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The "baghdad Boil."

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FWD FROM Colonel Dan

Note this has been noted for soldiers serving & training in the US SW

desert, AZ, NM, CA, TX, NTC

Spread of disease tied to US combat deployments

Stateside doctors are left grappling

By John Donnelly, Globe Staff | May 7, 2007





WASHINGTON -- A parasitic disease rarely seen in United States but common in

the Middle East has infected an estimated 2,500 US troops in the last four

years because of massive deployments to remote combat zones in Iraq and

Afghanistan, military officials said.

Leishmaniasis , which is transmitted through the bite of the tiny sand fly,

usually shows up in the form of reddish skin ulcers on the face, hands,

arms, or legs. But a more virulent form of the disease also attacks organs

and can be fatal if left untreated.

In some US hospitals in Iraq, the disease has become so commonplace that

troops call it the "Baghdad boil." But in the United States, the appearance

of it among civilian contractors who went to Iraq or among tourists who were

infected in other parts of the world has caused great fear because family

doctors have had difficulty figuring out the cause.

The spread of leishmaniasis (pronounced LEASH-ma-NYE-a-sis) is part of a

trend of emerging infectious diseases in the United States in recent years

as a result of military deployments, as well as the pursuit of adventure

travel and far-flung business opportunities in the developing world, health

officials say.

Among those diseases appearing more frequently in the United States are

three transmitted by mosquitoes: malaria, which was contracted by 122 troops

last year in Afghanistan; dengue fever; and chikungunya fever.

Nathan Yang , 42, a civilian from Dorchester, contracted visceral

leishmaniasis -- the most serious form of the disease -- most likely during

a vacation to Greece last September. Yang, who works for an Internet travel

company, said it took Boston doctors more than three months to determine

what was causing his night sweats, chills, and low-grade fevers.

Fortunately, prodding by Yang's sister, an infectious disease doctor

practicing in Annapolis, Md., led to a test at a US military laboratory,

which found that he had the disease. Until then, a doctor had suggested

removing Yang's spleen, which was enlarged because of the illness.

"It was kind of worrying not knowing what it was," said Yang, who said he

feels much better after taking medications.

Leishmaniasis has long hounded the US military in its past deployments to

the Middle East.

During World War II, troops in the Persian Gulf region reported high

incidences of the disease; during the deployment for the first Gulf War, in

1990-91, just 31 cases were reported -- which received large headlines in

the United States because it was unusual. But military officials interpreted

the numbers as an improvement, reflecting good preventive techniques as well

as troops spending more time in urban areas.

But the increasing cases in the last few years, which has gone almost

completely unnoticed, has been due in part to a breakdown of efforts aimed

at protecting troops from getting bitten by sand flies, military officials

acknowledged. About 80 percent of the cases are from Iraq and most of the

others are from Afghanistan.

When Army Colonel Peter J. Weina , director of the leishmania diagnostics

laboratory at the Walter Reed Army Institute of Research in Silver Spring,

Md., spent months traveling around Iraq in 2003, he found that some

commanders had taken no precautions to guard against infection.

The military recommends making sure troops have bed nets and uniforms

treated with the insect repellant permethrin , applying the chemical DEET to

exposed areas of skin, and wearing long pants, socks, and long-sleeved

shirts while outside.

"In some areas, every one had heard about bed nets and about leishmaniasis,

but other military units were totally oblivious," Weina said.

He said the lack of attention to leishmaniasis is understandable, though:

"From the perspective of the person on the ground, they are bombarded with

so many concerns. The way the war is going now, getting a little sore that

may or may not go away is minor compared to losing your leg" in a roadside

bomb attack.

The sand flies, which are a third the size of a mosquito, don't actually

fly, but hop, giving them a limited range. Weina took sand fly samples from

several parts of Iraq and found parasites from Basra to Mosul. He also found

scores of cases of Iraqi children hospitalized with leishmaniasis.

The World Health Organization estimates 2 million new cases of leishmaniasis

each year in 88 countries, ranging from rain forests in Costa Rica to the

deserts of Iraq and Iran. In the United States, infections are very rare.

On average, about 100 American tourists or business travelers have

contracted the disease in recent years, more than in past years because of

more frequent travel to areas where the parasite flourishes, the US Centers

for Disease Control and Prevention said.

The sharp increase in cases in the US military has also raised concerns

about transmission of leishmaniasis from person to person.

While scientists found little evidence suggesting that the disease can be

transmitted through blood transfusions, the US Food and Drug Administration,

not wanting to take a risk, advised in late 2003 that US citizens traveling

to Iraq should not be allowed to donate blood for a year upon their return

-- and Americans diagnosed with leishmaniasis should be banned from donating

blood over their lifetime. Weina, the Army medical researcher, said there is

less reason to believe that the disease could be transmitted through casual

or sexual contact. While some cases suggest that leishmaniasis might have

occurred between couples, Weina said, no scientific study has proven it. But

the wife of a civilian contractor who returned from Iraq with leishmaniasis

said she fears she may have already been exposed to the disease.

"If you consider it can be transmitted sexually, and my husband has it, and

I could have it as well, I'm furious," said Marcie Hascall Clark of

Satellite Beach, Fla., whose husband, Merlin, spent two months clearing

minefields in Iraq. Clark said she was also concerned because symptoms of

leishmaniasis sometimes do not show for months or even years in some cases.

"I worry that a lot of soldiers are coming back and they don't even know

they have it," she said.

Beverly Rorrer of Zanesfield, Ohio, said her husband, Ken, served seven

months in a National Guard unit in Iraq and returned home last fall with a

large sore on his left leg. After waiting months for a correct diagnosis,

Rorrer said, they learned about leishmaniasis only after she happened to

watch a PBS documentary.

"I've told more than a few people that it's amazing what is out there in

this world," Rorrer said. "We are fortunate and blessed not to come in

contact with it every day."

John Donnelly can be reached at <mailto:donnelly@globe.com>




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