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File: 123096_sep96_decls23_0020.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
1. The recommended first line therapy of uncomplicated
(not interfering with function and not cosmetically
disfiguring) is ketoconazole, 600 mg PO QD for 28 days
(Note: this recommendation is a different than the VISCERAL LEISMMIABIS
original guidance provided in "Diagnosis and Treatment
of Diseases of Tactical Importance to U.S. CENTCOM I. Communicability:
Forces, 1990"). This treatment can be administered in
theater. Based on data from Panama, ketoconazole A. Route:
treatment will be effective in about two-thirds of the 1. Sandfly (Phlabotomus species) bites.
patients with cutaneous leishmaniasis. 2. Isolated instances of sexual transmission have
been reported.
2. Patients who do not respond (lesion doubles in area 3. Isolated cases of transmission by infected blood
during treatment or has not reduced by 75% in area by transfusion have been reported.
four weeks after the end of treatment) or relapse 4, Disease transmission by accidental inoculation in
(lesion re-ulcerates after healing or increases in size the laboratory has occurred.
after initial reduction) after ketoconazole treatment, 5 Vertical transmission from mother to fetus has
and patients with complicated initial disease, must be been reported.
evacuated to CONUS facilities experienced in treating
leishmaniasis and that have an approved protocol for B. Isolation: generally not required; in forward areas or
the use of sodium stibogluconate (pentostam, Burroughs under field conditions where continued exposure to
Wellcome, UK). Currently, the only facility with an sandflies may occur, personal measures to protect the
approved protocol is Walter Reed Army Medical center patient from sandfly bites, including insect repellents
(WRAMC), Washington, D.C. The sodium stibagluconate and permethrin-impregnated netting, should be used.
(Pentostam) regimen used is 20 mg/kg/day IV x 20 days. C. Prophylaxis: not required.
1. Disposition: II. Incubation: normally 3-8 months (range 10 days - 34 month,
A. Evacuate all patients to CONUS if sodium stibogluconate or longer).
therapy is required. III. Diagnosis:
B. Report all cases through Preventive Medicine channels. A. Symptoms:
FE. Prognosis: excellent. I . Onset may be insidious (more common) or abrupt.
2. Fever: high intermittent or remittent, not
Public health measures: generally associated with chills or prostration.
3. Sweats.
4. Cough.
5. Epistaxis.
B. Host (gerbil) control. 6. Abdominal discomfort and/or swelling.
7. Weight loss.
C. Personal protection with clothing, insect repellent. S. Diarrhea.
9. Peripheral edema (late).
10. Bleeding diathesis (late).
11. Generalized weakness (as emaciation progresses).
B. signs:
1. Weight loss/emaciation.
2. Splenomegaly (presents early, progressively
worsens).
3. Hepatomegaly (less pronounced than splenomegaly).
4. Lymphadenopathy (especially femoral, inguinal, but
may be generalized).
5 . Fever (39 to 40'C) .
31
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Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996