Outbreak of Cutaneous Leishmaniasis in Peruvian Military Personnel Undertaking Training Activities in the Amazon Basin, 2010 (original) (raw)
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PLOS Neglected Tropical Diseases
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 onl...
Rev. Cient. Gen. José María Córdova, 2020
Military operations occurring in areas where Leishmania spp. is endemic continually expose the military personnel of the Colombian National Army to contracting leishmaniasis. Medical treatments for this disease represent high costs in military logistics. The objective of this study was to quantify the parasitic load of Leishmania spp. in patients diagnosed with cutaneous leishmaniasis, using real-time PCR kDNA minicircle amplification. Also, to identify the specific species using PCR amplification and sequencing of the HSP70 and MPI molecular markers to monitor and determine the effectiveness of meglumine antimoniate versus pentamidine isethionate treatment, and its relation to other clinical-epidemiological data. In addition to demonstrating the efficacy of treatments and their characteristics, the risk of future outbreaks of mucocutaneous leishmaniasis was identified in certain cases, and a multifactorial explanation of the differences found between clinical-epidemiological variables was noted.
PLoS neglected tropical diseases, 2017
In Colombia, the cutaneous leishmaniasis (CL) is the most common manifestation across the army personnel. Hence, it is mandatory to determine the species associated with the disease as well as the association with the clinical traits. A total of 273 samples of male patients with CL were included in the study and clinical data of the patients was studied. PCR and sequencing analyses (Cytb and HSP70 genes) was performed to identify the species and the intra-specific genetic variability. A georeferenced database was constructed to identify the spatial distribution of Leishmania species isolated. The identification of five species of Leishmania that circulate in the areas where army personnel are deployed is described. Predominant infecting Leishmania species corresponds to L. braziliensis (61.1%), followed by Leishmania panamensis (33.5%), with a high distribution of both species at geographical and municipal level. The species L. guyanensis, L. mexicana and L. lainsoni were also detec...
2010
Cutaneous leishmaniasis caused by Leishmania major infection affected 172 (18.3%) of 938 Dutch military troops deployed in northern Afghanistan in 2005. The high attack rate was a result of initial insufficient availability of means of prevention and insufficient adherence to preventive measures. At presentation, the lymphatic system was involved in 24.8%. Treatment with intralesional injections of antimony with or without cryotherapy was satisfactory, but 19.5% of patients received secondary treatment with miltefosine. Six months after treatment, 128 (77.1%) of 166 treated patients were cured, 16 (9.6%) were lost to follow-up, and 22 (13.3%) already experienced cure at six weeks but were not seen at six months. Natural evolution played a role in this observational study, which showed cure of all patients seen at six months. In general, management of cutaneous leishmaniasis was feasible under field conditions.
Clinical Microbiology and Infection, 2018
Objectives: The incidence of leishmaniasis is known to increase in conflict areas. The aims of this study were to determine the exposure to Leishmania species in Austrian soldiers returning from missions abroad and to assess possible risk factors. Methods: A retrospective explorative cross-sectional serologic study was conducted in 225 healthy Austrian soldiers returning from UN or EU peacekeeping missions in Syria, Lebanon and Bosnia and Herzegovina (BIH). Sera were tested for anti-Leishmania antibodies using a commercial enzyme-linked immunosorbent assay. All positive individuals were screened for Leishmania DNA by PCR targeting the ITS1 region using EDTA blood samples. Results: In total, 13.3% (30/225) of the individuals tested were either positive (8%, 18/225) or borderline (5.3%, 12/225) in the enzyme-linked immunosorbent assay, with the highest seroprevalence in soldiers returning from Syria (17.8%, 18/101; 12 positive, six borderline), second from Lebanon (11.1%, 7/63; four positive, three borderline) and lowest from BIH (8.2%, 5/61; two positive, three borderline). Ten soldiers returning from Syria and one from BIH were also positive for Leishmania DNA. Six of these were identified as Leishmania donovani/infantum complex, two as L. tropica and another three as mixed infections by DNA sequencing. Epidemiologic data were collected via a questionnaire, and seropositivity was correlated with a history of insect bites that took a long time to heal (odds ratio, 5.33; 95% confidence interval, 1.23e23.04; p 0.025). Conclusions: Although pretravel serologic data were not available in this study, the exposure of soldiers to Leishmania spp. during their missions can be assumed to be considerable. Because even asymptomatic infections may resurge in case of emerging immunodeficiencies, adequate prevention measures seem important.
