Wuchereria bancrofti Lymphatic Filariasis, Barrancabermeja, Colombia, 2023.

We describe a recent case of lymphatic filariasis in Colombia caused by Wuchereria bancrofti nematodes. Our study combines clinical-epidemiologic findings with phylogenetic data. Resurgence of lymphatic filariasis may be linked to increasing urbanization trends and migration from previously endemic regions. Fieldwork can be a beneficial tool for screening and containing transmission.

Human Lobomycosis Caused by Paracoccidioides (Lacazia) loboi, Panama, 2022.

We report a patient from Panama who had lobomycosis caused by Paracoccidioides (Lacazia) loboi. We used combined clinical-epidemiologic and phylogenetic data, including a new gene sequence dataset on this fungus in Panama, for analysis. Findings contribute useful insights to limited knowledge of this fungal infection in the Mesoamerican Biologic Corridor.

Analysis of ANRIL Isoforms and Key Genes in Patients with Severe Coronary Artery Disease.

ANRIL (Antisense Noncoding RNA in the INK4 Locus), also named CDKN2B-AS1, is a long non-coding RNA with outstanding functions that regulates genes involved in atherosclerosis development. ANRIL genotypes and the expression of linear and circular isoforms have been associated with coronary artery disease (CAD). The CDKN2A and the CDKN2B genes at the CDKN2A/B locus encode the Cyclin-Dependent Kinase inhibitor protein (CDKI) p16INK4a and the p53 regulatory protein p14ARF, which are involved in cell cycle regulation, aging, senescence, and apoptosis. Abnormal ANRIL expression regulates vascular endothelial growth factor (VEGF) gene expression, and upregulated Vascular Endothelial Growth Factor (VEGF) promotes angiogenesis by activating the NF-κB signaling pathway. Here, we explored associations between determinations of the linear, circular, and linear-to-circular ANRIL gene expression ratio, CDKN2A, VEGF and its receptor kinase insert domain-containing receptor (KDR) and cardiovascular risk factors and all-cause mortality in high-risk coronary patients before they undergo coronary artery bypass grafting surgery (CABG). We found that the expression of ANRIL isoforms may help in the prediction of CAD outcomes. Linear isoforms were correlated with a worse cardiovascular risk profile while the expression of circular isoforms of ANRIL correlated with a decrease in oxidative stress. However, the determination of the linear versus circular ratio of ANRIL did not report additional information to that determined by the evaluation of individual isoforms. Although the expressions of the VEFG and KDR genes correlated with a decrease in oxidative stress, in binary logistic regression analysis it was observed that only the expression of linear isoforms of ANRIL and VEGF significantly contributed to the prediction of the number of surgical revascularizations.

Knowledge Discovery for Higher Education Student Retention Based on Data Mining: Machine Learning Algorithms and Case Study in Chile.

Data mining is employed to extract useful information and to detect patterns from often large data sets, closely related to knowledge discovery in databases and data science. In this investigation, we formulate models based on machine learning algorithms to extract relevant information predicting student retention at various levels, using higher education data and specifying the relevant variables involved in the modeling. Then, we utilize this information to help the process of knowledge discovery. We predict student retention at each of three levels during their first, second, and third years of study, obtaining models with an accuracy that exceeds 80% in all scenarios. These models allow us to adequately predict the level when dropout occurs. Among the machine learning algorithms used in this work are: decision trees, k-nearest neighbors, logistic regression, naive Bayes, random forest, and support vector machines, of which the random forest technique performs the best. We detect that secondary educational score and the community poverty index are important predictive variables, which have not been previously reported in educational studies of this type. The dropout assessment at various levels reported here is valid for higher education institutions around the world with similar conditions to the Chilean case, where dropout rates affect the efficiency of such institutions. Having the ability to predict dropout based on student's data enables these institutions to take preventative measures, avoiding the dropouts. In the case study, balancing the majority and minority classes improves the performance of the algorithms.

Improving Clinical Documentation in an Academic Setting: A Multidisciplinary Team Approach Focused on the Physician's Perspective.

