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Cutaneous leishmaniasis of the New World, in particular when caused by Leishmania (L.) braziliensis, harbours the risk of lymphogenic as well as hematogenic dissemination. This may result in mucocutaneous leishmaniasis causing severe destruction of orofacial structures. Dissemination may occur years after the disappearance of the skin lesions. In contrast, cutaneous leishmaniasis of the old world, is typically restricted to the site of inoculation. Therefore, a conservative diagnostic and therapeutic approach is usually sufficient. Infections acquired in the new world should be treated systemically, if infection with Leishmania (Viannia) braziliensis complex cannot be excluded. Here we report on three Austrian soldiers, who, weeks after having participated in an international jungle patrol course in Belize, presented themselves with multiple ulcers on the upper limbs. Diagnosis of cutaneous leishmaniasis was made based upon histological evaluation of biopsies taken from several ulcers revealing the presence of leishmanial bodies, and detection of amastigote leishmania in smears of material obtained from the ulcers. As species phenotyping could not be performed, infection with L. brasiliensis as well as progression into a mucocutaneous form were possible, demanding systemic therapy. Several treatment options including local cryotherapy with liquid nitrogen, paromomycin (Humatis Pulvis, Parke-Davis) 15% topically or oral fluconazole (Diflucan, Pfizer) 200 mg/d were applied, but showed no effect. Hence, a systemic therapy with intravenous pentamidine (Pentacarinat, Gerot), three times in total, 3-4 mg/kg body weight each, led to a complete regression of the lesions within four weeks.

Die drei Atolle Glovers Reef, Lighthouse Reef und Turneffe Islands vor der belizischen Küste im Karibischen Meer unterscheiden sich in Geomorphologie, Lagunentiefe, Sedimentbeschaffenheit, Mangroven- und Seegrasbewuchs, Wellen- und Strömungseinfluss sowie in ihren Sedimentationsraten und ihrem Entstehungsalter. Um herauszufinden, ob die Bivalven-Vergesellschaftungen verschiedener Lagunenzonen diese Unterschiede widerspiegeln, wurden 32 bis 44 rezente Sedimentproben auf jedem Atoll entnommen (Gesamtprobenzahl: 111). Deren Datensatz von insgesamt 32 122 Bivalvenschalen wurde anschließend Q-Mode-Cluster-Analysen unterzogen. Neben der Verteilung charakteristischer Arten wurde auch die Verteilung von Bivalven unterschiedlicher Lebens- und Ernährungsweise untersucht. Chione cancellata, ein flach grabender Suspensionsfresser, besiedelt bevorzugt (1) flache, wellen- und strömungsbeeinflusste Lagunenzonen. Die Sedimente (2) sehr hoch energetischer Flachwasserbereiche enthalten zudem hohe Anteile tiefer grabender Suspensionsfresser der Gattung Ervilia. Im (3) Rückriffbereich und am Atollrand sind tief grabende, Detritus fressende Telliniden häufig. Gouldia cerina, wie Chione ein flach grabender Suspensionsfresser, ist typisch für (4) geschlossene Flachwasserbereiche, während die Chemosymbionten-tragende, ebenfalls flach grabende Parvilucina sp. A. vorwiegend in (5) geschlossenen, tiefen Lagunenzonen vorkommt. Charakteristisch für (6) Mangrovengebiete ist Crassinella lunulata, ein sehr flach grabender Suspensionsfresser. Die Anteile taphonomischer Signaturen auf den Schalen, wie Bohrspuren, Inkrustationen, Fragmentierung und Abrasion sowie Diversität, Evenness und Richness sind auf Glovers Reef am höchsten und nehmen über Lighthouse Reef nach Turneffe Islands ab. Da in die gleiche Richtung zunehmende Sedimentationsraten auf den drei Atollen zu verzeichnen sind (GISCHLER 2003), ist vermutlich der abnehmende Effekt des Time-averaging für diesen Trend verantwortlich. Neben der rezenten Fauna wurden auch die Bivalven aus Vibrationsbohrkernen (ein Kern von jedem Atoll) untersucht. Die fossilen Bivalven-Vergesellschaftungen der inneren Lagunen von Glovers Reef, Lighthouse Reef und Turneffe Islands zeigen seit deren Entstehung eine für das jeweilige Atoll typische Fauna, die sich seit ~7000 YBP weiter entwickelte. Sie reflektieren damit die bereits im Anfangsstadium charakteristischen Unterschiede der drei Atolle. The three atolls Glovers Reef, Lighthouse Reef and Turneffe Islands are located offshore Belize in the Caribbean Sea. They show differences in geomorphology, lagoonal depth, bottom sediment, growth of mangroves and sea grass, exposure to waves and currents as well as in their sedimentation rates and their age. To find out if the bivalve assemblages in different lagoonal areas reflect these differences, 32 to 44 recent sediment samples were taken on each atoll (total number of samples: 111). The resulting data base (32.122 bivalve shells in total) underwent Q-mode cluster analyses. Besides the distribution of characteristic species, the distribution of bivalves with different life and feeding habits was investigated. Chione cancellata, a shallow burrowing suspension feeder, prefers (1) shallow lagoonal zones which are exposed to waves and currents. The sediments of (2) high energetic shallow water areas also contain high amounts of deeper burrowing suspension feeders of the genus Ervilia. In the (3) back-reef area and on the atoll margin deep burrowing, detritus feeding tellinids are common. Gouldia cerina, a shallow burrowing suspension feeder as Chione, is typical of (4) restricted shallow water areas, whereas the chemosymbiont-carrying, also shallow burrowing Parvilucina sp. A is most abundant in (5) restricted deep lagoonal zones. A characteristic bivalve in (6) environments with mangrove growth is the very shallow burrowing, suspension feeding Crassinella lunulata. Taphonomic damage to shells, such as boring traces, encrustations, fragmentation and abrasion as well as diversity, evenness and richness are highest on Glovers Reef and decrease towards Lighthouse Reef with the lowest values on Turneffe Islands. Accordingly increasing sedimentation rates are documented from Glovers Reef towards Turneffe Islands (GISCHLER 2003) and therefore the decreasing effect of time-averaging is presumably responsible for this trend. In addition to the recent fauna, bivalves from vibracore samples (one core from each atoll) were investigated. Since the beginning of the lagoonal development fossil bivalve assemblages from the interior lagoons of Glovers Reef, Lighthouse Reef and Turneffe Islands exhibit a faunal composition which is typical of the corresponding atoll and which further developed from ~7000 YBP onwards. They therefore reflect the characteristic differences of the three atolls which already existed from the very beginning.