Letters to the Editor

Resources for Management of Cutaneous Leishmaniasis

Am Fam Physician. 2005 Feb 15;71(4):663.

to the editor: We were pleased to see the recent review on cutaneous leishmaniasis by Markle and Makhoul.1 Cutaneous leishmaniasis is a significant health concern for the U.S. Armed Forces with more than 650 cases diagnosed over a nine-month period, primarily acquired in Iraq.2 It is common for family physicians or other primary care clinicians to make the initial diagnosis. Given the number of Reserve and National Guard personnel serving in this conflict, it is important for physicians who care for these patients to recognize and be aware of management guidelines because they may see returning military servicemen who did not seek care initially or had late activation of their infection (incubation period can vary from 30 days to six months).3

The authors note that trauma is a potential source of disease reactivation. Returning soldiers infected with cutaneous leishmaniasis should be alerted that tattoos can lead to local dissemination of disease over the tattoo site.4

Since 1978, Walter Reed Army Medical Center (WRAMC) in Washington, D.C., and, more recently, Brooke Army Medical Center (BAMC) in San Antonio, are the military sites for treatment of leishmaniasis. The authors state that sodium stibogluconate (Pentostam) is available from the Centers for Disease Control and Prevention, but it is important to mention that this medication also is available under protocol at WRAMC and BAMC. Service members with deployment-related infection for up to two years after the end of deployment can be referred to these centers for care. Questions should be referred to the Department of Defense Deployment Health Clinical Helpline, telephone: 866-559-1627, or http://www.pdhealth.mil. Health care professionals may refer patients to the treatment centers at WRAMC, telephone: 202-782-1663, or BAMC, telephone: 210-916-5554. Assistance with diagnostic support can be obtained from the military Leishmania Diagnostic Laboratory in Silver Spring, Md., at 301-319-9956.

While pentavalent antimony for 20 days remains the standard treatment duration for cutaneous leishmaniasis (when Pentostam is elected for treatment), a recent clinical trial demonstrated that 10 days of treatment was effective and associated with fewer side effects.5 A controlled trial of heat treatment recently has been completed at WRAMC.

The opinions and 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 U.S. Army Medical Department or the U.S. Army Service at large.

REFERENCES

1. Markle WH, Makhoul K. Cutaneous leishmaniasis: recognition and treatment. Am Fam Physician. 2004;69:1455–60.

2. Centers for Disease Control and Prevention (CDC). Update: cutaneous leishmaniasis in U.S. military personnel—Southwest/Central Asia, 2002–2004. MMWR Morb Mortal Wkly Rep. 2004;53:264–5.

3. Magill AJ. Leishmaniasis. In: Strickland GT, ed. Hunter’s Tropical medicine and emerging infectious diseases. 8th ed. Philadelphia: Saunders, 2000:665–87.

4. Wortmann GW, Aronson NE, Miller RS, Blazes D, Oster CN. Cutaneous leishmaniasis following local trauma: a clinical pearl. Clin Infect Dis. 2000;31:199–201.

5. Wortmann G, Miller RS, Oster C, Jackson J, Aronson N. A randomized, double-blind study of the efficacy of a 10- or 20-day course of sodium stibogluconate for treatment of cutaneous leishmaniasis in United States military personnel. Clin Infect Dis. 2002;35:261–7.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

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