Outbreak of Zoonotic Cutaneous Leishmaniasis with Local Dissemination in Balkh, Afghanistan

Bailey, Margaret; Caddy, AJ; McKinnon, KA; Fogg, LF; Roscoe, Michael; Bailey, J. W.; O’Dempsey, TJ; Beeching, Nicholas J.

doi:10.1136/jramc-158-03-16

Cited by 26 publications

(20 citation statements)

References 24 publications

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“…4,7 In three patients (patients 2, 5, and 6), we observed disappearance of the subcutaneous nodules following the resolution of the primary lesions, without initiating systemic treatment. Therefore, we suggest that initiation of systemic treatment in cases of lymphatic dissemination of Old World CL should be guided by the response of the primary lesion to the local treatment.…”

mentioning

confidence: 86%

“…3 Lymphatic dissemination of CL is uncommon but has been reported, usually with dermal or subcutaneous nodules along lymphatic vessels draining the region of the primary lesion. [4][5][6][7] Herein, we present six cases of CL with subcutaneous sporotrichoid dissemination after local treatment of the primary lesion, probably caused by lymphatic spread of the parasites. The sporotrichoid dissemination was characterized by deep subcutaneous nodules without any sign of epidermal involvement.…”

mentioning

confidence: 99%

“…6,7 The majority of reported sporotrichoid CL cases were shown to be caused by L. major, 4,7 although L. tropica has also been implicated. The prevalence of this phenomenon may be species dependent but there are no data comparing rates of sporotrichoid CL among various species.…”

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confidence: 99%

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Lymphatic Dissemination in Cutaneous Leishmaniasis Following Local Treatment

Thomaidou

Horev

Jotkowitz

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Cutaneous leishmaniasis (CL) is diverse in its clinical presentation but usually demonstrates an erythematous, infiltrated, ulcerated, and crusted papule or nodule in exposed areas of the body. Rare clinical features have been reported including lymphatic dissemination, usually with subcutaneous nodules along lymphatic channels. Herein, we present six patients suffering from Old World CL with lymphatic dissemination characterized by sporotrichoid subcutaneous nodules along the lymphatic channels draining the primary lesion. Patients' history, clinical and laboratory findings were collected and summarized. Lymphatic dissemination of CL in our patients manifested as subcutaneous nodules without epidermal involvement within the axis of lymphatic drainage toward the regional lymph node, at times accompanied by regional lymphadenopathy. In all patients, the lymphatic dissemination was not present at initial diagnosis of CL, appearing only after local (topical or intralesional) treatment was initiated.

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confidence: 86%

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confidence: 99%

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Lymphatic Dissemination in Cutaneous Leishmaniasis Following Local Treatment

Thomaidou

Horev

Jotkowitz

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…The seasonality in the occurrence of zoonotic cutaneous leishmaniasis in humans was attributed to seasonal activity of the rodents which are natural reservoir hosts of the disease [11,52]. Regions with good vegetation for plant growth have been described to provide shelter and food for rodents thereby providing ideal sand fly habitats [53].…”

Section: Discussionmentioning

confidence: 99%

Spatially Correlated Time Series and Ecological Niche Analysis of Cutaneous Leishmaniasis in Afghanistan

Adegboye

2016

Preprint

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Leishmaniasis is the third most common vector-borne disease and a very important protozoan infection. Cutaneous leishmaniasis is one of the most common types of leishmaniasis infectious diseases with up to 1.2 million occurrences of new cases each year worldwide. A dynamic transmission multivariate time series model was applied to the data to account for overdispersion and evaluate the effects of three environmental layers as well as seasonality in the data. Furthermore, ecological niche modeling was used to study the geographically suitable conditions for cutaneous leishmaniasis using temperature, precipitation and altitude as environmental layers, together with the leishmaniasis presence data. . An upward trend and regularly repeating patterns of highs and lows were observed related to the months of the year which suggests seasonality effect in the data. Two peaks were observed in the disease occurrence-January to March and September to December-which coincide with the cold period. Ecological niche modelling indicates that precipitation has the greatest contribution to the potential distribution of leishmaniasis.

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“…This may have been true for established military operations with good facilities in areas where exotic, emerging or re-emerging infections did not occur. However, during operations in Sierra Leone (1999–2002), there were outbreaks of malaria47 and intestinal helminths;48 in Iraq (2003–2009), there were outbreaks of viral gastroenteritis (Figure 6)49 50 and bacterial gastroenteritis (L Lines, personal communication); and in Afghanistan (2001 onwards) there were outbreaks of viral gastroenteritis,51 bacterial gastroenteritis (E Hutley, personal communication), cutaneous leishmaniasis52 and ‘Helmand Fever’ caused by sandfly fever, acute Q fever or rickettsial infections (including typhus) 43 53. In Iraq and Afghanistan, complex trauma-related wound infections with multi-drug resistance have also occurred and these create new challenges for surgeons, medical microbiologists, infectious disease physicians and infection control practitioners 54 55.…”

Section: British Military Experiences In the 21st Centurymentioning

confidence: 99%

A brief history of British military experiences with infectious and tropical diseases

Bailey

2013

J R Army Med Corps

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Infectious and tropical diseases have been a problem for British expeditionary forces ever since the Crusades. Outbreaks were especially common on Navy ships from the 16th to 18th centuries due to poor living conditions and travel to the tropics. However, since these occurred in small, isolated and controlled environments it meant that naval medical practitioners were able to keep detailed records and develop empirical approaches for their prevention. The first Royal Naval Hospitals were established in response to these diseases and Royal Navy doctors made valuable early contributions towards understanding them. Even larger outbreaks of infectious and tropical diseases occurred in the Army during the Napoleonic, Crimean and Boer Wars and throughout the colonial era, which strongly influenced the formation of the Army Medical Services including provision for teaching and research. The establishment of germ theory led to a golden era of discovery regarding these diseases and British Army doctors made numerous important contributions. Subsequent improvements in prevention, diagnosis and treatment reduced the mortality from infectious and tropical diseases during the World Wars, but they remained a significant problem in the non-European campaigns and also the numerous ‘small wars’ that followed. Even in the 21st century some of these diseases still cause outbreaks with significant morbidity and impact on deployments, but the military clinical and academic resources to deal with them are now much reduced. Preventive measures such as hygiene, sanitation, infection control, vaccination and chemoprophylaxis are invaluable, but history shows that these can become neglected over time and disrupted or overwhelmed during the early or most intense stages of military operations. This is why military specialists in infectious diseases, tropical medicine, sexual health, medical microbiology and communicable diseases control are still required.

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Outbreak of Zoonotic Cutaneous Leishmaniasis with Local Dissemination in Balkh, Afghanistan

Abstract: Zoonotic CL due to L. major is a significant threat for foreign troops based in Balkh, Afghanistan and may present with unusually severe clinical features and be resistant to previously recommended treatments.

Cited by 26 publications

References 24 publications

Lymphatic Dissemination in Cutaneous Leishmaniasis Following Local Treatment

Lymphatic Dissemination in Cutaneous Leishmaniasis Following Local Treatment

Spatially Correlated Time Series and Ecological Niche Analysis of Cutaneous Leishmaniasis in Afghanistan

A brief history of British military experiences with infectious and tropical diseases

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