Boiling the boil.

Leishmaniasis is a vectorborne disease caused by parasitic protozoa of the genus Leishmania. Transmitted to humans by sand flies, the disease is endemic in 88 countries on 4 continents. In the United States, the disease is something of a medical curiosity, although some clinicians may be surprised to read that autochtho-nous cases of cutaneous leishmaniasis occur in Texas [1], that visceral disease has been described in American dogs [2], and, most recently, several hundred cases of cu-taneous disease and a handful of visceral infections have occurred among US servicemen and servicewomen deployed to Iraq and Afghanistan in support of Operation Iraqi Freedom and Operation Enduring Freedom [3, 4]. Outside the United States, leishmaniasis takes a devastating toll, and it is estimated that 1.5–2 million cases of leishmaniasis occur each year, with many of these cases occurring among the world's most economically disadvantaged patients. Treatment for leishmaniasis depends on several factors, including the clinical presentation of disease (in broad terms, vis-ceral versus cutaneous), the infecting species of Leishmania, and the host's immune status. For visceral disease, therapy is always indicated, as untreated infection can progress to death. Fortunately, there are several effective options for the treatment of visceral disease. The 2 pentavalent an-timonials sodium stibogluconate (Pentos-tam, Glaxo-Smith-Kline; in the United States, available under investigational new drug protocols via the Centers for Disease Control and Prevention, for civilian use, and via the Walter Reed Army Medical for the military) and meglumine anti-moniate (Glucantime, Specia Rhone Pou-lenc) have a long track record of success, although rising reports of drug resistance in some part of the world have indicated their effectiveness is limited [5]. Lipid-associated amphotericins have proven very efficacious for visceral leishmaniasis, and liposomal amphotericin B (Ambi-some; Fujisawa Healthcare) was approved by the US Food and Drug Administration (FDA) in 1997 for this indication [6]. Unfortunately , the high cost of these drugs and their potential toxicities preclude their use in many areas of the world. Intravenously administered paromomycin offers a lower-cost option, and preliminary results from a recently concluded study suggest good efficacy [7]. Finally, the development of an orally administered drug, miltofosine, offers a real breakthrough in the ability to provide convenient and effective therapy for visceral disease [8]. Cutaneous leishmaniasis, which has numerous colorful eponyms, including " the Delhi boil " and " Baghdad boil, " typically results in chronic, ulcerative lesions. Without treatment, most skin lesions caused by cutaneous …