Old World Leishmaniasis: An Emerging Infection among Deployed US Military and Civilian Workers

Abstract

Many veterans of Operation Iraqi Freedom are now returning to the United States after potential exposure to leishmaniasis. In the past year, large numbers of leishmaniasis cases of a magnitude not encountered in the United States since World War II have challenged clinicians in both the military and the civilian sectors. Many Reserve and National Guard troops were deployed to Iraq and are now back in their communities. Hundreds of leishmaniasis cases, which were managed by a few practitioners initially, permitted further appreciation of the epidemiology and diagnostic and treatment options for Old World leishmaniasis. We describe the current situation, with on-the-ground experience, complimented by a literature review, and we provide a practical list of options for the clinician likely to encounter this parasitic infection in the coming months and years.

Evaluation of a Microculture Method for Isolation of Leishmania Parasites from Cutaneous Lesions of Patients in Peru

“…Giemsa-stained lesion smear, leishmanin skin testing, and kDNA PCR all proved to have diagnostic sensitivities and specificities on the order of what has been reported previously (7,15,25,31,37,40). While positive predictive values were high for all tests, indicating that positive tests are generally good predictors of disease, negative predictive values were poor for all assays, though highest with the leishmanin skin test and direct smear.…”

“…While PCR-based detection of parasites in specimens is generally regarded as the most sensitive method for the diagnosis of CL and mucosal leishmaniasis (13,15,30,38,40), it is rarely the only test that produces positive results (30,40). Thus, culturebased testing may be a more practical approach, particularly in underresourced settings.…”

Diagnosis of leishmaniasis

“…Amastigotes are observed as round or oval bodies, 2-4 μm in diameter, with characteristic nuclei and kinetoplasts. The material from the ulcer base usually has the highest yield; however, other authors have not found significant differences in the diagnostic outcomes when smears or culture samples are taken from the center or the border of the ulcer or from an incision made tangential from the ulcer [17,18]. Conventionally, three to five aspirates from different lesions or portions of lesions are dissected.…”

Leishmaniosis visceral en un paciente con infección por VIH

“…La dosis para LV en países del Mediterráneo es de 20 -21 mg/kg iv como dosis total a administrar en diversos esquemas que van desde 2 a 7 días [8][9][10][11][12] . En tanto, los antimoniales pentavalentes presentan menor toxicidad renal, pero pueden producir pancreatitis, toxicidad cardíaca, reacciones alérgicas y molestias digestivas 2,13 . Adicionalmente tienen el problema de aparición de resistencia del parásito a éste fármaco, en especial en India y otros países asiáticos 2 .…”

“…Afecta en forma endémica a países de Asia especialmente el subcontinente indio, África, Latinoamérica y la cuenca mediterránea 1 . Existen variadas formas de presentación en el hombre siendo tres las principales: leishmaniosis cutánea, mucosa y visceral 2,3 . Esta última es la más grave y letal y puede afectar tanto a pacientes inmunocompetentes como inmunocomprometidos.…”