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Giornale Italiano di Dermatologia e Venereologia 2006 August;141(4):393-9

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Old World cutaneous leishmaniasis in American soldiers deployed to Iraq highlights diagnostic and therapeutic options

Walsh D. S.

Department of Clinical Trials Walter Reed Army Institute of Research Silver Spring, MD, USA


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Cutaneous leishmaniasis (CL), a parasitic skin disease transmitted by sand flies, has been common in soldiers serving in Operation Iraqi Freedom (Gulf War 2, began 2003). Active CL lesions on the face or hands cause stigma and, upon healing, potentially unsightly scarring. Prompt therapy of CL speeds healing and likely improves cosmetic outcome. This has prompted renewed interest among clinicians in becoming re-acquainted with the clinical features of CL, as well as diagnostic and treatment options. In the US Army, well-established diagnostic procedures include Giemsa-stained lesional skin smear or punch biopsy, as well as highly sensitive polymerase chain reaction. Therapies for CL in soldiers include local heat application (ThermoMed™), cryotherapy (liquid nitrogen), oral fluconazole or intraconzole, and intravenous sodium stibogluconate (pentavalent antimony, Pentostam®). Paromomycin, a promising anti-Leishmania aminoglycoside topical preparation that is safe, convenient and cost effective, and already commercially available in some countries, is under investigation by the US Army as a combined paromomycin-gentamicin topical formulation. This review describes current and in-development diagnostic and therapeutic options for CL acquired in the Middle East or Southwest Asia.

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