Emily Mora

Tamara Marie Neff

October 8, 2014
Biology Lab 1615
Cutaneous Leishmaniasis in Dutch Troops Deployed in Northern
Afghanistan: Epidemiology, Clinical Aspects, and Treatment
Introduction
In 2005, south central Asia lies Afghanistan where two conditions were being presented;
one called Anthorponotic Cutaneous Leishmaniasis and the other Zoonotic Cutaneous
Leishmaniasis. Both of these conditions are fairly similar but still have their differences.
Anthorponotic Cutaneous Leishmaniasis is transmitted by a sandfly bite usually leaving
characteristics of painless, chronic, dry ulcerations that develops between two to eight months
and heals within a year leaving a scar. Zoonotic Cutaneous Leishmaniasis is another form of
Cutaneous Leishmaniasis that spreads through individuals living in rural regions near infected
rodents. The characteristics of these skin lesions become severely inflamed with moist
necrotizing sores and/or ulcers that heal within two to eight months leaving scars.
Dutch military recruits were experiencing skin lesions after getting deployed to Mazar-eSharif, some troops werent responding to treatments, which caused the military to lose lives.
Researchers chose to research about this because the only people that were getting these skin
lesions were the military after getting deployed, which had harsh conditions where
Anthroponotic Cutaneous Leishmaniasis and Zoonotic Cutaneous Leishmaniasis occur.
Scientists decided to start studying this case is because within six weeks these Dutch military
recruits were getting skin lesions in the northern part of Afghanistan, Mazar-e-Sharif where
Zoonotic Cutaneous Leishmaniasis happens yearly and Anthropponotic Cutaneous
Leishmaniasis happens less often. Meanwhile the researchers were gathering any kind of

evidence around the militarys surroundings. Researchers were trying to prove that the skin
lesions came from somewhere around the militarys surroundings because the skin lesions
werent occurring elsewhere. The main reason why this topic is so important because it can save
lives.
Materials and Methods
Some of the information gathered includes dates of when the Dutch military troops
arrived and departured, and medical data of the diagnosis of the Leishmaniasis. They also
tracked when the lesions began to occur, when they got bigger, and how much bigger they
became. From there the medical data went into further studies by using microscopes. These
microscopes gave a better view of the parasites in Geimsa-stained smears of biopsy specimens
from the lesions. The Gram stains on these tests were streptococci and staphylococci.
Results
The military from Mazar-e-Sharif was at a median of 86 days building their camps, and
just before they got departure they were informed about a vector-borne disease prevalent to
malaria and Cutaneous Leishmaniasis. Anti-malarial drugs were performed. Dress code and bed
nets were assigned after deployment. After a few weeks these troops being out, some of them
were experiencing skin lesions, and those troops who were experiencing skin lesions would
consume the anti-malaria drugs. 25% of individuals werent responding to the anti-malarial drug
so other treatments were exposed with ilSb, (intralesional stibogluconate, injections that are
placed on every single lesion that are filled with sodium) and even further treatment was
available in the Netherlands. The uniforms were independent because 81.5% of lesion started to
occur underneath the uniform. During all of this the Academic Medical Center had done the

diagnosis by isolating the parasite on 169 patients. 11 patients were repatriated because of facial
or extensive lesions and needed five sessions of treatment. 25.8% of patients needed further
treatment because of complications, which lead to 14.1% of patients needed the additional
treatment of ilSb injections because of how severe the lesions were. The response of the
treatments for nodular lesions verses ulcerative and mixed lesions at six weeks wasnt different.
One thing that came by surprise in this study was that scientists didnt investigate the
parasitological for exactly 38 patients by mistake. Another thing that came by surprise is that
when individuals bodies werent responding to the antibiotics, malaria and Cutaneous Lesions
was diagnosed. Lastly, a patient refused treatment for lesions and experienced a spontaneous
cure.
Discussions
With the given information the results provided, all of the studies that were being
practiced were helpful, to which treatments were needed for the Dutch military. In this study,
the combination of ilSb with cryotherapy was not better than ilSb alone (Pieer-Paul van Theil et
al), and with those treatments the size of the lesions started to decrease and were able to be
controlled. Finding out that the lesions did come from either a bite of a rodent or a sandfly did
help with finding out what was causing the lesions and in which way to treat them. In this study
anything and everything that scientists and researchers were getting was a limitation. If
something, anything, was going to stop the military from dying, it was helping.

Bibliography
The American Society of Tropical Medicine and Hygiene, Department of Internal Medicine,
Department of Dermatology, Department of Medical Microbology. 2010. Copyright.
PDF file.
Pieer-Paul van Theil, Tjalling Leenstra, Henry J. de Vries, Allard van der Sluis, Tom van Gool,
Alex C. Krul, Michele van Vuft Peter J. de Vries, Jimmy E. Zeegelaar, Aldert Bart,
Wendy F. Van Der Meide, Henk D. F. H. Schallig,William R. Gaber, and Piet A.
Kager. Cutaneous Leishmaniasis (Leishmania major Infection) in Dutch Troops
Deployed in Northern Afghanistan: Epidemiology, Clinical Aspects, and Treatment.
The American Society of Tropical Medicine and Hygiene. 83(6) (2010): pg. 12951300. Web. 14 July, 2010.
McCall, Dr. Personal interview. 1 October 2014.
Epidemic. The Merriam-Webster Dictionary. New Edition. 2005. Print.
Urban. The Merriam-Webster Dictionary. New Edition. 2005. Print.
Reservoir. The Merriam-Webster Dictionary. New Edition. 2005. Print.
Cohort. The Merriam-Webster Dictionary. New Edition. 2005. Print.
Repatriated. The Merriam-Webster Dictionary. New Edition. 2005. Print.