Lisa Hoffman
Another hazard facing GIs in Iraq: ulcerous
Wed Mar 17 21:58:17 2004
64.140.158.25

Another hazard facing GIs in Iraq: ulcerous boils

By LISA HOFFMAN
Scripps Howard News Service
March 17, 2004
http://www.knoxstudio.com/shns/story.cfm?pk=IRAQ-BOILS-03-17-04&cat=II

- As if U.S. troops in Iraq didn't have enough troubles, now there's the spreading scourge known as the "Baghdad boil."

At least 500 soldiers have contracted the tropical skin disease leishmaniasis, a sand-fly-borne malady that, while commonly not fatal, causes ulcerous boils that can linger for months and even years, according to the Walter Reed Army Institute of Research and the Centers for Disease Control and Prevention.

And, if research models on the infection rate prove correct, hundreds more GIs could come down with the festering sores that can reach three-inches in diameter and leave disfiguring scars.

"The number of confirmed cases probably will continue to increase," the CDC said in an October report.

Army tests on trapped Iraqi sand flies have shown that an "extraordinary" number carry the "leish" parasite. That infection rate, if extrapolated, could mean hundreds more American soldiers who are now in the region, or have rotated home, could be struck by the disease.

"We found ... some extraordinary infection rates in the flies," Lt. Col. Peter Weina told an in-house Army publication. (The Walter Reed research institute did not respond to a request for an interview.) "We expected to find maybe one-tenth of 1 percent of the sand flies to be infected with leishmaniasis, and we were finding 2 percent" actually were.

Leishmaniasis (pronounced: leesh-ma-NYE-uh-sis) is a lurking disease in which symptoms normally do not surface for weeks or months after a person is bitten by a female sand fly.

The flies are silent and so tiny - just one-third the size of mosquitoes - that they can fit through the mesh of insect netting. The insects are voracious, biting some soldiers as many as 100 times a night, the research institute reported.

The disease comes in two types - a relatively mild sort that strikes just the skin, and a potentially fatal variety that also attacks the spleen, liver and other internal organs, the CDC says. The more severe type generally is accompanied by fever and flu-like symptoms.

So far, it is the skin variety that has been overwhelmingly diagnosed in U.S. troops, with no more than a handful of cases of the more severe type, Walter Reed officials have said. During the first Persian Gulf War, 32 soldiers were afflicted with leishmaniasis, they said.

Leishmaniasis has been found in 88 countries, including Afghanistan, Iran, Peru and Brazil. It has also been detected, though rarely, in the rural southern reaches of Texas.

An estimated 1.5 million new cases of the skin, or cutaneous, variety of leishmaniasis, and 500,000 of the systemic, or visceral, type occur each year around the world. In all, about 59,000 people die from it annually.

There is no vaccine or drug to prevent the disease. About all soldiers can do to avoid being bitten is to treat their uniforms with the powerful pesticide permethrin, apply the repellent DEET to all exposed skin, and sleep under insect netting.

Treatment for those infected consists of daily intravenous infusions of an antimony compound of sodium stibogluconate. In U.S. troops bitten in Iraq, 10 days of outpatient treatments appear to cure it. Even without treatment, the boils will eventually go away on their own, although it can take as long as 18 months. Untreated cases also may leave some huge scars.

The Walter Reed Army Medical Center in Washington is the only U.S. military facility that can diagnose and treat GIs with the disease, and its staff is stretched by the volume of patients coming through its doors, Weina told the in-house Army publication.

"This is really the largest outbreak in the history of the military since World War II," he said. "We've never been set up to be able to treat this many cases."

(Reach Lisa Hoffman at hoffmanl@shns.com .)
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• IRAQ: TROOPS ATTACK BY BIT OF PARASITIC SAND FLIES — RESEARCHER, Wed Mar 17 22:05