Cutaneous leishmaniasis acquired during U.S. Military overseas duty

We reviewed the epidemiologic and clinical characteristics of 81 parasitologically confirmed cases of cutaneous leishmaniasis diagnosed in American servicemen 1989-1996. The patients were referred to Walter Reed Army Medical Center for treatment with the sodium stibogluconate investigational new drug protocol. All cases were males, median age 24 years (range 18-53). 77% of patients were in the Army, 18% Marine Corps, and 5% Navy. All cases had recent deployment to areas known to be endemic for leishmaniasis including Panama (64%), French Guiana (18%), Belize (12%), and Saudi Arabia (12%). The mean time from onset of lesion to presentation for treatment was 118 days. The median number of skin lesions was 2 (range 1-12). 60% of the cases presented as chronic skin ulcers, while the remainder presented with papulonodular lesions (26%), an eschar (10%), or verrucous lesions (3%). 61% of the lesions occurred on the extremities, 21% head or neck, 8% back, 10% torso and abdomen. 59% had palpable regional adenopathy and 26% had subcutaneous nodules observed. The Leishmania species identified (determined in 46 cases) were L. (V.) panamensis (39%), L. (V.) braziliensis (22%), L. (V.) guyanensis (11%), L. (L.) major (11%), L. (L.) mexicana (9%), L. (L.) tropica (6%). Cutaneous leishmaniasis is an important occupational illness in U.S. servicemen deployed to endemic areas.