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

Abstract

ArticleMilitary 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.The outbreak response was supported by the Peruvian Army Health Command COSALE and the Peruvian Ministry of Health through the General Epidemiology Directorate and the Health Directorate II, south Lima, and the. In addition, partial support was provided by grants CO497_11_L1 and CO466_11_L1 of the Global Emerging Infections Surveillance and Response System (AFHSC/GEIS) of the U.S. Department of Defense and the training grant 2D43 TW007393 awarded to the U.S. Naval Medical Research Unit No. 6 (NAMRU-6) by the Fogarty International Center of the National Institutes of Health (FIC/NIH). This study is part of the dissertation of Marianela Ore for a Masters in Epidemiological Research offered jointly by the Universidad Peruana Cayetano Heredia (UPCH) and NAMRU-6