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Journal of the American Academy of Dermatology
Volume 52, n° 6
pages 977-987 (juin 2005)
Doi : 10.1016/j.jaad.2005.01.109
accepted : 19 January 2005
REPORTS

Cutaneous leishmaniasis in soldiers from Fort Campbell, Kentucky returning from Operation Iraqi Freedom highlights diagnostic and therapeutic options
 

Robert J. Willard, MD a, Anelia M. Jeffcoat, BS a, Paul M. Benson, MD b, Douglas S. Walsh, MD c,
a From Dermatology Services, Blanchfield Army Community Hospital, Fort Campbell 
b Walter Reed Army Medical Center, Washington 
c Eisenhower Army Medical Center, Fort Gordon 

Correspondence to: Douglas Walsh, MD, Chief, Dermatology Service, Eisenhower Army Medical Center, Ft Gordon, GA 30905.

Fort Campbell, Kentucky; Washington, DC; and Fort Gordon, Georgia

Abstract
Background

Cutaneous leishmaniasis (CL), rare in the first Gulf War, is common in American troops serving in Operation Iraqi Freedom. Awareness of the clinical features and treatment options of CL would benefit clinicians who may encounter soldiers, as well as civilians, returning from the Middle East with skin lesions.

Objective

Our purpose was to describe our clinical experience in treating soldiers with CL.

Methods

From December 2003 through June 2004, approximately 360 of an estimated 20,000 soldiers returning from a yearlong deployment in Iraq with skin lesions suspected of being CL were examined by dermatologists. We summarized CL diagnoses, laboratory evaluations, and treatments, including localized heat therapy (ThermoMed model 1.8; ThermoSurgery Technologies, Inc, Phoenix, Ariz), oral fluconazole, cryotherapy, and itraconazole.

Results

Among 237 soldiers diagnosed with CL, 181 had one or more laboratory confirmations, most by Giemsa-stained lesion smears and polymerase chain reaction (PCR). PCR was positive for all 122 smear-positive and 26 biopsy-positive lesions and all 34 smear negative and all 3 biopsy-negative cases. Primary outpatient treatments, including ThermoMed (n=26), oral fluconazole (n=15), cryotherapy (n=4), and itraconazole (n=2), were safe and tolerable. Treatment failure occurred in 2 fluconazole recipients and was suspected in 1 ThermoMed and 2 fluconazole recipients. Seventy-two soldiers elected no treatment.

Limitation

This was a retrospective study.

Conclusion

Approximately 1% of Ft Campbell troops returning from Iraq were diagnosed with CL, most by laboratory confirmation. PCR appeared to be the most useful diagnostic technique. Among outpatient treatments, ThermoMed and cryotherapy had favorable safety and efficacy profiles.

The full text of this article is available in PDF format.

 Funding sources: None.
Conflicts of interest: None.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of Defense or the Department of the Army.



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