Troops' Skin Infection (Leishmaniasis) Treatment Delayed

(Arlington, Virginia) A single-celled protozoan parasite transmitted by sand fly bites is causing skin infections among American troops in Iraq and Afghanistan. The disease is called leishmaniasis (also called kala-azar) and the vector is a tiny 2 to 3 millimeter-long insect, the phlebotomine sandfly. When the female sandfly feeds on the blood of a human or mammal, the parasite is injected which normally produces skin ulcers, called cutaneous leishmaniasis, on the exposed body parts such as the face, arms and legs. The lesions are painful and leave scars. According to Dr. Alan McGill, infectious disease specialist at Walter Reed Army Institute of Research, about 750 cases of leishmaniasis were diagnosed among troops in the first rotations of Operations Iraqi Freedom or Enduring Freedom in Afghanistan.

Principal medications for treating leishmaniasis are antimony-containing compounds and cure rates are high. In a small percentage of cases, the parasite invades mucus membranes or the viscera. Mucocutaneous leishmaniasis can cause disfigurement which may require plastic surgery. Visceral leishmaniasis, involving the internal organs, may be life-threatening.

The current problem with leishmaniasis among military units in combat areas is that doctors are foregoing routine treatment of the disease on the basis that travel to a medical facility could be life-threatening to the troops. In other words, if delaying treatment is preferable to driving through a dangerous war zone, then treatment is delayed. "Doctors in the field are making some hard choices, because any movement in Iraq places your life in jeopardy," says Dr. McGill, who is the military's leading expert on leishmaniasis. As a result of delaying treatment, doctors are preparing to see a surge of leishmaniasis cases when troops rotate out of Iraq and Afghanistan.

For the sake of comparison, although 750 troops were infected in the first rotations in Iraq and Afghanistan, it's estimated that 12 million people in the world's tropics and subtropics are infected with leishmaniasis with 1.5 to 2 million new cases yearly. To date, within the second rotation of troops in Iraq and Afghanistan, only about 20 cases of leishmaniasis have been confirmed. And, of all cases of leishmaniasis in American troops, only four have been visceral, two in Iraq and two in Afghanistan. Of note is that leishmaniasis has been suggested by some physicians as the root cause of Gulf War Syndrome.

In summary, doctors are expecting to treat a rash of leishmaniasis infections when troops rotate out of war zones because it's safer than trying to treat them in war zones. By the way, the unit believed to have the most infections is the 1st Brigade of the 25th Infantry Division, the Army's "Stryker Brigade."


[Update 12/25/05]

As expected, troops are returning from tours of duty with leishmaniasis, now nicknamed "Baghdad Boil." Reports of infections now indicate that more than 800 U.S. service members have contracted the disease since the Iraq War began in early 2003. Recently, 13 members of the same small unit were medevac'd to Walter Reed Army Medical Center for treatment with a drug called Pentostam. Notably, the drug is approved for experimental use only.

There is a fear that some people may acquire the parasite and not know it since it may take months for symptoms to appear. As a precaution, health officials announced that troops who served in Iraq would be barred from giving blood for a year after returning home. (Source)