Table 2.
Treatment and outcome of cutaneous leishmaniasis in Dutch military personnel deployed in northern Afghanistan during July–November 2005*
| Characteristic | Treatment location† | |
|---|---|---|
| MeS‡ | AMC | |
| No. patients given first-line treatment§ | 118 | 45 |
| Parasitologic confirmation, no. (%)¶ | 79/80 (98.8) | 42/44 (95.5) |
| Clinical presentation | ||
| No. lesions, median (interquartile range) (range) | 2 (1–3) (1–11) | 2 (1–3) (1–9) |
| Maximal diameter of lesions (mm), median (IQR) (range) | 20 (13–30) (5–80) | 15 (10–20) (4–50) |
| Lymphatic involvement, no. (%) | 22/103 (21.4) | 16/44 (36.4) |
| First-line treatment | ||
| Total treatment duration (days),# median (IQR) (range) | 18 (11–38) (1–163) | 14.5 (7–21) (3–96) |
| MeS | ||
| il SbV (no. sessions),#** median (IQR) (range) | 5 (4–8) (1–13) | NA |
| Duration (days),# median (IQR) (range) | 16 (10–32) (1–56) | NA |
| AMC | ||
| il SbV (no. sessions),#** median (IQR) (range) | 1 (1–3) (1–7) | 4 (3–6) (2–11) |
| Cryotherapy (no. sessions),#†† median (IQR) (range) | 1 (0–1) (0–3) | 2 (1–2) (1–4) |
| Duration (days),# median (IQR) (range) | 1 (1–8) (1–64) | 14.5 (7–21) (3–96) |
| Outcomes | ||
| Recurrence; no./N (%) | 18/118 (15.3) | 5/45 (11.1) |
| Treatment duration > 28 days (prolonged because of unsatisfactory treatment response or poor compliance), no./N (%) | 34/118 (28.8) | 8/45 (17.8) |
| Second-line treatment with oral miltefosine,‡‡ no./N (%) | 24/118 (20.3)9 because of recurrence and 15 because of unsatisfactory treatment response | 6/45 (13.3)1 because of recurrence and 5 because of unsatisfactory treatment response |
| Present at final follow-up (6 months),§§¶¶ no. /N (%) | 65/94 (69.1) | 30/39 (76.9) |
| Definite cure 6-months post-treatment,§§## no. (%) | 65 (100) | 30 (100) |
IQR = interquartile range; ilSbv = with intralesional pentavalent antimony; NA = not available.
MeS = Mazar-e-Sharif, Afghanistan; AMC = Academic Medical Center, Amsterdam, The Netherlands.
Twenty-one persons who started treatment at M-e-S continued treatment at AMC after redeployment, 9 because of recurrence.
Six patients are not included: four received alternative treatment (three received primary miltefosine because of extensive or numerous lesions; in one patient, the lesion was excised), two persons were not treated (one refused one showed spontaneous resolution of the lesion).
Sixty-eight of 68 samples were subtyped as Leishmania major by polymerase chain reaction.
Excluding patients with a recurrence.
One session includes all injections without or with cryotherapy given on one occasion.
Four of 21 redeployed soldiers continuing treatment did not receive cryotherapy.
Details reported elsewhere.6
Excluding patients receiving secondary miltefosine treatment.
Of those absent at final follow-up (6 months) but present at the 6-week follow-up, 16 (84.2%) of 19 at MeS and 6 (100%) of 6 at AMC showed good clinical response.
Of those present at final follow-up (6 months) and present at the 6-week follow-up, 30 (54.5%) of 55 at MeS and 13 (46.4%) of 28 at AMC showed good clinical response.