cqvip:Background:Cutaneous leishmaniasis (CL), rare in the first Gulf War, is common in American troops serving in Operation Iraqi Freedom. Awareness of the clinical features and treatment options of CL would benefit clinicians who may encounter soldiers, as well as civilians, returning from the Middle East with skin lesions. Objective:Our purpose was to describe our clinical experience in treating soldiers with CL. Methods:From December 2003 through June 2004, approximately 360 of an estimated 20,000 soldiers returning from a year long deployment in Iraq with skin lesions suspected of being CL were examined by dermatologists. We summarized CL diagnoses, laboratory evaluations, and treatments, including localized heat therapy (ThermoMed model 1.8; ThermoSurgery Technologies, Inc, Phoenix,Ariz),oralfluconazole,cryotherapy,anditraconazole. Results:Among 237 soldiers diagnosed with CL, 181 had one or more laboratory confirmations, most by Giemsa-stained lesion smears and polymerase chain reaction (PCR). PCR was positive for all 122 smear-positive and 26 biopsy-positive lesions and all 34 smear negative and all 3 biopsy-negative cases. Primary outpatient treatments, including ThermoMed (n=26), oral fluconazole (n=15), cryotherapy (n=4), and itraconazole (n=2), were safe and tolerable. Treatment failure occurred in 2 fluconazole recipients and was suspected in 1 ThermoMed and 2 fluconazole recipients. Seventy-two soldiers elected no treatment. Limitation:This was a retrospective study. Conclusion:Approximately 1%of Ft Campbell troops returning from Iraq were diagnosed with CL, most by laboratory confirmation. PCR appeared to be the most useful diagnostic technique. Among out patient treatments,Thermo Medandcry other apyhad favorable safety and efficacy profiles.
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