[leish-l] Leishmaniasis - Colombia: 2004

[Fred R. Opperdoes]

At 1:05 PM -0500 2/3/05, ProMED Digest wrote:
>Date: Thu, 3 Feb 2005 11:59:13 -0500 (EST)
>From: ProMED-mail <promed at promed.isid.harvard.edu>
>Subject: PRO/AH/EDR> Leishmaniasis - Colombia: 2004
>
>LEISHMANIASIS - COLOMBIA: 2004
>***************************
>A ProMED-mail post
><http://www.promedmail.org>
>ProMED-mail, a program of the
>International Society for Infectious Diseases
><http://www.isid.org>
>
>
>Date: Wed 2 Feb 2005
>From: Dr. Alfonso J. Rodriguez <ajrm_msds at yahoo.es>
>Source: Yahoo News / AP, 31 Jan 2005
><http://news.yahoo.com/news?tmpl=story&u=/ap/20050131/ap_on_re_la_am_ca/colombia_troops_bugged_2>
>
>
>Leishmaniasis, military troops - Colombia
>- ---------------------------------------
>Colombian Army troops must dodge land mines and ambushes in their offensive
>against rebels in the jungle, but one of their biggest obstacles is the
>lowly sand fly.
>
>Leishmaniasis, caused by sand-fly bites that produce nasty open sores and
>swelling, now forces more troops from the battlefield into hospitals than
>gunshots and mine blasts combined. It has hampered the army's unprecedented
>onslaught to wipe out the Revolutionary Armed Forces of Colombia, or FARC.
>Caused by a parasite living in the sand fly's gut, the disease is found in
>parts of 88 countries, mostly tropical or subtropical. U.S. soldiers in
>Iraq call it "Baghdad boil," and during 2004, hundreds of them had to be
>ferried home for treatment.
>
>In Colombia, about 2500 soldiers were hospitalized in 2004 for
>leishmaniasis -- up more than 3-fold from 2003 and more than double the
>1150 injured in combat, Defense Ministry officials said. "Our soldiers are
>going into jungle regions where they've never been before and the rise in
>leishmaniasis cases is one of the unfortunate results," Dr. Hector Navarro,
>top medical adviser at the ministry, told The Associated Press at the Tres
>Esquinas military base in southern Colombia.
>
>He said it usually takes about a month for soldiers, receiving daily
>injections to combat leishmaniasis, to recover. The government is now
>issuing the troops with long-sleeved T-shirts, teaching them to use bug
>spray and ensuring medicine is available, Navarro said. Medicine alone
>costs more than $425 per affected soldier. Leishmaniasis has especially
>afflicted troops spearheading the offensive known as Plan Patriot deep into
>Colombia's steamy southern jungles that began in 2004 and is aimed at
>capturing or killing rebel leaders.
>
>"The soldiers make camp at sundown, sit down against a tree to relax, and
>unbutton their fatigues, leaving them totally exposed to sand flies,"
>Navarro said.
>
>[A  21 year old male], got the disease while fighting in the southern
>Cacqueta  province. He's been getting treatment at a military clinic in
>Bogota for nearly 3 months, but the ugly, itchy boil on his chin won't go
>away. "I'm going to have this for the rest of my life," said the distraught
>soldier, who said he had been living and fighting in the jungle for 7
>months straight when he got infected. "I used repellent, I slept in
>hammocks with netting, I did everything to avoid it, but when you're out
>there for so long, it's impossible to avoid getting bitten," he said.
>
>The guerrillas are also suffering, judging by the thousands of tubes of
>leishmaniasis medicine netted in raids on their camps last year. The New
>England Journal of Medicine recently reported that the disease is so
>prevalent in the deepest jungles of Colombia that it is seen as a way of
>identifying insurgents or their supporters, and that the army may choose to
>detain mobile clinics carrying medication.
>
>Leishmaniasis causes large bumps and open sores on the skin, and if
>untreated, can cause permanent disfigurement. Many soldiers regard
>leishmaniasis scars as a badge of honor, proving they have been on the
>front lines pressing the offensive against the insurgents. On a recent day,
>troops heading into the jungle at the Miraflores military base in southern
>Colombia proudly pulled up their sleeves to show a reporter their
>leishmaniasis scars.
>
>Gen. Carlos Alberto Fracica, Plan Patriot's field commander, sought to play
>down the concerns. "Getting leishmaniasis is like getting the common cold.
>You get it, you take some medicine and you're back on the battlefield. It's
>nothing," Fracica said.
>
>[Byline: Dan Molinski]
>
>- --
>Alfonso Rodriguez, M.D.
><ajrm_msds at yahoo.es>
>
>[Leishmaniasis is endemic in the Amazonas region including Columbia. The
>article referred to in the posting [Reilly and Morote, NEJM
>2004,351:2576-8] describes how health care facilities that treat
>leishmaniasis are used by both sides. - Mod.EP]
>
>[The epidemiology of cutaneous leishmaniasis in Colombia and most other
>South American countries can be very complex, involving different species
>of parasite and different vectors, much depending on geographical location
>and local ecology.  Although the report on the infection in Colombia is not
>specific, this will be cutaneous leishmaniasis, which can be caused by
>several _Leishmania_ species such as _L. amazonensis_, _L. panamensis_ or
>_L. braziliensis_. Following treatment or a relapse   mucocutaneous
>leishmaniasis or espundia can occur, due usually to infection with _L.
>braziliensis_ which is  often transmitted by the sandfly _Lutzomyia
>wellcomei_. This can result in severe facial disfigurement, such as loss of
>the nose and destruction of the palate. So I think the gung ho statement
>that "leishmaniasis is like getting a common cold. You get it take some
>medicine and you're back on the battlefield"  is -- to say the least --
>optimistic!
>
>Incidentally  Colombian  sandflies also transmit bartonellosis (sometimes
>called Oroya fever or Carrion's disease) caused by _Bartonella
>bacilliformis_, and  several strains of sandfly fevers (_Phlebovirus_). -
>Mod.MS]
>
>[see also:
>2004
>- ----
>Leishmaniasis - Venezuela 20040516.1317
>2003
>- ----
>Leishmaniasis - Brazil (Sao Paulo) 20030114.0114
>2002
>- ----
>Leishmaniasis - Brazil (Mato Grosso do Sul) (02)      20020524.4314
>Leishmaniasis - Brazil (Mato Grosso do Sul): RFI      20020520.4284
>2001
>- ----
>Leishmaniasis - Colombia (background) 20010530.1056
>Leishmaniasis - Colombia 20010526.1028
>2000
>- ----
>Leishmaniasis? - Nicaragua 20000628.1068
>Leishmaniasis? - Nicaragua (02) 20000705.1116
>1999
>- ----
>Leishmaniasis, visceral, fatal - Brazil (Sao Paulo) 19990616.1023
>Leishmaniasis, visceral, fatal - Brazil (Sao Paulo... 19990722.1235
>Leishmaniasis - Nicaragua (west) 19990821.1453
>Leishmaniasis - Nicaragua (west) (04) 19990827.1499
>1998
>- ----
>Leishmaniasis - Brazil: Background 19981114.2203
>1997
>- ----
>Leishmaniasis, cutaneous - Peru 19971119.2328]
>.........................ep/pg/mpp
>
>------------------------------