Outbreak of Cutaneous Leishmaniasis among military personnel in French Guiana, 2020: Clinical, phylogenetic, individual and environmental aspects

Abstract

Background Cutaneous Leishmaniasis (CL) is endemic in French Guiana but cases are usually sporadic. An outbreak signal was issued on May 15th 2020 with 15 suspected cases after a military training course in the rainforest. An outbreak investigation was carried out. Methodology/Principal findings Thirty cases were confirmed. Leishmania guyanensis was the most frequent species (90%). The most frequent presentation was ulcerative (90%). Lesions on the face and hands were frequent (40% each). Eight cases (26%) presented a poor outcome after treatment with pentamidine and required a second line with amphotericin B. Three of them required further treatments with meglumine antimoniate or miltefosine. Two spots within the training area were deemed as likely sites of contamination, due to illegal logging. The isolated Leishmania strains did not form a separate cluster. Participation in Week 13 of year 2020 was associated with infection (OR = 4.59 [1.10–19.83]; p = 0.016) while undergoing only the “Fighting” exercise was protective (OR = 0.1 [0–0.74]; p = 0.021). There was no association between infection and other risk factors at the individual level. The attack rate of Regiment B (14/105 = 13.3%) was significantly higher (OR = 4.22 [1.84–9.53], p = 0.0001) compared to Regiment A (16/507 = 3.2%). The attack rate during this training course (30/858 = 3.5%) was significantly higher (OR 2.29 [1.28–4.13]; p = 0.002) than for other missions in French Guiana during the same period (22/1427 = 1.5%). Conclusions This outbreak could be explained by a combination of factors: climatic conditions around week 13, at-risk activities including night trainings, absence of impregnation, a lesser experience of rainforest duties in Regiment B and illegal logging attracting sandflies on military training grounds.

Cutaneous leishmaniasis in British troops following jungle training in Belize: cumulative incidence and potential risk practices

“…The traditional occupational risk of CL due to L. (L.) mexicana infection (giving rise to the name chiclero's ulcer) was predominant amongst collectors ("chicleros") of chewing-gum latex (chiclé) from Sapodilla trees Manilkara zapota, conducted in forests during the wet season [46]. Beltran & Bustamente (1942) as well as the majority of values for French Guiana (French soldiers) [10] and Afghanistan (Dutch soldiers) [21], which share similar deployment characteristics (duration, training activities, and period).…”

“…CL is commonly observed among soldiers who have returned from international deployments to CL endemic regions. Notable case numbers are associated with deployments to Iraq [7,8], Afghanistan [7][8][9], French Guiana [10,11], Brazil [12,13], Panama [14], Peru [15], and Belize [16][17][18][19], with attack rates ranging from 2.1% to 25.2%. The risk of sand fly bite exposure leading to infection has been attributed to several factors, including failure to adopt personal protective measures (PPMs) [10,14,15,18,[20][21][22][23][24][25], participation in military training activities during periods of sand fly biting [10,14,15], and in marshy areas near streams or rivers [20,23], and operations in areas undergoing significant environmental changes including deforestation, illegal logging, and other land use alterations for agriculture [10,15].…”

A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health

“…The refugees are relevant vectors of disease, as demonstrated by the net increase in Leishmania cases in Lebanon from the period 2000–2012, when the annual number of cases ranged between 0 and 6, to 2013, when 1033 cases were reported, 998 (96.6%) of which in the Syrian refugees as a consequence of the Syrian war, and the remaining 3.4% due to Lebanese nationals and Palestinian refugees [ 381 ]. Even military training activity in at-risk areas is burdened by a high rate of leishmaniasis incidence, as demonstrated in the French military exercising in French Guyana [ 382 ], in the Peruvian military making training activity in the Amazon Basin, in which an incidence rate of cutaneous leishmaniasis of 25% was observed [ 383 ], in two cohorts of Dutch military troops exercising in Belize, in which an attack rate of 25.2% and 17.5%, respectively, was observed [ 384 ], in the British military following jungle training in Belize [ 385 ], and in the Colombian military [ 386 ]. Despite that the number of cases of leishmaniasis is relatively low, the vulnerability of the military to this sand-fly-borne disease makes the search for a safe and effective preventive vaccine for human use a high priority for the military.…”

Genetic characteristics and phylogenetic analysis of Leishmania infecting sandflies and humans based on the kDNA and ITS2 gene dataset in the new focus of Cutaneous Leishmaniasis in Shiraz, south of Iran

“…Daily temperature varies between 40˚ C in the summer and 10˚ C in the winter. The city contains a considerable number of gardens (Henry et al, 2021). There are mountainous and plain areas around the city that have created living conditions for various animal and plant species Sand-y Sampling sticky paper traps were used for catching sand ies indoors (bedrooms, bathrooms, storage rooms, etc.)…”

“…However, Phlebotomus and Lotzumia species are the main vectors of leishmaniasis in its spreading areas. ZCL and ACL are caused by Leishmania major and Leishmania tropica, especially in the old world and Iran (Golpayegani et al, 2018;Henry et al, 2021;Yaghoobi-Ershadi et al, 1996). Many studies from the past have con rmed the presence of Phlebotomus papatasi, the primary vector of ZCL and Phlebotomus sergeanti, the main vector of ACL, in different parts of Iran and Fars province (Alipour et Shiraz is one of the most populated cities in Iran.…”