[Peace-discuss] sand fleas and their parasites from Iraqi

[Dlind49 at aol.com]

XX Army medical staff wrote: two types of leishmaniasis [1]skin/cutaneous
[2] visceral/internal organs. This report omit stats on how many have
the second type and they fail to tell you that the major for Desert Storm
number has the visceral type of leishmaniasis
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Army treating hundreds of leishmaniasis cases 

            FORT DETRICK, Md. (Army News Service, March 4, 2004) -- A 
little-known 
      parasite that causes chronic, festering sores will be returning home 
with 
      some of Operation Iraqi Freedom's warfighters.

      Cutaneous leishmaniasis, which affects the skin, is caused by a sand 
fly 
      bite that deposits the parasite that eventually causes weeping sores 
that 
      don't heal as quickly as regular sores. 

      Iraq's sand flies are most active during warm nights from March to 
      October, so troops on the move during Operation Iraqi Freedom were 
right 
      in the middle of "Sand fly Central."

      "In the march up to Baghdad, people would literally fall asleep on 
their 
      HUMVEE or out in the middle of the desert, so we had enormous amounts 
of 
      exposure in the evenings in areas where there were a lot of sand 
flies," 
      said Col. Alan Magill, another of Walter Reed Army Institute of 
Research's 
      experts on leishmaniasis. 

      Leish experts suspected the disease was going to be a problem for 
troops, 
      but until Weina arrived in theater to serve with the 520th Theater Army 
      Medical Laboratory, they didn't know just how big the problem was. 
      Initially sent to look for weapons of mass destruction, Weina's team 
also 
      looked for common diseases in the area, like leish, to see what risk 
they 
      posed to warfighters. 

      By April 2003, fears were confirmed. 

      "We found sand flies in the area and started testing them and found 
some 
      extraordinary infection rates in the flies," he said. "We expected to 
find 
      maybe one tenth of one percent of the sand flies to be infected with 
      leishmaniasis, and we were finding two percent of the sand flies were 
      infected in some locations."

      Finding that many infected sand flies meant a huge increase in the 
      potential number of cases, so Weina and his team went into full 
prevention 
      mode.

      The discovery  of the leish problem coincided with the war, so getting 
the 
        word out on  the disease wasn't easy, Weina said. 

      "I tried to get the attention of the brass above me ... but their 
concerns 
      weren't about the guys sleeping under bed nets but making sure they 
      weren't going to get killed." 

      He and his team also talked to the medical professionals in the area so 
      they'd be on the lookout for leish. "The problem is that some (lesions) 
      look like any other type of sore that you may have with a bacterial 
      infection, but they just don't get better," Weina said. "We treated 
with 
      antibiotics first. Then if the antibiotics failed, we considered 
      leishmaniasis." 

      So far, more than 500 cases of leishmaniasis have been diagnosed. 
Magill 
      said he hedges when he's asked how many total cases to expect. 
        [how many are visceral- internal organs is unknown! ]

      "The simple answer is: I don't know. But if you extrapolate, you're 
      probably looking at the 750 to 1,250 range. It could be higher."

      Because the disease is difficult to diagnose without a lab and experts 
      equipped to look for it, all leish smears are currently sent to the 
Walter 
      Reed Army Institute of Research for confirmation. The institute, in 
fact, 
      has the only leishmaniasis lab in the country that is accredited by the 
      College of American Pathologist and is operated in accordance with the 
      Clinical Laboratory Improvement Act. 

      The ability to deliver a diagnosis lets the lab cross the boundary that 
      typically exists between research and health care, Magill said. "Though 
      the (institute's leishmaniasis) research program was eliminated (in 
1996), 
      the lab was maintained for just the scenario being played out today," 
he 
      said. 

      Many of the leish researchers, like Weina and Magill, are also 
caregivers 
      at the only U.S. military hospital where the treatment for leish can be 
      offered, the Walter Reed Army Medical Center. Because the drug of 
choice 
      used to treat the most severe cases was never submitted to the Food and 
      Drug Administration for its approval, the drug must be offered as an 
      investigational new drug, which means following strict research 
protocols 
      and keeping meticulous records when the drug is given. The drug, sodium 
      stibogluconate (Pentostam), is hardly "new," as it's been used for over 
50 
      years to successfully treat leish.

      Treatment typically consists of an outpatient regimen of receiving the 
      drug intravenously daily for 20 days, though the type of leish acquired 
in 
      Iraq, leishmaniasis major, responds in 10 days. (in skin Lesh only)

      The volume of patients who need treatment has challenged both the 
      institute and the hospital named after Walter Reed, Weina said.

      To put the current leish outbreak into perspective, Magill said that 
for 
      Operations Desert Shield and Storm, the official number of 
      leishmaniasis cases was 32. 

      "When you're treating 30 to 40 cases a year at the most, it's no big 
deal 
      having the patients come to Walter Reed Army Medical Center to be 
      treated," Weina said. "But having 400 in a couple of months, now 
there's a 
      problem."

      Weina and Magill are traveling to posts with large numbers of returning 
      troops -- like Fort Campbell, Ky.; Fort Hood, Texas; and Fort Carson, 
      Colo. -- to let the troops and the medical professionals there know 
what 
      to look for. 

      "The only problem is, like with most of tropical medicine, the 
expertise 
      to make the diagnosis is not well distributed. To physicians and lab 
      technicians at Fort Campbell, this is not something many of them have 
seen 
      in their entire careers," Magill said. 

      The leish experts are also looking at other treatment options for 
      patients, including freezing the lesions or using a device that uses 
heat 
      to kill the parasite.

      "There's a good biologic rationale for it (heat therapy) to work and 
some 
      data that we've seen that says it works, but we are reluctant to 
recommend 
      a treatment when there's been no experience." Fifteen patients at 
Walter 
      Reed are currently enrolled in a study see if the thermal device works, 
      and results should be available by March.

      "In the natural history of these lesions, if you do nothing, even for 
the 
      worst lesions, they will get better, he said. "But cosmetically this is 
      very damaging. If you're walking around with some of these big lesions 
on 
      your face, psychologically there's a big impact there. This is an 
      operationally acquired disease, and it's our job to address that." 

      Treating the lesions is important to the troops and their families, 
Weina 
      said. 

      "The American public sees Johnny come marching home from the war, and 
Mom 
      and Dad aren't thrilled about this nasty weeping lesion that's on his 
face 
      that might be there for a year. They want it to go away," he said. 
"Even 
      though it's not contagious, it's still a stigmata that they'd rather 
not 
      have." 

 http://www4.army.mil/ocpa/read.php?story_id_key=5726