EXECUTIVE SUMMARY: This research article discusses the results of a pilot study at a large academic medical center to appropriately describe patient severity and the likelihood of mortality. In this study, we compare two projects, both of which use a clinical document specialist (CDS). The control case measures documentation quality using an attending physician-focused model. This model, supplemented by a CDS who requests additional documentation on a post hoc basis, is measured against an intervention where a CDS offers suggestions in real time during rounds with residents and attending physicians.Our findings indicate that documentation training with real-time feedback by a CDS results in higher levels of medical staff participation and a significant increase in submitted physician charges. Additionally, we note that documentation improvement projects do not eliminate coding problems; rather, they support a better alignment between patient state and documentation of that state. Although physicians are key players in the provision of care and the revenue cycle, the physician perspective is missing in the current discourse about documentation. Where quality, profitability, education, teamwork, and profiling drive documentation improvement, ensuring that we understand the problem from both ends is crucial to documentation improvement projects. Therefore, there is a need for more research on the impact of such programs beyond the facility.

Human rotavirus strains circulating in Venezuela after vaccine introduction: predominance of G2P[4] and reemergence of G1P[8].

BACKGROUND: Rotavirus (RV) is the most common cause of severe childhood diarrhea worldwide. Despite Venezuela was among the first developing countries to introduce RV vaccines into their national immunization schedules, RV is still contributing to the burden of diarrhea. Concerns exist about the selective pressure that RV vaccines could exert on the predominant types and/or emergence of new strains. RESULTS: To assess the impact of RV vaccines on the genotype distribution 1 year after the vaccination was implemented, a total of 912 fecal specimens, collected from children with acute gastroenteritis in Caracas from February 2007 to April 2008, were screened, of which 169 (18.5%) were confirmed to be RV positive by PAGE. Rotavirus-associated diarrhea occurred all year-round, although prevailed during the coolest and driest months among unvaccinated children under 24 months old. Of 165 RV strains genotyped for G (VP7) and P (VP4) by seminested multiplex RT-PCR, 77 (46.7%) were G2P[4] and 63 (38.2%) G1P[8]. G9P[8], G3P[8] and G2P[6] were found in a lower proportion (7.3%). Remarkable was also the detection of <5% of uncommon combinations (G8P[14], G8P[4], G1P[4] and G4P[4]) and 3.6% of mixed infections. A changing pattern of G/P-type distribution was observed during the season studied, with complete predominance of G2P[4] from February to June 2007 followed by its gradual decline and the reemergence of G1P[8], predominant since January 2008. Phylogenetic analysis of VP7 and VP4 genes revealed a high similarity among G2P[4] and global strains belonging to G2-II and P[4]-V lineages. The amino acid substitution 96D → N, related with reemergence of the G2 genotype elsewhere, was observed. The G1P[8] strains from Caracas were grouped into the lineages G1-I and P[8]-III, along with geographically remote G1P[8] rotaviruses, but they were rather distant from Rotarix® vaccine and pre-vaccine strains. Unique amino acid substitutions observed on neutralization domains of the VP7 sequence from Venezuelan post-vaccine G1P[8] could have conditioned their re-emergence and a more efficient dissemination into susceptible population. CONCLUSIONS: The results suggest that natural fluctuations of genotypes in combination with forces driving the genetic evolution could determine the spread of novel strains, whose long-term effect on the efficacy of available vaccines should be determined.

Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death.

