Page 139 - Journal of Special Operations Medicine - Spring 2015

Figure 2 Sand fly life cycle. Before initiating treatment, it is prudent to consult with
the leishmaniasis experts at the CDC or with an infec­
tious disease physician experienced in the care of pa­
tients with this disease.

Importance in a Deployed Setting
Several hundred military patients with cutaneous leish­
maniasis were treated at US military treatment facilities
early in the conflicts in Afghanistan and Iraq, when US
Servicemembers were bedding down in areas where the
sand flies were in great numbers. The insect vector is
challenging, as it is actually too small to be controlled
by standard bed netting. Personal protection by using
permethrin­treated bed nets and uniforms, as well as
judicious use of N,N­diethyl­meta­toluamide (DEET)­
Source: http://www.cdc.gov/dpdx/leishmaniasis/. containing insect repellent on exposed skin, is key to
prevention. Personnel should also locate areas where the
Diagnosis sand flies live and breed and spray them with insecti­
The US Centers for Disease Control and Prevention cides to control their population.
(CDC) provides reference diagnostic services for leish­
maniasis. For cutaneous leishmaniasis, the diagnosis is Disclaimer
made by finding the parasite or its DNA in skin tissue.
Methods of collection and submission of tissue for diag­ The views expressed in this publication are those of the
nosis can be found at the following website: http://www. author and do not reflect the official policy or position
cdc.gov/parasites/leishmaniasis/health_professionals/ of the Department of the Army, Department of Defense,
index.html#dx, or by contacting the CDC directly at or the US Government.
+1 404­718­4175. A new rapid assay, the CL Detect
™
Rapid Test (InBios International, Inc), was recently ap­ Disclosure
proved by the US Food and Drug Administration. More
information on this test, developed in part by Army re­ The author has nothing to disclose.
searchers, can be found at inbios.com.
Bibliography
Treatment US Centers for Disease Control and Prevention. Infectious diseases
related to travel. In: CDC Health Information for Interna­
Treatment of cutaneous leishmaniasis infections is com­ tional Travel. http://wwwnc.cdc.gov/travel/yellowbook/2014/
plicated in that more than 20 different types of the para­ chapter­3­infectious­diseases­related­to­travel/leishmaniasis
site exist worldwide, and different types cause different ­cutaneous.
manifestations of the disease, which respond differently US Centers for Disease Control and Prevention. Parasites: leish­
to the treatments available. Drug treatments used in the maniasis. http://www.cdc.gov/parasites/leishmaniasis/.
recent past include Pentostam (sodium stibogluconate;
®
GlaxoSmithKline plc; hcp.gsk.co.uk/products/pentostam
®
.html), AmBisome (liposomal amphotericin B; Astellas COL Burnett is currently the Area­Support Group­Kuwait
Pharma US, Inc; www.ambisome.com), and the oral Command Surgeon and is board­certified in pediatrics and pe­
agent miltefosine. Local therapies of cryotherapy with diatric infectious diseases. He has served overseas in Korea,
liquid nitrogen, and thermotherapy, with the use of a Germany, Kosovo, Iraq, Afghanistan, Kuwait and as the
localized current of radiofrequency heat, have been tried JSOTF­P Surgeon in the Philippines. He is a graduate of the
with some success. No vaccination is available for pre­ University of Wisconsin­Madison and the Medical College of
vention of leishmaniasis infections. Wisconsin.

Cutaneous Leishmaniasis 129