Medical Surveillance Monthly Report (MSMR). Volume 2, Number 3, March 1996
Abstract
In the US military, New World cutaneous leishmaniasis is a disease that is typically seen in personnel who have deployed to Central and South America, particularly to the Jungle Operations Training Center (JOTC) at Ft. Sherman, Panama, or the French Foreign Legion jungle training school in French Guiana (4). In the Americas, the causative agents are intracellular protozoa (L. braziliensis, L. peruviana and L. mexicana; rarely L. chagasi). The organism is spread by sand flies, Lutzomyia and Psychodopygus species in the Americas and Phlebotomus species elsewhere. The disease "ranges from a self-healing, localized ulcer to widely disseminated, progressive lesions of the skin and mucous membranes." (1). This zoonotic disease's primary reservoir is small forest rodents or in the case of L. peruviana, dogs. New world cutaneous leishmaniasis is most common in individuals who work in jungles (rural settlers, road builders, and soldiers). It is seen during the hot season and after the summer rains (2). Definitive diagnosis is by demonstrating amastigotes upon biopsy/scraping/aspirate taken from the edge of the lesion, NOT the center. Treatment is with either sodium stibogluconate (Pentostam) in the US or meglumine antimoniate (Glucantime) in South America. The U.S. FDA classifies Pentostam as an investigational new drug; therefore, its use requires adherence to specific protocol guidelines. Only two locations in the United States are allowed to use Pentostam: the CDC and WRAMC. The WRAMC protocol for cutaneous leishmaniasis uses intravenous Pentostam 20 mg/kg each day for 20 days. The protocol for treatment with Pentostam requires close monitoring of treatment including a weekly EKG (looking for QT prolongation, a side effect of Pentostam), CBC (looking for cytopenia, anemias, leukopenias, pancytopenias), and lipase/amylase (drug-induced pancreatitis occurs in 50 percent of patients (5)).
Document Details
- Document Type
- Technical Report
- Publication Date
- Mar 01, 1996
- Accession Number
- ADA497680
Entities
People
- Bruce H. Jones
- Cynthia R. Towle
- John Brundage
- Mark V Rubertone
- Sharon L. Ludwig
- Vincent P. Fonseca
Organizations
- Armed Forces Health Surveillance Center