BACKGROUND: Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based on the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (ie, maternal deaths). In 2013, the Intensive Care National Audit and Research Center Case Mix Program reported the first statistically validated early warning scoring system for pregnant women. OBJECTIVE: We sought to assess the performance of the Intensive Care National Audit and Research Center Obstetric Early Warning Score in predicting death among pregnant women who required admission to the intensive care unit. STUDY DESIGN: This retrospective cohort study included pregnant women admitted to the intensive care unit at a tertiary referral center from January 2006 through December 2011 in Colombia, a developing country, with direct and indirect obstetric-related conditions. The Obstetric Early Warning Score was calculated based on data collected during the first 24 hours of intensive care unit admission. The Obstetric Early Warning Score is calculated based on values of the following variables: systolic and diastolic blood pressure, respiratory rate, heart rate, fraction of inspired oxygen (FiO2) required to maintain an oxygen saturation ≥96%, temperature, and level of consciousness. The performance of the Obstetric Early Warning Score was evaluated using the area under the receiver operator characteristic curve. Outcomes selected were: maternal death, need for mechanical ventilation, and/or vasoactive support. Statistical methods included distribution appropriate univariate analyses and multivariate logistic regression. RESULTS: During the study period, 50,897 births were recorded. There were 724 obstetric admissions to critical care, for an intensive care unit admission rate of 14.22 per 1000 deliveries. A total of 702 women were included in the study, with 29 (4.1%) maternal deaths, and a mortality ratio of 56.98 deaths per 100,000 live births. The most frequent causes of admission were direct, obstetric-related conditions (n = 534; 76.1%). The Obstetric Early Warning Score value was significantly higher in nonsurvivors than in survivors [12 (interquartile range 10-13) vs 7 (interquartile range 4-9); P < .001]. Peripartum women with normal values of Obstetric Early Warning Score had 0% mortality rate, while those with high Obstetric Early Warning Score values (>6) had a mortality rate of 6.3%. The area under the receiver operator characteristic curve of the Obstetric Early Warning Score in discrimination of maternal death was 0.84 (95% confidence interval, 0.75-0.92). The overall predictive value of the Obstetric Early Warning Score was better when the main cause of admission was directly related to pregnancy or the postpartum state. The area under the receiver operator characteristic curve of the score in conditions directly related to pregnancy and postpartum was 0.87 (95% confidence interval, 0.79-0.95), while in indirectly related conditions the area under the receiver operator characteristic curve was 0.77 (95% confidence interval, 0.58-0.96). CONCLUSION: Although there are opportunities for improvement, Obstetric Early Warning Score obtained upon admission to the intensive care unit can predict survival in conditions directly related to pregnancy and postpartum. The use of early warning scores in obstetrics may be a highly useful approach in the early identification of women at an increased risk of dying.

Mortality risk prediction with an updated Acute Physiology and Chronic Health Evaluation II score in critically ill obstetric patients: a cohort study.

BACKGROUND: Acute Physiology and Chronic Health Evaluation II (APACHE II) score has shown low prognostic ability to predict death in the obstetric population. The objective of this study was to evaluate whether an updated form of the APACHE II score would perform better in predicting mortality in critically ill obstetric patients. METHODS: A retrospective cohort study of pregnant and postpartum women (up to 42 days after delivery) who were admitted to the intensive care unit (ICU) was carried out at an ICU at Rafael Calvo Maternity Hospital, a large obstetric hospital in Colombia. Data were collected on consecutive obstetric patients admitted to the ICU between 2006 and 2011. A discrimination and calibration analysis was completed on the original APACHE II score and an updated APACHE II score. RESULTS: Data were collected on a total of 726 obstetric patients. The area under the receiver-operating characteristic curve was 0.86 (95% confidence interval [95% CI], 0.80-0.93) for both APACHE II and the updated APACHE II scores. Mortality ratio for the original APACHE II was 0.30 (95% CI, 0.19-0.41) and 0.85 (95% CI, 0.56-1.24) for the updated APACHE II. CONCLUSIONS: The APACHE II overestimates mortality in the sample population. The updated APACHE II model predicts mortality more accurately in the obstetric population. This formula may be useful in adapting the existing APACHE II to current mortality risk in obstetric critical care populations.

Snakebite-Associated Infections: A Systematic Review and Meta-Analysis.

Snakebites still constitute a significant public health problem in developing countries and are considered a neglected tropical condition by the WHO. Snake accidents are associated with substantial morbidity and mortality and may produce secondary complications, such as severe infections. The objective of this systematic review was to determine the prevalence of snakebite infections and characterize the bacteria isolated from these infections. A systematic literature review in five databases was carried out to assess the prevalence of snakebite infection. A meta-analysis was performed using a random-effects model to calculate the pooled prevalence and 95% CIs. Cochran's Q test and the I2 statistic were used to assess between-study heterogeneity. The pooled prevalence of infection due to snakebite was 27.0% (95% CI: 22.0-32.0%), with high heterogeneity among studies (I2 = 99.7%). The prevalence was higher in Asia (32%) than in the Americas (21%). Snakebite infections required surgical interventions in 68% (95% CI: 37.0-98.0%). The leading group of pathogens identified corresponded to Gram-negative bacteria (63%), particularly Morganella morganii (32%), but also, Gram-positive cocci (40%), especially Enterococcus spp. (23%) and Staphylococcus aureus (15%). However, multiple other pathogens, including anaerobes, were found. A high prevalence of snakebite-associated infection has been described, primarily due to M. morganii, with the corresponding implications for empirical therapy. Rational use of antimicrobials is recommended, and this should guide initial empirical treatment. Moreover, isolation and identification of the possible bacteria present in snakebite wounds is recommended in all cases to confirm or rule out associated infection.

