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Leishmaniasis is an infectious disease that has plagued unkind for millennia and continues to do so into the 21st Century. The disease in humans comprises a diverse group of clinical syndromes caused by various species of the protozoan parasite, Leishmania. Syndromes range from cutaneous to mucocutaneous to visceral manifestations, and can be both a psychologically and physically debilitating disease. The disease is transmitted from person to person via various species of the sand fly, Lutzomyia and Phlebotomus. This disease is found in Central and South America, Africa, Asia, the Middle East, and Southern Europe.
Cutaneous leishmaniasis manifests itself as a papule that often progresses into an ulcerative lesion that can become many centimeters in diameter. Mucocutaneous leishmaniasis develops in about 3 percent of those infected and involves erosion of the nasal, pharyngeal and buccal mucosa, eventually leading to destruction of the nasal septum, palates, lips, pharynx, and larynx.
The life cycle of the Leishmania parasite is complex. The form of the parasite found in the insect vector, the promastigote, is normally transmitted to man by the bite of female sand flies. These promastigotes attach themselves and enter macrophages where the promastigotes round up into amastigotes, the intracellular form of the parasite, that then divide, and are released from the cell and infect other cells. When a sand fly takes a blood meal from an infected host, the amastigotes are released into the sand fly gut and mature into infective promastigotes ready to repeat the cycle.
Leishmaniasis has become a persistent health threat to military forces deployed in endemic areas where it can cause significant morbidity in immunologically naive individuals. There are 10-25 new cases of cutaneous leishmaniasis occurring in military personnel each year, with occasional outbreaks yielding more than 50 cases per year and with attack rates as high as 50 percent. Cases of cutaneous and vicerotropic Leishmaniasis in U.S. Soldiers deployed during the Gulf War and numerous cases of cutaneous leishmaniasis, and some mucocutaneous, acquired in Central America have been evaluated at the Walter Reed Army Medical Center (WRAMC) (Martin et al., Leishmaniasis in the United States Military; Military Medicine 163:801).
The Naval Medical Research Center Detachment (NMRCD) in Lima, Peru, is currently involved in several research projects dealing with...