Old World cutaneous leishmaniasis in American soldiers underscores diagnostic and therapeutic options

Abstract

Cutaneous leishmaniasis, a parasitic skin disease that was rare in American soldiers who served in Gulf War I (1991), has been more common in Gulf War II (Operation Iraqi Freedom began in 2003). This has prompted interest among military and civilian clinicians in becoming reacquainted with the clinical features of cutaneous leishmaniasis, as well as diagnostic and treatment options. In the US Army, well-established diagnostic procedures include the Giemsa-stained lesional skin smear or punch biopsy, as well as polymerase chain reaction. Therapies for cutaneous leishmaniasis used to treat soldiers include local heat application (ThermoMed™), cryotherapy (liquid nitrogen), oral fluconazole or itraconazole, and intravenous sodium stibogluconate (pentavalent antimony, Pentostam®). Paromomycin, a promising antileishmania aminoglycoside topical preparation, already commercially available in some countries, is under investigation by the US Army as a combined paromomycin–gentamicin topical formulation. This comme...