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17 : Leishmaniasis in American Soldiers: Parasites from the Front

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Leishmaniasis in American Soldiers: Parasites from the Front, Page 1 of 2

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Abstract:

Leishmaniasis is caused by a protozoan parasite of the genus Leishmania and is associated with several clinical syndromes: visceral (the most serious), mucosal (the most disfiguring), and cutaneous (the most common). To date, only five cases of visceral leishmaniasis have been reported, with three cases from Operation Enduring Freedom and two acquired during Operation Iraqi Freedom. Using the Defense Medical Surveillance System, all reportable medical events, hospitalizations, and ambulatory visits to military treatment facilities coded with the diagnosis of leishmaniasis (ICD-9, 085.0 to 085.9) were searched. The leishmaniasis attack rate in one squadron was 211/1,000, with the associated division having an attack rate of 12/1,000. The major clinical syndromes of leishmaniasis are cutaneous, mucosal, and visceral leishmaniasis. There have been instances of significant enlargement of leishmaniasis lesions along broken-down suture lines and discourage excision as a treatment modality. The symptomatic expression of visceral leishmaniasis (VL) (known as kala-azar) includes fever, cachexia, pancytopenia, hepatosplenomegaly, and hypergammaglobulinemia with hypoalbuminemia. Visceral leishmaniasis can be asymptomatic, subclinical, symptomatic, or very severe. While the old world cutaneous leishmaniasis (OWCL) described in U.S. military personnel is generally benign, the impact of VL on the global poorest of the poor can be associated with high mortality and is estimated by the World Health Organization (WHO) to be in excess of 500,000 cases per year. Much remains to be done; the most effective treatments are expensive and generally challenging to administer, drug resistance is developing, and the prevalence of concomitant immunocompromising conditions is increasing.

Citation: Aronson N. 2007. Leishmaniasis in American Soldiers: Parasites from the Front, p 325-342. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch17
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Figures

Image of Figure 1.
Figure 1.

Number of confirmed U.S. Army leishmaniasis cases reported by date of symptom onset, 1 January 2003 to 31 July 2005. (Data provided by the Army Medical Surveillance Activity.)

Citation: Aronson N. 2007. Leishmaniasis in American Soldiers: Parasites from the Front, p 325-342. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch17
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Image of Figure 2.
Figure 2.

Amastigotes seen in a skin scraping; the stain is Diff-Quik (Dade-Behring, Newark, Del.). Magnification, ×300. (Photograph courtesy of R. Neafie, Armed Forces Institute of Pathology.)

Citation: Aronson N. 2007. Leishmaniasis in American Soldiers: Parasites from the Front, p 325-342. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch17
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Image of Figure 3.
Figure 3.

Treatment algorithm for Old World cutaneous leishmaniasis.

Citation: Aronson N. 2007. Leishmaniasis in American Soldiers: Parasites from the Front, p 325-342. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch17
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Tables

Generic image for table
Table 1.

Clinical summary of VL cases among American military personnel, 2002 to 2005

Citation: Aronson N. 2007. Leishmaniasis in American Soldiers: Parasites from the Front, p 325-342. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch17

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