Introduction/Objectives:  According to official World Health Organisation data there is little leprosy in Central America, but the disease may be unrecognised and therefore under-reported. Traditionally, diagnosis is based on clinical criteria and histology.

Materials and methods: This study was part of an on-going project with colleagues in Spain, Nicaragua and Honduras. We found patients, including many children, with skin lesions clinically suggestive of cutaneous leishmaniasis or tuberculoid leprosy. Histology could not distinguish between these diseases, although acid-fast organisms were visible in a few biopsies. Lesions healed after standard antimicrobial therapy for leprosy. Biopsies were taken from a subgroup of patients with clinical signs of infection. Nasal swabs and blood samples were obtained from patients, family members and other community members. Environmental samples were taken from local yards, ponds and ditches. Polymerase chain reactions (PCRs) were used to detect Mycobacterium leprae and Leishmania spp. DNA.

Results: M. leprae DNA was detected in blood samples and nasal swabs where leprosy was not clinically suspected. All biopsies contained Leishmania DNA and co-location of Leishmania with M. leprae occurred. Specific PCRs detected the L. donovani and L. mexicana complexes. M. leprae DNA was detected and sequenced from environmental samples. In Honduras a higher proportion of samples were M. leprae positive.

Conclusions: Leprosy and leishmaniasis are present in both regions and leprosy appears to be widespread. There are many questions to be answered about the nature of any relationship between these two pathogens, and the epidemiology of these infections.