Clinical Guidelines For The Management Of Cutaneous Leishmaniasis In British Military Personnel

Cutaneous leishmaniasis (CL) is an increasingproblem for British military personnel due tocurrent deployments in Belize, Iraq andAfghanistan. Recent developments in thediagnosis and treatment of CL haveemphasised the importance of a species-specific approach to management (1).This isespecially important in New World CL(NWCL), where there may be a risk ofmucocutaneous leishmaniasis (MCL)developing.These guidelines are primarily written forthe management of military patients. Theydiffer from civilian patients because havingCL will usually prevent them from carryingout their duties and so there must be a greateremphasis on active treatment. Theseguidelines are not intended to replace SurgeonGeneral’s Policy Letter (SGPL) 09/04 (2),butaim to establish clinical standards for themanagement of suspected CL by physicians.There are currently no plans nor any need forinvestigation or treatment of suspected casesto take place on overseas deployments. Anysuspicious lesions in personnel deployedoverseas should be discussed with anappropriate specialist (Appendix 1) and theindividual affected must be evacuated forinvestigation and treatment if advised.The guidelines are summarised in Figure 1,but the following text should also be read infull.