[leish-l] LEISHMANIASIS - IRAQ: U.S. MILITARY (04)

[Fred R. Opperdoes]

At 09:25 -0400 4/20/04, ProMED Digest wrote:
>LEISHMANIASIS - IRAQ: U.S. MILITARY (04)
>***************************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail is a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>Date: Mon 19 Apr 2004
>From: Alfonso Rodriguez <arodriguezm at SaludFMV.org>
>Source: CNN, News [edited]
><http://www.cnn.com/2004/HEALTH/04/18/baghdad.boil.ap/index.html>
>
>
>Increasing numbers of U.S. troops get Cutaneous Leishmaniasis
>- -----------------------------------------------
>Staff Sgt. Eric DiVona didn't notice the small bumps on his face and left
>earlobe until he returned from serving for 9 months in Iraq. "Nothing
>much," he thought, "probably just a spider bite." But soon those bumps
>erupted into open sores, one growing to the size of a half-dollar. The left
>side of his face puffed up, a swelling that wouldn't go away. And he
>noticed that he was not the only one in his unit with such symptoms. "A lot
>of people started coming down with sores," he said, sitting at Walter Reed
>Army Medical Center with an IV taped to his right arm. "It was like, 'You
>ain't cool unless you got it.'"
>
>What DiVona thought was a spider bite was actually caused by a tiny sand
>fly with a fierce parasite stewing in its gut, an organism that causes
>stubborn and ugly sores that linger for months. Scientists and doctors
>refer to the disease caused by the parasite as cutaneous leishmaniasis. But
>soldiers serving in sand-fly-rich Iraq call it, with little affection, the
>"Baghdad boil." The sores are not painful or contagious, but, left
>untreated, can last up to 18 months leaving permanent, burn-like scars.
>Since the flies bite exposed skin, many soldiers have sores on their necks,
>faces and arms.
>
>Doctors at Walter Reed have seen 653 cases of leishmaniasis, and the
>hospital's infectious disease wards, until recently, overflowed with
>soldiers undergoing a 20-day treatment regimen. "We see a few cases every
>year, but not the numbers we saw come out of Iraq," said Col. Dallas Hack,
>chief of preventive medicine at Walter Reed.
>
>The military has made a big effort to treat the disease, even pulling
>soldiers with confirmed leishmaniasis out of the field and flying them back
>to Washington for medical care. But Walter Reed doctors say it was almost
>inevitable that they would see a high number of cases in 2004.
>
>Leishmaniasis occurs in hot and tropical countries where sand flies dwell,
>Hack said. Still, only about 20 soldiers got leishmaniasis during the first
>Gulf War, and a handful more contracted it in Afghanistan. This time,
>though, American forces arrived in Iraq during the peak season for sand
>flies and were in the field much longer. Many slept outside at night,
>exposing themselves at the sand fly's favorite feeding time.
>
>Iraqis have done little to control the problem, such as using insecticide
>to kill off the flies, Hack said. Local residents have come to accept the
>disease, he said, exposing young children to sand flies in hopes of
>building immunity.
>
>Doctors have told soldiers in Iraq what to look for and have implored them
>to wear bug spray. Medical teams with front-line combat troops have tested
>sand flies for the parasite. But with enemy bullets flying, the 1st concern
>of most soldiers is not slathering on bug spray every morning. "You didn't
>think about leishmaniasis too much," said Maj. Eric Moore, who contracted
>the parasite on the Iran-Iraq border with the 4th Infantry Division. The
>lesions eventually go away on their own and do not affect a soldier's
>ability to serve. Even so, the military thought it was important that
>soldiers with bad cases be flown out of Iraq for treatment so they wouldn't
>be disfigured.
>
>In Moore's unit of about 750 men, more than 200 came down with
>leishmaniasis during a 10-month tour that ended in Mar 2004. He was
>relatively lucky. He has only one quarter-sized sore on his left arm.
>Others had lesions all over their bodies, he said. Moore isn't too worried
>about scarring. He predicts it will delight his children, especially his
>3-year-old, who has a fascination with Band-Aids. "They will probably think
>it's cool," he said, while getting his daily dose of a drug called
>Pentostam. "They'll probably say, 'Daddy has an  ouchie.'" "For most
>soldiers, it isn't a war-stopper," said Lt. Col. Glenn Wortmann, an
>infectious disease physician at Walter Reed. "But most patients want
>treatment so the thing will go away."
>
>Walter Reed is one of only 2 hospitals where patients are sent, because the
>treatment can only be done in a clinical trial setting. With domestic cases
>a rarity, Pentostam is not  licensed in the United States. However, the
>Army is developing a treatment that can be used in the field. Many soldiers
>didn't realize they had the boils until weeks after exposure. DiVona
>remembers being bitten constantly by flies, but he and other members of his
>unit didn't see any sores until after they got home to Fort Campbell,
>Kentucky in Nov 2004.
>
>- --
>ProMED-mail
><promed at promedmail.org>
>
>[ProMED has covered the risk of cutaneous leishmaniasis in U.S. troops
>stationed in Iraq extensively. Though the incidence of 200 cases out of 750
>men in a single unit seems extremely high, it is not impossible with
>soldiers staying outside in a highly endemic area at the height of the
>transmission season. So far, there have been two cases of visceral
>leishmaniasis reported. - Mod.EP]
>
>[see also:
>Leishmaniasis - Iraq: U.S. Military (03) 20040402.0895
>Leishmaniasis - Iraq: U.S. Military (02): comment 20040316.0729
>Leishmaniasis - Iraq: U.S. Military 20040313.0696
>2003
>- ----
>Leishmaniasis - Iraq: U.S. military 20031210.3026
>Leishmaniasis - Iraq, Kuwait, Afghanistan: military 20031024.2669
>Leishmaniasis - Iraq: comments 20030602.1348
>Leishmaniasis - Iraq: RFI 20030531.1331
>2001
>- ----
>Leishmaniasis, suspected - Iraq 20010917.2245]
>...........................ep/msp/pg/dk
>
>------------------------------

-- 
Fred R. Opperdoes,      	      	      	    
Research Unit for Tropical Diseases (TROP) and
Laboratory of Biochemistry (BCHM) 
Christian de Duve Institute of Cellular Pathology (ICP)
and Catholic University of Louvain (UCL)
Avenue Hippocrate 74-75, B-1200 Brussels, Belgium

Tel: +32-2-764.74.39 (secretary) Fax: +32-2-762.68.53
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E-mail:Opperdoes at bchm.ucl.ac.be
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           http://www.icp.ucl.ac.be/~opperd/Fred.html