[Epidemics of cutaneous leishmaniasis in military personnel working in French Guiana].

Cutaneous leishmaniasis transmitted by phlebotomine sandflies is endemic in the rain forests of French Guyana. The 3rd Régiment Etranger d'Infanterie, based in Kourou carries out numerous operations in the Amazonian areas. In 1998 two outbreaks of cutaneous leishmaniasis occurred: one during an exercise at the training center in the equatorial forest of Regina (10 patients) and the other during a mission in Saint Elie (21 patients). Clinical findings were variable and diagnosis was confirmed by skin smear tests. Patients were treated by two intramuscular injections of pentmidine isethionate (Pentacarinate). Recurrence was observed in two patients who were retreated using the same agent. Persistent lesions were treated by intralesional injection of meglumine antimoniate (Glucantime). Both outbreaks were characterized by high attack rates (91 p. 100 and 84 p. 100) and were facilitated by non-observance of standard procedures because of training or operational requirements at the beginning of the leishmaniasis season. Strict planning of activities, wearing protective clothing, deployment of insecticide treated bed nets, and of candles rather than electrical lamps for lighting are key preventive measures. Greater emphasis is needed on the use of insect repellents.