Outbreak of Cutaneous Leishmaniasis in Peruvian Military Personnel Undertaking Training Activities in the Amazon Basin, 2010

• Published in: The American journal of tropical medicine and hygiene Vol. 93; no. 2; pp. 340 - 346
• Main Authors: Oré, Marianela, Sáenz, Eliana, Cabrera, Rufino, Sanchez, Juan F, De Los Santos, Maxy B, Lucas, Carmen M, Núñez, Jorge H, Edgel, Kimberly A, Sopan, Justino, Fernández, Jorge, Carnero, Andres M, Baldeviano, G Christian, Arrasco, Juan C, Graf, Paul C F, Lescano, Andres G
• Format: Journal Article
• Language: English
• Published: United States 01-08-2015
• Subjects: Adolescent; Antimony Sodium Gluconate - therapeutic use; Disease Outbreaks; Female; Humans; Leishmania; Leishmania braziliensis - isolation & purification; Leishmania guyanensis - isolation & purification; Leishmaniasis, Cutaneous - drug therapy; Leishmaniasis, Cutaneous - epidemiology; Male; Military Personnel; Peru - epidemiology; Real-Time Polymerase Chain Reaction; Surveys and Questionnaires; Viannia braziliensis; Young Adult; Peru; ISE, Peru; South America, Amazon R
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.15-0107

Military personnel deployed to the Amazon Basin are at high risk for cutaneous leishmaniasis (CL). We responded to an outbreak among Peruvian Army personnel returning from short-term training in the Amazon, conducting active case detection, lesion sample collection, and risk factor assessment. The attack rate was 25% (76/303); the incubation period was 2-36 weeks (median = 8). Most cases had one lesion (66%), primarily ulcerative (49%), and in the legs (57%). Real-time polymerase chain reaction (PCR) identified Leishmania (Viannia) braziliensis (59/61 = 97%) and L. (V.) guyanensis (2/61 = 3%). Being male (risk ratio [RR] = 4.01; P = 0.034), not wearing long-sleeve clothes (RR = 1.71; P = 0.005), and sleeping in open rooms (RR = 1.80; P = 0.009) were associated with CL. Sodium stibogluconate therapy had a 41% cure rate, less than previously reported in Peru (~70%; P < 0.001). After emphasizing pre-deployment education and other basic prevention measures, trainees in the following year had lower incidence (1/278 = 0.4%; P < 0.001). Basic prevention can reduce CL risk in deployed militaries.