Caterpillar Envenomation (Lepidopterism) in a Panamanian Jungle: About a Case.

Caterpillar venom has the potential to cause acute pain and systemic symptoms in individuals seeking medical attention in the jungles of Panama. Although this is not an obligatory notifiable disease, the hazards associated with exposure to this animal are widely recognized within the local community. Here, we present a case of a patient who sought medical attention after being rescued from a river in a Panamanian jungle after feeling acute pain in an upper extremity associated with shortness of breath and how tropical medicine teleconsult allowed for quick identification of the cause and assisted in the management. About his case, we examine the phenomenon of caterpillar envenomation and suggest that further research is needed to assess the potential impact of climate change on this disease. Of particular concern is the likelihood of an increase in contact accidents. We recommend that scientists and public health officials work together to understand the mechanisms of this disease better and to develop effective strategies for prevention and treatment. Our analysis underscores the importance of ongoing monitoring and surveillance to ensure we are prepared for future outbreaks.

Tropical splenomegaly in a migrant-in-transit crossing the Darien gap, Panamá: A probable case of hyper-reactive malarial splenomegaly.

Hyper-reactive malarial splenomegaly (HMS), or tropical splenomegaly syndrome, is a severe complication of chronic and recurrent infections caused by Plasmodium spp. This condition typically results in splenomegaly greater than or equal to 10 cm and a constellation of laboratory findings, including the absence of identifiable parasites in peripheral blood smears. However, patients with HMS demonstrate serological or molecular evidence of infection. Despite being a familiar entity in malaria holoendemic countries in Africa, and regions of Papua New Guinea, the pathophysiology, natural history, and treatment of the syndrome remains to be fully elucidated. Herein, we describe a highly suggestive case of HMS in a Senegalese patient migrating northbound to reach the U.S.-Mexico border and for whom we provided medical care during his crossing of the Darien Gap in Panama. We also reviewed the literature on diagnosing and treating HMS in-depth.

The Endless Vulnerability of Migrant Children In-Transit across the Darién Gap.

Many people from poverty-stricken countries are migrating across South and Central America to reach the México-United States border, a movement exacerbated by the COVID-19 pandemic. Migrant people who begin their northbound journey in South America must transit across a significant geographic bottleneck, the Darién Gap, a mountainous rainforest region between Colombia and Panama. Most migrant people crossing this region originate from Cuba, Haiti, and Venezuela. Other people reach the shores of South American countries from west and central Africa or central and southeastern Asia and continue to the Darién Gap. Poverty and violence drive families with children to flee their homes and endure incalculable risks in their path. Children traveling with their families or as unaccompanied minors across the Darién Gap are exposed to life-threatening situations and human rights violations, including abuse, exploitation, malnourishment, and limited access to medical care. In addition to experiencing untreated medical illnesses, children experience mental health disorders during migration and after they reach their destination as a result of victimization and adverse traumatic experiences. Therefore, providing migrants, especially children, with rapid medical screenings and mental health support when they arrive at their destination is critical to reduce health inequities. Furthermore, making these interventions available during their transit and ensuring their safety may prevent further human rights abuses in children and families. Latin American governments must address the ongoing humanitarian crisis endured by migrants throughout their migratory path by offering access to essential healthcare services and safeguarding the rights and security of children and vulnerable groups.

Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis.

OBJECTIVE: Reducing maternal morbidity and mortality has been a challenge for low and middle-income countries, especially in the setting of hypertensive disorders of pregnancy. Improved strategies for treating obstetric patients with resistant hypertension are needed. We sought to explore whether hemodynamic parameters may be used to identify patients that develop resistant hypertension in pregnancy. METHODS: Retrospective cohort study among pregnant patients with gestational hypertension or preeclampsia that experienced severe blood pressure elevations. Hemodynamic variables were evaluated, including cardiac output (CO), and total peripheral resistance (TPR). The primary endpoint was resistant hypertension. An exploratory logistic regression was performed to evaluate the association between the hemodynamic profile and the development of resistant hypertension. Adverse maternal and fetal outcomes were additionally described according to the presence of resistant hypertension. RESULTS: Fifty-seven patients with severe pregnancy hypertension were included, of whom 34 developed resistant hypertension (59.7%). The resistant hypertension group, in comparison to those without resistant hypertension, presented with a hypodynamic profile characterized by reduced CO < 5 L/min (41.2% vs. 8.7%, p: 0.007), and increased TPR > 1400 dyn-s/cm5 (64.7% vs. 39.1%, p: 0.057). Logistic regression analysis revealed an association between a hypodynamic profile and resistant hypertension (OR 3.252, 95% CI 1.079-9.804; p = 0.035). Newborns of the resistant hypertension group had more frequent low birth weight (<2500 g), low Apgar scores, ICU admissions, and acute respiratory distress syndrome. CONCLUSION: Patients experiencing hypertensive crisis during pregnancy and exhibiting a hypodynamic profile (TPR ≥1400 dyn·s/cm5 and CO ≤ 5 L/min) developed higher rates of resistant hypertension.

