Don’t Forget Leishmaniasis When Servicemembers Have Mysterious Symptoms

By Brenda L. Mooney

Maps of the geographic distribution of cutaneous leishmaniasis (CL

BETHESDA, MD – Military physicians stumped by a diagnosis might want to consider leishmaniasis in personnel returning from Iraq or Afghanistan, according to a new report.

The sand fly-transmitted disease was much more in the news years ago when a larger number of servicemembers were deployed to the Middle East, but the problem persists, according to a new report. The Defense Medical Surveillance System reported about 1,000 cases from 2005 to 2014, and more than 500 cases were confirmed between 2002 and 2004, according to a report from the national Centers for Disease Control and Prevention.

Now, a rise in ecotourism as well as the presence of the disease in immigrants from some countries is increasing cases in the United States, emphasize new guidelines published in the journal Clinical Infectious Diseases.1

The parasitic infection, dubbed “Baghdad Boil” by troops stationed in the area, is being identified in more and more U.S. patients, but the diagnosis often eludes physicians, according to the report authored by Uniformed Services University researchers and colleagues.

Among the strategies to address leishmaniasis in the new guidelines, released by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH), are rapid diagnostic tests and cutting-edge treatments.

The Leishmania parasite, which is transmitted by the bite of the nearly invisible sand fly, is found in more than 90 countries around the world–including Mexico and those in Central and South America, Asia, Africa, the Middle East and southern Europe.

Guideline authors point out that the infection rarely occurs in the United States, although a few cases have been reported to have been acquired in Texas and Oklahoma. Creation of the new guidelines, however, was prompted by the increase in travelers, military servicemembers and immigrants with leishmaniasis being seen in the United States, they add.

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