1 figure omitted
Cutaneous leishmaniasis (CL) is a sand fly–borne parasitic infection.
Preliminary data about cases of CL in military personnel deployed to three
countries (Afghanistan, Iraq, and Kuwait) in Southwest/Central Asia have been
published previously.1 During August 2002–February
2004, Department of Defense (DoD) staff identified 522 parasitologically confirmed
cases of CL in military personnel. Leishmania major was
the etiologic agent for all 176 cases for which species data, obtained by
isoenzyme electrophoresis of cultured parasites, are available. This update
focuses on the 361 cases (69% of 522) in patients whose demographic data were
collected systematically under treatment protocols for therapy with the pentavalent
antimonial compound sodium stibogluconate (Pentostam®; GlaxoSmithKline,
United Kingdom) at Walter Reed Army Medical Center, District of Columbia.1 U.S. health-care providers should consider CL in
persons with persistent skin lesions who were deployed to Southwest/Central
Asia or who were in other areas where leishmaniasis is endemic.
Of the 361 patients with CL, 352 (98%) were male; 274 (76%) were non-Hispanic
white, 54 (15%) were non-Hispanic black, and 25 (7%) were Hispanic. The median
age was 25 years (range: 18-57 years). On the basis of the patients' deployment
histories, all but four of the patients probably were infected in Iraq, notably
in areas near the Iraq-Syria border (e.g., Tall Afar) and the Iraq-Iran border
(e.g., Balad Ruz, Kanaquin, Mandali, and Tursaq). The patients represented
multiple branches of the U.S. military, including the Active Force, Reserve,
and National Guard components of the Army, Air Force, and Marine Corps; the
majority of the patients were in the Active Force component of the Army. Self-reported
dates of onset of skin lesions ranged from May 2002 to January 2004, with
274 (78% of 350) occurring during August-November 2003, including 169 (48%
of 350) during September-October.
DoD is implementing measures to decrease the risk for CL among U.S.
military personnel in Southwest/Central Asia and to expedite detection and
treatment of cases of CL. The measures include (1) improving living conditions
for deployed personnel; (2) heightening awareness that leishmaniasis is endemic
in this region (e.g., through publicity about cases of CL in U.S. military
personnel and pre- and postdeployment briefings about leishmaniasis); (3)
emphasizing the importance of deployed personnel using personal protective
measures (e.g., using permethrin-treated clothing and bed nets or other barriers
to sand flies, minimizing the amount of exposed skin, and applying insect
repellent containing 30%-35% DEET to exposed skin, especially from dusk through
dawn); and (4) enhancing vector-control activities.
Persons deployed previously to Southwest/Central Asia who have questions
about their general health or leishmaniasis may contact DoD's Deployment Health
Clinical Center, telephone 866-559-1627 or at http://www.pdhealth.mil. For evaluation, treatment, and referral of military health-care beneficiaries
with suspected or confirmed cases of leishmaniasis, clinicians should contact
the Infectious Disease Service of either Walter Reed Army Medical Center (District
of Columbia), telephone 202-782-1663/8691, or Brooke Army Medical Center (San
Antonio, Texas), telephone 210-916-5554/1286. Diagnostic support can be obtained
by contacting the director of the leishmaniasis diagnostic laboratory at Walter
Reed Army Institute of Research (Silver Spring, Maryland), telephone 301-319-9956.
N Aronson, MD, Uniformed Svcs Univ of the Health Sciences, Bethesda;
M Ananthakrishnan, MD, W Bernstein, MD, L Hochberg, M Marovich, MD, C Ockenhouse,
MD, I Yoon, MD, P Weina, MD, Walter Reed Army Institute of Research, Silver
Spring, Maryland. P Benson, MD, J Fischer, MD, D Hack, MD, C Hawkes, MD, M
Polhemus, MD, G Wortmann, MD, Walter Reed Army Medical Center; P McEvoy, MD,
R Neafie, MA, Armed Forces Institute of Pathology, District of Columbia. R
Defraites, MD, Office of the Surgeon General of the Army, Alexandria, Virginia.
BL Herwaldt, MD, Div of Parasitic Diseases, National Center for Infectious
This report is based in part on data provided by L Figuero, E Fleming,
MS, J Mendez, J Tally, Walter Reed Army Institute of Research, Silver Spring,
Maryland, and staff of the Infectious Disease Svc, Walter Reed Army Medical
Center, District of Columbia.
Update: Cutaneous Leishmaniasis in U.S. Military Personnel—Southwest/Central Asia, 2002-2004. JAMA. 2004;291(18):2188. doi:10.1001/jama.291.18.2188