Mycobacterium tuberculosis Drug Resistance, Ghana

1170 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 7, July 2006 Several infection risk factors exist simultaneously in this situation. In a CL-endemic area, immigrant populations, who are mostly nonimmune, exert pressure on the environment (deforestation) that directly increases their risk for exposure to infected vectors, in the absence of prophylactic measures. The initial short-term effect of deforestation is the mobilization of aggressive adult sandflies, which have been disturbed while resting. However, the ability of zoophilic vectors to adapt to peridomestic environments has also already greatly influenced the distribution of leishmaniases in South America (5–7). Considering the uncertainty of the population estimate, turnover, and immunity status, we assume that incidence rates should be considered cautiously. Nevertheless, we found that gold mining in forested areas constitutes a risk factor for CL, at least in French Guiana and probably in all Amazonian rainforests. This risk could be a public health concern. Larger studies in other gold-mining areas are required to quantify the incidence of CL among workers to effectively focus prophylactic and preventive campaigns.