title: Cutaneous leishmaniasis in three Dutch military cohorts following jungle training in Belize.
abstract: Skin lesions occur frequently in travelers to tropical countries. Military personnel acquire skin lesions regularly during jungle training as did Dutch troops who trained in the jungle of Belize in 1998, 2004 and 2009, in an area endemic for cutaneous leishmaniasis. Demographic and clinical data were collected retrospectively. Diagnostic investigations for cutaneous leishmaniasis included Giemsa stain, culture, PCR and NASBA and histopathology of biopsies. Treatment of leishmaniasis was with sodium stibogluconate, given intravenously or intralesionally, the latter with cryotherapy. In 1998 and 2004 cutaneous leishmaniasis due to Leishmania braziliensis and Leishmania mexicana infection was diagnosed in 25 persons out of 99 (attack rate 25.2%) and 14 persons out of 80 (attack rate 17.5%) respectively. In 2009 cutaneous leishmaniasis was not acquired. Skin problems were common during and after jungle training. Cutaneous leishmaniasis was important in the first two cohorts but not observed in the third cohort. Factors that could have played a role in the absence of cutaneous leishmaniasis in the third cohort include variability in transmission and availability of better preventive measures and adherence to these. Sodium stibogluconate treatment, intralesional or intravenous, was effective.
authors: Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS and Center for Infection and Immunity, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. p.p.vanthiel@amc.uva.nl
authors: P P A M
authors: PP
authors: van Thiel
authors: J E
authors: JE
authors: Zeegelaar
authors: T
authors: T
authors: van Gool
authors: W R
authors: WR
authors: Faber
authors: P A
authors: PA
authors: Kager
mesh_terms: D000293:Adolescent; D000328:Adult; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D001531:Belize / Q000453:epidemiology; D006801:Humans; D007892:Leishmania braziliensis / Q000302:isolation & purification; D007894:Leishmania mexicana / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology / Q000473:pathology; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D009426:Netherlands / Q000208:ethnology; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000627:therapeutic use
chemical_list: D014344:Trypanocidal Agents; D000967:Antimony Sodium Gluconate