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December 6, 2003
MEDICINE
Hundreds of U.S. Troops Infected by Parasite Borne by Sand Flies, Army Says
By DONALD G. McNEIL Jr.
HILADELPHIA, Dec. 5 — Hundreds of American troops in Iraq have been infected with a parasite spread by biting sand flies, and the long-term consequences are still unknown, Army doctors said Friday.
The resulting disease, leishmaniasis, has been diagnosed in about 150 military personnel so far, but that is sure to climb in the coming months, the doctors said.
All have only the skin form of the disease, which creates ugly "volcano crater" lesions that may last for months, but usually clear up by themselves.
None have developed the visceral form that attacks the liver and spleen and is fatal if untreated. Military doctors have told all troops who were in the region to carefully watch themselves for persistent fevers.
Sand flies may actually disrupt some units' missions, said Lt. Col. Glenn Wortmann, an infectious disease specialist at the Walter Reed Army Medical Center, who is treating many patients.
Although the skin form of the disease is not life-threatening, 100 to 200 soldiers in some units have been badly bitten and are in danger of developing the disease. Right now, those that develop leishmaniasis lesions are sent back to Walter Reed for treatment. Those soldiers are lost to duty for 30 to 40 days, Colonel Wortmann said.
Almost all Iraqis killed by the visceral form of the disease are malnourished children under 5, not healthy adults. "For us in the military, that's a good thing," said Lt. Col. Russell E. Coleman, an insect specialist with the 520th Theater Army Medical Laboratory, who gave a presentation here to the American Society of Tropical Medicine and Hygiene. "We're well fed and have healthy immune systems, so hopefully we won't see visceral leishmaniasis in even one soldier."
The soldiers were bitten during the dry, hot season that began in March, just after the invasion began, but the disease can take months to develop. Iraqi doctors told American doctors that in Iraq cases usually peaked in December and January.
Only about 32 of the 500,000 American troops involved in the Persian Gulf war a decade ago developed skin leishmaniasis, he said. But that war was fought mostly in Kuwait in colder weather, before the fly season. However, a dozen developed visceral leishmaniasis. All recovered.
No treatment for either form of leishmaniasis has been approved by the United States Food and Drug Administration, but the military gives 10 to 20 days of intravenous Pentostam, a 50-year-old drug recommended by the World Health Organization.
Civilians, including contractor employees, can get the drug through the Centers for Disease Control and Prevention, said Dr. Philip Coyne, a treatment specialist at the Walter Reed Army Institute of Medical Research.
Pentostam speeds healing, with less scarring, and doctors hope it helps prevent skin leishmaniasis from becoming visceral. However, long-term Pentostam can poison the liver and pancreas and is hard to administer in war areas.
Dr. Coleman estimates that more than 1,000 cases may be diagnosed by February. His unit, based at Tallil Air Base near Nasiriya, specializes in detecting and treating chemical and biological warfare, he said, and detects diseases like malaria. "But we spent 95 percent of our time on leishmaniasis," he said.
Dr. Coleman found soldiers who got more than 200 bites in a single night, he said. Because of the heat, he said, soldiers ignored precautions, sleeping outside in their underwear and scorning insect repellent because sand stuck to it.
Sleeping inside under mosquito netting is recommended, though the military's nets had mesh too large to stop Iraq's sand flies, which are about one-quarter the size of mosquitoes.
Air Force tents at Tallil, where 15,000 troops were stationed, were air-conditioned and some had cement floors, so they had few flies, Dr. Coleman said. Army tents were hot and were built on the ground or on wood slats, under which mice and other rodents that can also carry the parasite that causes leishmaniasis scampered freely.
Dr. Coleman said that military officials at the base took precautions, like spraying insecticides, killing rodents and shooting stray dogs, which can also be infected. Nonetheless, the flies persisted through the hot season, he said.
Now the soldiers they bit are turning up at Walter Reed in numbers that have risen to more than 40 a day. "It's going to be a long slog — as long as we're in Iraq," Colonel Wortmann said.
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