Cutaneous and Presumed Visceral Leishmaniasis in a Soldier Deployed to Afghanistan

James P. Woodrow, MD; Joshua D. Hartzell, MD; Jim Czarnik, MD; David M. Brett-Major, MD; Glenn Wortmann, MD

Disclosures

November 30, 2006

Introduction

Infection with the obligate intramacrophage parasite Leishmania is common in the Middle East, posing a serious health concern for immune-naive US troops deployed to the area.[1] Between August 2002 and February 2004, 522 cases of parasitologically confirmed cutaneous leishmaniasis (CL) have been reported in this particular population.[2] No official data have been published since 2004, but Walter Reed Army Medical Center (WRAMC) Infectious Diseases staff physicians indicate that the number of cases has continued to grow since 2004.

Leishmania is found in humans only as an incidental host, using small mammals as a reservoir in most urban cases. Using the sand fly as a vector,[3] Leishmania causes 3 distinct clinical syndromes in humans, encompassing cutaneous, visceral, and mucosal variants. The large majority of clinically apparent infections in US military personnel have been cutaneous. Of the cases evaluated from Operations Iraqi and Enduring Freedom, visceral involvement has been confirmed in only 4 patients.[4] Leishmania major has been identified as the responsible species in the overwhelming majority of cutaneous cases, while L donovani complex has been the only isotype recovered from patients with visceral disease. The current report is the first case of an American soldier with both cutaneous and visceral manifestations of leishmaniasis.

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