It was found that in 50% of clinically diagnosed cases of cutaneous leishmaniasis in Damascus, microscopic examination failed to detect the presence of the amastigote form of the parasite inside the macrophages or in the extracellular media, i.e. 50% were false negative. However, in over 1000 photographs from 32 slides of 16 cases, the presence of microorganisms was noted in the extracellular fluid that did not match any of the known blood cells or components but did match the promastigote form as seen by general and electron microscopy. Since the promastigote form is not generally thought to be present in humans, this finding needs further investigation.