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File: 123096_sep96_decls23_0022.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
B. Hepatic: 2 Pentamidine isethionate, 4 mg/kg IM or IV, 3 times
1. Acute liver failure may rarely occur. per week. The duration of therapy is not well
2. cirrhosis (rare). defined; five weeks is minimum and probably
inadequate. Four months is advised. Daily
C. Disseminated intravascular coagulation (DIC). therapy is unacceptably toxic.
a. Drug toxicity includes: hypoglycemia, per-
D. Hemorrhage. manent d@g-induced diabetes mellitus, and
possible cardiovascular collapse. Lesser
E. Secondary infections (common, due to immunosuppres- effects include headaches, nausea, vomiting,
sion). flushing and sterile abscesses after IM
1. Tuberculosis. injections.
2. Pneumonia. 3. Amphotericin B, to a cumulative dose of 1.5 to 2.0
3. Dysentery. grams. Drug is suspended in D5W (not saline) and
duals. administered IV. Initiate therapy with a test
dose of 1.0 mg administered over 15 to 20 minutes
F. Persistent post-disease splenomegaly. with monitored vital signs Q 30 minutes for 4
hours. Repeat dose daily, advancing to a daily
VI. Treatment: visceral leishmaniasis is a life threatening dose of 0.5 mg/kg by day 5 of therapy and continu-
lisease; therefore, all patients with suspected or confirmed ing until total desired dose has been administered
visceral leishmaniasis must be evacuated to CONUS facilities or toxicity as become unacceptable.
(WRAMC). These patients should not be treated in theater or in a. Toxicity includes renal damage, electrolyte
@:urope. abnormalities, fever, anemia, abdominal pain,
nausea, anorexia, and vomiting.
A. Standard therapy: 4. Additional regimens including combinations of
1. Sodium stibogluconate (Pentostam), 20 mg/kg IV QD, drugs and/or gamma interferon may be used in
for 30 days. Some recommendations in past have refractory cases.
advised not exceeding a maximal daily dose of 850
d 20 C. Treatment Failure/Relapses: refer for specialist
mg/kg/day, toxicity is not excessive, and efficacy evaluation and management, as described above.
may be improved.
a. Drug toxicity includes: coughing, nausea, VII. Prognosis: generally good; mortality usually occurs only in
vomiting, arthralgias, myalgias, diarrhea, advanced disease, but even advanced disease may be success-
rash, headache, lethargy, renal toxicity, fully cured. Therapy, particularly when pentamidine or
hepatic toxicity, brady-dysrhythmias, QT amphotericin is required, may result in permanent morbidity.
segment prolongation, ST segment abnor-
malities, T-wave inversion, and cardiac Vill. Disposition: evacuate all patients with suspected or
arrest (rare, to be anticipated only at confirmed visceral leishmaniasis. This disease is
dosages higher than those advised here). slowly progressive and should not be so far advanced in
U.S. military personnel that emergency treatment is re-
2. Sodium stibogluconate is not a licensed product in the quired.
United States; it must, therefore, only be given under
a protocol. Currently, the only DOD facility with an IX. Public health:
approved protocol is the Walter Reed Army Medical
A. Command emphasis on use of personal protection (re-
pellent, impregnated netting, application of permethrin
B. Alternatives: insecticides to clothes and netting if not previously
I . Because of their greater toxicity, alternative treated).
regimens are generally reserved for treatment
failures or relapses. Such cases should be B. Insecticide applications to sandfly habitats located
referred to tropical disease or infectious disease near troop areas.
specialists for management.
3 4 35
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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