title: Outbreak of zoonotic cutaneous leishmaniasis with local dissemination in Balkh, Afghanistan.
abstract: OBJECTIVE
  In Afghanistan zoonotic cutaneous leishmaniasis (CL) due to Leishmania major has been less widely reported than anthroponotic CL due to L. tropica. However, an outbreak of zoonotic CL occurred amongst a group of British soldiers at a military camp near Mazar-e-Sharif in the Balkh province of northern Afghanistan in 2004.
  
  
  METHODS
  A study was performed to assess the epidemiology, clinical features, parasitology results, treatment outcomes and environmental health measures associated with this incident.
  
  
  RESULTS
  Twenty (17%) of 120 soldiers developed CL due to L. major and the risk of infection increased with the proximity of their accommodation to an area of recently cleared scrub, where many wild rodents were observed. Most cases had features of local dissemination, including secondary lesions from the pseudo-Koebner phenomenon, sporotrichoid lymphatic spread, lymphadenopathy and satellite papules or milia formation around healing lesions. Several cases responded poorly to fluconazole and low dose (10 mg/kg) sodium stibogluconate, which were considered suitable treatments at the time. Environmental health measures at the military camp were found to be deficient.
  
  
  CONCLUSIONS
  Zoonotic CL due to L. major is a significant threat for foreign troops based in Balkh, Afghanistan and may present with unusually severe clinical features and be resistant to previously recommended treatments.
authors.affiliation: Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5ST England, UK. markbailey@nhs.net
authors.forename: M S
authors.initials: MS
authors.lastname: Bailey
authors.forename: A J
authors.initials: AJ
authors.lastname: Caddy
authors.forename: K A
authors.initials: KA
authors.lastname: McKinnon
authors.forename: L F
authors.initials: LF
authors.lastname: Fogg
authors.forename: M
authors.initials: M
authors.lastname: Roscoe
authors.forename: J W
authors.initials: JW
authors.lastname: Bailey
authors.forename: T J
authors.initials: TJ
authors.lastname: O'Dempsey
authors.forename: N J
authors.initials: NJ
authors.lastname: Beeching
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000208:ethnology; D000818:Animals; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D018320:Leishmania major / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000208:ethnology* / Q000469:parasitology / Q000635:transmission; D008297:Male; D008889:Military Personnel; D012189:Retrospective Studies; D012377:Rodentia / Q000469:parasitology*; D006113:United Kingdom; D015047:Zoonoses / Q000453:epidemiology* / Q000635:transmission