Performance of the INTERGROWTH-21st and World Health Organization fetal growth charts for the detection of small-for-gestational age neonates in Latin America.

OBJECTIVE: To evaluate the performance of INTERGROWTH-21st (IG-21st ) and World Health Organization (WHO) fetal growth charts to identify small-for-gestational-age (SGA) and fetal growth restriction (FGR) neonates, as well as their specific risks for adverse neonatal outcomes. METHODS: Multicenter cross-sectional study including 67 968 live births from 10 maternity units across four Latin American countries. According to each standard, neonates were classified as SGA and FGR (birth weight <10th and less than third centiles, respectively). The relative risk (RR) and diagnostic performance for a low APGAR score and low ponderal index were calculated for each standard. RESULTS: WHO charts identified more neonates as SGA than IG-21st (13.9% vs 7%, respectively). Neonates classified as having FGR by both standards had the highest RR for a low APGAR (RR, 5.57 [95% confidence interval (CI), 3.99-7.78]), followed by those who were SGA by both curves (RR, 3.27 [95% CI, 2.52-4.24]), while neonates with SGA identified by WHO alone did not have an additional risk (RR, 0.87 [95% CI, 0.55-1.39]). Furthermore, the diagnostic odds ratio for a low APGAR was higher when IG-21st was used. CONCLUSION: In a population from Latin America, the WHO charts seem to identify more SGA neonates, but the diagnostic performance of the IG-21st charts for low APGAR score and low ponderal index is better.

Leptospirosis: Epidemiological and Clinical Characteristics at the National Reference Hospital in Panama.

Leptospirosis represents a public health problem in Panama, with an incidence rate of 1 in 100,000 inhabitants in 2014. Despite active surveillance and reports of outbreaks in the news, publications about human leptospirosis in Panama are scarce. The objective of this study was to describe the epidemiological and clinical features of leptospirosis in a cohort of patients admitted to the national reference hospital from January 2013 to December 2018. A total of 188 patients with suspected leptospirosis were identified, but only 56.9% (107 of 188) of the medical records could be retrieved. Microagglutination assays were completed in 45% (48 of 107) of the patients, confirming leptospirosis in 29.2% (14 of 48) of the patients. The most prevalent serogroup identified was Leptospira interrogans icterohemorrhagiae (4 of 14, 28.6%). The majority of patients with confirmed disease were middle-aged (36.4 ± 15.7 years), male (11 of 14, 78.6%), and symptomatic for 6.8 ± 0.7 days before admission. The predominant clinical presentation was fever (13 of 14, 92.9%), abdominal pain (7 of 14, 50%), and jaundice (8 of 14, 57.1%). Respiratory failure (8 of 14, 57.1%), elevated creatinine levels on admission (8 of 14, 57.1%), transfusion of blood-derived products (6 of 14, 42.9%), and required use of vasopressors (4 of 14, 28.6%) were common complications. Mortality was 28.6% (4 of 14). Empiric antibiotic therapy was initiated in almost all patients (10 of 12, 83.3%), and was appropriate in 90% (9 of 10) of them. Our study highlights the high prevalence of severe disease and reveals the diagnostic challenges concealing the true burden of leptospirosis in Panama. However, the small number of confirmed patients limits the generalization of these findings.

Genomic diversity and genetic variation of Leishmania panamensis within its endemic range.