Recent Epidemiological Profile of Cutaneous Leishmaniasis in Iranian Military Personnel
Journal of Archives in Military Medicine, 2014
Background: Leishmaniasis is one of the zoonotic diseases caused by protozoa of trypanosomatidae family. The cutaneous type with various manifestations is endemic in Iran and affects people of many provinces. Outbreaks may occur in military personnel who deploy these endemic areas. Objectives: The main objective of this study was to evaluate the most important epidemiologic features of leishmaniasis in Iranian military personnel from 2005-2010. Patients and Methods: This was a cross-sectional study. Data was gathered from the regional passive surveillance system of the Iranian Army and double checked by the Deputy of Health of Aja University of Medical Sciences. Analysis was performed by the STATA Software using appropriate statistical functions. Results: During the 6 years of study, 3767 cases of cutaneous leishmaniasis were reported, 15% of the total reported infectious diseases (excluding upper respiratory infections, which were not included in this study). Cutaneous leishmaniasis was the third most prevalent infectious disease. Sixty nine percent of cases were reported in autumn. Most were related to three provinces: Isfahan, Khuzestan and Bushehr. Two thirds of the reports were from the Air Force. Conclusions: There has been a decline in the overall trend of cutaneous leishmaniasis in the recent years, but there are still peaks in some provinces particularly during autumn. Army health commanders must do their best to prevent the disease and control its cycle, especially in high endemic areas.
Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru
Tropical Medicine and Health, 2021
Background American cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and children were infected with CL raising concern among authorities that transmission was shifting towards domestic spaces and population centers. Methods We describe the characteristics of CL patients from four participating clinics after digitizing up to 10 years of patient data from each clinic’s CL registries. We assessed risk factors of CL associated with intradomestic, peridomestic, or non-domestic transmission through a matched case-control study with 63 patients who had visited these same clinics for CL (cases) or other medical reasons (controls) between January 2014 and August 2016. The study consisted of an in-home interview of participants by a trained field worker using a standard questio...
Clinical Infectious Diseases, 2002
The recommended treatment for cutaneous leishmaniasis is pentavalent antimony at a dosage of 20 mg/kg/ day for 20 days. Some studies conducted in locales in which Leishmania is endemic have suggested that shorter courses of treatment may be as efficacious. We conducted a randomized, double-blind, placebo-controlled study of 10 versus 20 days of sodium stibogluconate (SSG) in United States military personnel who contracted cutaneous leishmaniasis while serving overseas; 19 patients received SSG for 10 days (and placebo for 10 days), and 19 patients received SSG for 20 days. Cure rates were 100% (19 of 19 patients) in the 10-day group and 95% (18 of 19 patients) in the 20-day group. Side effects were more common among patients who received 20 days of therapy. In this group of otherwise healthy young adults, SSG at a dosage of 20 mg/kg/day for 10 days appears to have been therapeutically equivalent and less toxic than the standard 20-day course.
The American journal of tropical medicine and hygiene, 2015
The Amazon is responsible for approximately 40% of the American tegumentary leishmaniasis (ATL) in Brazil. Herein the sustained presence of ATL in Manaus, the largest settlement in the Amazon, was investigated. Records of notification of historic cases, and data from cases prospectively enrolled in the Tropical Medicine Foundation of the Amazonas State were used. Geographic coordinates of prospective patients' living sites were used to detect inner-city clusters of ATL. Infecting Leishmania species was determined by polymerase chain reaction. Among prospectively enrolled subjects, 94.8% were infected with Leishmania (Viannia) guyanensis, 76.7% were male, 30.2% were 0-20 years old, and 69.8% had an urban residence. Historic cases showed a profile similar to that of prospectively enrolled subjects. Several clusters of ATL, widely distributed within the city of Manaus, could be detected. In conclusion, there was a high frequency of disease in young age groups and cases clustered in...