An outbreak of cutaneous leishmaniasis from Belize in British Army personnel: a prospective clinical analysis.

BACKGROUND

Cutaneous leishmaniasis (CL) is a vector-borne protozoal infection that causes skin lesions. Military personnel make up around 45% of UK cases. This study reports an outbreak of 35 soldiers with suspected CL from an exercise in Belize.

METHODS

A prospective clinical analysis was conducted to characterise case presentations. Diagnostic results, time to cure and adverse effects were recorded.

RESULTS

Thirty cases had laboratory-confirmed CL and three had suspected/resolved CL. Fifty percent of lesions were on the ear or face and 45% were on sites normally covered by clothing. Combined laboratory testing of skin biopsies confirmed a diagnosis in all cases. Ninety-three percent of species identified were Leishmania mexicana. Initial treatment was with miltefosine in 27 of the 30 confirmed cases. Five patients required second-line treatment with liposomal amphotericin B and one patient required third-line treatment with meglumine antimoniate.

CONCLUSIONS

This study characterised the largest outbreak of CL from Belize in British Army personnel for at least 25 y. Aspects of this outbreak were atypical and more research is required to investigate these. A simultaneous testing strategy with histology, microscopy and polymerase chain reaction of biopsy samples was sensitive. Treatment with miltefosine was less effective than expected in L. mexicana infection.