animals as potential reservoirs and spending nocturnal periods in the forest for cultivation of agricultural crops (e.g., chili

In conclusion, our findings are interesting because we have shown that in the typical endemic regions of Gulf of Mexico and Ocean Pacific of Mexico, CL can be caused by several species of the L. mexicana and L. braziliensis complexes and in some clinical samples, we found DNA of both complexes. Furthermore, we found DCL caused by a mix infection with strains of L. (L.) amazonensis and L. (L.) mexicana [12], both belonging to the L. mexicana complex. VL can be caused by L. (L.) chagasi and in immunocompromised patients by L. (L.) mexicana. Diagnosis of leishmaniasis by PCR and hybridization of kDNA and ITS1 PCR-RFLP analysis of Leishmania DNA must be combined for the reliable characterization of Leishmania species mainly in endemic areas where the presence of multiple species of Leishmania overlap clinical pictures demands simultaneous species identification [12]. In Mexico, the geographic range in which CL is endemic has increased in size due to urbanization, new settlements, and ecological, social, and educative conditions, which favors its permanence and transmission, as it has

Financial support for this research was provided by Secretaría de Investigacion y Posgrado, Instituto Politecnico Nacional, Mexico, and Conacyt. Amalia Monroy-Ostria is a fellow of COFAA, Instituto Politecnico Nacional, Mexico. We thank Erik Fabila-Monroy, MBA, for

mexicana [27].

spontaneously [19].

162 The Epidemiology and Ecology of Leishmaniasis

5. Conclusion

occurred in Calakmul.

Acknowledgements

reviewing the English of the manuscript.

and coffee) (Figure 3a–d) [11, 19, 20].

Amalia Monroy-Ostria<sup>1</sup> \* and Gustavo Sanchez-Tejeda<sup>2</sup>

\*Address all correspondence to: amaliahmo@gmail.com

1 National School of Biological Sciences, National Polytechnic, Carpio and Plan de Ayala, Mexico City, Mexico

2 Program for Vector Borne Diseases, Secretary of Health, Benjamín Franklin, Mexico City, Mexico