Species belonging to the Leishmania (Viannia) subgenus are important causative agents of cutaneous and mucocutaneous leishmaniasis in Central and South America. These parasites possess several distinctive biological features that are influenced by their genetics, population structure, and genome instability. To date, several studies have revealed varying degrees of genetic diversity within Leishmania species. Particularly, in species of the L. (Viannia) subgenus, a generalized high intraspecific genetic diversity has been reported, although, conflicting conclusions have been drawn using different molecular techniques. Despite being the most common Leishmania species circulating in Panama and Colombia, few studies have analyzed clinical samples of Leishmania panamensis using whole-genome sequencing, and their restricted number of samples has limited the information they can provide to understand the population structure of L. panamensis. Here, we used next generation sequencing (NGS) to explore the genetic diversity of L. panamensis within its endemic range, analyzing data from 43 isolates of Colombian and Panamanian origin. Our results show the occurrence of three well-defined geographically correlated groups, and suggests the possible occurrence of additional phylogeographic groups. Furthermore, these results support the existence of a mixed mode of reproduction in L. panamensis, with varying frequencies of events of genetic recombination occurring primarily within subpopulations of closely related strains. This study offers important insights into the population genetics and reproduction mode of L. panamensis, paving the way to better understand their population structure and the emergence and maintenance of key eco-epidemiological traits.

A Review of Leishmaniasis: Current Knowledge and Future Directions.

PURPOSE OF REVIEW: The goal of this review is to summarize the current knowledge of the epidemiology, clinical manifestations, diagnosis, and treatment of cutaneous, mucosal, and visceral leishmaniasis. We will describe the most recent findings and suggest areas of further research in the leishmaniasis field. RECENT FINDINGS: This article reviews newer leishmaniasis tests (including rapid diagnostic tests using rK39 antibodies), vaccine candidates, and updated treatment recommendations. SUMMARY: While leishmaniasis is a complex disease, learning the prominent clinical manifestations and major parasite species can guide the recommendations for diagnosis and treatment.

Visceral leishmaniasis in the island of Margarita, Venezuela: a neglected parasitic infection in the Caribbean.

Visceral leishmaniasis carries a significant burden of disease in the Americas with up to 7000 cases reported annually. There are several reports of autochthonous visceral leishmaniasis cases in the Caribbean, including the Dominican Republic, Guadalupe, Martinique, and Trinidad and Tobago. However, we lack recent clinical description and epidemiologic data of visceral leishmaniasis in other islands in the Caribbean. Herein, we describe an autochthonous case of visceral leishmaniasis in the Caribbean Island of Margarita in Venezuela. This index case of visceral leishmaniasis highlights the need for further regional surveillance efforts to identify animal reservoirs and to monitor the occurrence of further clinical cases. Additionally, there is an urgent need for implementing vector control strategies.

Molecular Identification of Parasites Causing Cutaneous Leishmaniasis in Panama.

Isolates from 475 cutaneous leishmaniasis (CL) patients from three endemic regions were studied by three typing techniques. The molecular analysis from lesion scrapings based on hsp70 PCR-restriction fragment length polymorphism (RFLP) showed that 78.1% (371/475) restriction patterns corresponded to Leishmania (Viannia) panamensis, 19% (90/475) to Leishmania (Viannia) guyanensis, and 3.0% (14/475) to Leishmania (Viannia) braziliensis. Promastigotes isolated by culture from lesions of 228 patients (48.0%, 228/475) were identified by multi-locus enzyme electrophoresis. Of them, 95.2% (217/228) were typified as L. (V.) panamensis, 1.3% (3/228) as L. (V.) guyanensis, 2.2% (5/228) as L. (V.) braziliensis, and 1.3% (3/228) as hybrids (L. [V.] braziliensis/L. [V.] panamensis). However, a partial sequencing analysis of the hsp70 gene from 77 selected samples showed 16.9% (13/77) typified as L. (V.) panamensis, 68.8% (53/77) as Leishmania (V.) sp., 1, 3.9% (3/77) as L. (V.) guyanensis, 1.3% (1/77) as L. (V.) braziliensis outlier, 2.6% (2/77) as Leishmania (Viannia) naiffi, 2.6% as (2/77) Leishmania (V.) sp., and 2 and 3.9% (3/77) hybrid isolates of L. (V.) braziliensis/L. (V.) guyanensis. These results confirm L. (V.) panamensis as the predominant species and cause of CL lesions in Panama and that L. (V.) guyanensis, L. (V.) braziliensis, and L. (V.) naiffi are circulating to a lower degree. Furthermore, the determination of parasite isolates belonging to atypical clusters and hybrid isolates suggests the circulation of genetic variants with important implications for the epidemiology and clinical follow-up of CL in Panama. No evidence of the existence of parasites of the Leishmania (Leishmania) mexicana complex in Panamanian territory was found in this study.