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                                    L UNCL~SSIFIED U
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                                   RECEIVED  ~T  1B~O1  Z

PRIORIT~                RHIP~~~ USC~NCCENT//CCS6l/

RIV~DH, ~L F'iH~RJ, ~ND G~SIM~     LEISHM~NI~ BODIES H~VE BEEN FOUND IN
LESIONS OF TWO GERBILS ~ND ONE DOG FROM THE ~L KH~RJ ~RE~. WEST -
SOUTHWEST 4RE~S:       BISH~q 6IZ~N, ~ND ~SIR H~VE ~LL DOCUMENTED C~SES OF
ZCL.   PHELBOTOMUS P~P~T~SI H~S BEEN DOCUMENTED IN ~LL OF THESE
~RE~S ~ND SURVEYS IN THE ~SIR H~VE CONCLUDED TH~T THE DISE~SE


P~GE 0   RHIP~~~6517 UNCL~S
IS MORE ~~UND~NT WHERE THIS VECTO~ IS PRESENT IN L~RGE
NUMBERS.   THE DISE~SE H~S ~LSO BEEN MORE WIDESPRE~D~~T LOWER
*4LTITUDES OF THE TIH~M~.      THERE IS SPECUL~TION TH~T PHLEBOTOMUS
BERGEROTI SND/OR PHLEBOTOMUS ORIENT~LIS M~V BE SECOND~RY~VECTORS.
3.   CLINIC~L:  OLD WORLD ZOONOTIC CUT~NEOUS LEISHM~NI~SIS (ORIENT~L
SORE, B~GHD~D BOIL, ~LEPPO EVIL)      INCUB~TION PERIOD V~RIES FROM 2
WEEKS TO SEYER~L MONTHS.       M~NIFEST~TIONS SRE V~RI~BLE WITk THE RUR~L
OR MOIST FORM (L. M~JOR) LESIONS BEING MULTIPLE, M~TURING R~PIDLY,
~ND TEND TO HE~L ~FTER SEVER~L MONTHS.       THE LESION ST~RTS ~S ~
P~PULE TH~T GRSDU~LLY INCRE~SES IN SIZE, BECOMES CRUSTED ~ND
FIN~LL~ ULCER~TES.       S~TELLITE LESIONS M~Y BE PRESENT ~ND REGION~L
LYMPH~DENOP~THY M~V OCCUR.       DI~GNOSIS DEPENDS ON IDENTIFIC~TION OF
THE P~R~SITE IN ST~INED SME~RS OF SCR~PINGS, BIOPSY SPECIMENS, OR
~SPIR~TES    SECOND~RY B~CTERI~L INFECTIONS ~RE NOT UNCOMMON ~ND M~~
OBSCURE VISU~LIZ~TION OF THE P~R~SITE ~S LEISHM~NI~-INFECTED
M~CROPH~GES ~RE DESTROYED        THE DIFFERENTI~L DI~GNOSIS INCLUDES
CUT~NEOUS FUNG~L INFECTIONS, Y~WS, SYPHILIS, LEPROSY, TUBERCULOSIS1
PkTYPIC~L MYCOB~CTERI~1 ~ND LUPUS VULG~RIS.
4.   TRE~TMENT        THE DECISION TO TR~~T DEPENDS ON THE LOC~TION ~ND
EXTENT OF THE LESION.       OPTIM~L DOS~GE ~ND DUR~TION OF THER~PY WITH


P~GE ()4 RHIP~~~6517 UNCL~S
PENT~V~LENT ~NTIMONI~LS ~RE UNCERT~IN WITH ~ RECOMMEND~TION FOR
10-20 MG~KG/D~~       (M~XIMUM OF 850 MG/D~Y) FOR 10-2':' D~YS DEPENDIN(3 ON
RESPONSE.   RETRE~TMENT OR PROLONGED TRE~TMENT M~~ BE REClUIRED IN
NON-RESPONDERS.        ~NECDOT~L REPORTS OF EFPIC~CY WITH ~NTIFUNG~LS OR
~NTIMICROBI~LS SHOULD BE INTERPRETED WITH C~UTION BECflUSE OLD WCIRLD
CUT~NEOUS LEISHM~NI~SIS C~N RESOLVE SPONT~NEOUSL~-
~.   PREVENT tON       PERSON~L P~OTECTIVE ME~SURES INCLUDE USE OF INSECT
REPELLENTS ~ND PROTECTIVE CLOTHING0 ~VOID~NCE OF }-`NOWN ENDEMIL
4RE~S,   INSECT CONTROL, ~ND ELIMIN~TION OF VECTOR BREEDING ~REHS SUCH
r~ r~t i~~ - ~LJ ~=~OO   I~1flonI IT~fl ~I=YT Thin I 1hIYCOJ\T~~ 1.1 T r~ T hIC~nT T  T C fl~

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