Cutaneous leishmaniasis in British troops from Belize

• Main Author: Hepburn, N. C.
• Published: University of Edinburgh 1995
• Subjects: 616.9883
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.652365

A general review of cutaneous leishmaniasis (CL) and its management is followed by a retrospective review of 306 cases of CL in British soldiers from Belize. The diagnosis was confirmed by demonstration of the parasite, by histology and/or culture, in 61% of cases. Leishmania braziliensis braziliensis (Lbb) was identified in 78 cases and Leishmania mexicana (Lmm) in a further 29 cases. Only cases in which the parasite was identified were analysed further. A single lesion was present in 71%, usually on the exposed extremities. The mean diameter of the ulcers was 14.4mm and lesions had been present for a mean of 9.9 weeks before treatment started. Those due to Lbb were larger, yet they had been present for a shorter time than those due to Lmm. There were no other distinguishing clinical features between them. Treatment with sodium stibogluconate was effective. A 10 day course of 600-800mg od healed 48.5%, whereas a 14 day course of 600 mg bd healed 63.9%. A total of 24g of sodium stibogluconate healed the ulcers of 90% soldiers irrespective of the regime used. Reports of myalgia, anorexia and malaise were more frequent in those who received the higher daily dose. A transient leucopenia and a rise in serum aminotransferases were noted during treatment. These studies led me to propose some management guidelines. The diagnosis should be confirmed histologically and by culture. Sodium stibogluconate 20mg/kg/day should be administered for 20 days. Patients should be assessed 6 weeks after the completion of treatment both clinically - complete epithelialisation with a flat, non-indurated, scar, and by culture of a biopsy.