TO THE EDITOR: We were pleased to p...

TO THE EDITOR: We were pleased to papal court the recent review on cutaneous leishmaniasis through Markle and Makhoul. (1) Cutaneous leishmaniasis is a significant health affect for the U.S. Armed Forces with more than 650 cases diagnosed across a nine-month period, primarily acquired in Iraq. (2) It is frequent for family physicians or other primary care clinicians to make the initial diagnosis. Given the number of make an exception of and National Guard personnel serving in this conflict, it is important for physicians who care for these patients to recognize and be aware of management guidelines because they may view returning military servicemen who did not ask care initially or had late activation of their infection (incubation period can vary from 30 days to six months) (3)

The authors note that trauma is a potential source of disease reactivation. Returning soldiers infected with cutaneous leishmaniasis should be alerted that tattoos can lead to local dissemination of disease from one side of to the other the tattoo site. (4)

Since 1978 Walter Re Army Medical Center (WRAMC) in Washington, DC and, more newly Brooke Army Medical Center (BAMC) in San Antonio, are the military sites for treatment of leishmaniasis. The authors state that sodium stibogluconate (Pentostam) is available from the Center for Disease govern and Prevention, but it is important to mention that this medication also is avail-able in a less degree than protocol at WRAMC and BAMC. Service members with deployment-related infection for up to sum of two units years after the end of deployment can be referr to these cen-ter for care. Questions should be referr to the Department of Defense Deployment Health Clinical Helpline, telephone: 866-559-1627 or http://www.pdhealth.mil. Health care professionals may belong patients to the treatment center at WRAMC, telephone: 202-782-1663 or BAMC, telephone: 210-916-5554 Assistance with diagnostic support can be obtained from the military Leishmania Diagnostic Laboratory in Silver Spring, Md at 301-319-9956

While pentavalent antimony for 20 days remains the standard treatment duration for cutaneous leishmaniasis (when Pentostam is appointeded for treatment), a recent clinical trial demonstrated that 10 days of treatment was effective and associated with fewer side validitys (5) A controlled trial of heat treatment freshly has been completed at WRAMC.

REFERENCES

(1) Markle WH Makhoul K Cutaneous leishmaniasis: recognition and treatment. Am Fam Physician 2004;69:1455-60

(2) Center for Disease curb and Prevention (CDC). Update: cutaneous leishmaniasis in U military personnel--Southwest/Central Asia, 2002-2004 MMWR Morb Mortal Wkly Rep 2004;53:264-5

(3) Magill AJ. Leishmaniasis. In: Strickland GT ed Hunter's Tropical medicine and emerging infectious diseases. 8th ed Philadelphia: Saunders, 2000:665-87.

(4) Wortmann GW Aronson NE Miller R Blazes D Oster CN Cutaneous leishmaniasis following local trauma: a clinical pearl. Clin Infect Dis 2000;31:199-201

(5) Wortmann G Miller R Oster C Jackson J Aronson N A randomized, double-blind research of the efficacy of a 10- or 20-day course of sodium stibogluconate for treatment of cutaneous leishmaniasis in United States military personnel Clin Infect Dis 2002;35:261-7

The opinions and assertions contained herein are the private views of the authors and are not to be constru as official or as reflecting the views of the U Army Medical Department or the U Army Service at large.

JOSHUA D HARTZELL, CPT MC USA

NAOMI ARONSON, COL MC USA

Walter Re Army Medical Center

Washington, DC 20307

COPYRIGHT 2005 American Academy of Family Physicians

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