Lesion on the Arm of a Returning Traveler
Bibliographic record
Abstract
Diagnosis: Cutaneous leishmaniasis. In each case, Geimsa stains of scrapings of the ulcers (figures 1–3) revealed intracellular and free, small, round or oval bodies (diameter, 3–5 μm) that were suggestive of Leishmania species (figure 4). Culture of biopsy specimens, which was subsequently performed at the Centers for Disease Control and Prevention, Atlanta, confirmed that these organisms were Leishmania viannia panamensis. All 3 patients were treated with a 21-day course of pentavalent antimony (sodium stibogluconate [Pentostam]) and had resolution of their lesions. Leishmaniasis is a tropical disease that has cutaneous, visceral, or mucosal syndromes. It is caused by Leishmania species, which are small protozoa that are transmitted to humans by sandflies that belong to the Lutzomyia genus in the Americas (“New World disease”) or that belong to the Phlebotomus genus in other parts of the world (“Old World disease”) [1]. The incubation period ranges from 3 weeks to 6 months [2], and although cutaneous lesions may be unsightly, they are often self-limiting and heal spontaneously. However, certain species of Leishmania from the Americas, particularly those in the Leishmania braziliensis group (which includes L. panamensis), may cause infections that progress to involve the nasopharyngeal mucosa and that can lead to “intractable mutilating ulcers and death” [3–5]. L. panamensis causes the ulcera de Bejuco in Panama; affected patients typically present with one or a few shallow ulcerations [3]. Although mucosal involvement is uncommon (2%–5% of cases), treatment is warranted because mucosal disease can potentially cause disfigurement. Pentavalent antimony compounds are the most effective agents for the treatment of New World leishmaniasis [2, 3]. Diagnosis is made by demonstration of amastigotes in tissue biopsy specimens or crush preparations obtained from ulcer scrapings, or by detection of the organism in cultures of ulcer specimens. Infection has also been confirmed by identification of Leishmania DNA in ulcer specimens by use of PCR [4, 6]. The majority of cases of leishmaniasis that have been seen in the United States involve individuals who have been exposed to Leishmania infection during travel or who work in areas where such infection is endemic. The prevalence of cutaneous leishmaniasis in Costa Rica is estimated to be 1 case per 1000 individuals [5]. Although leishmaniasis has only rarely been associated with travel to Costa Rica, increasing ecotourism to this country may result in an increase in the number of cases of leishmaniasis in travelers who return from the area.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".