Leishmaniasis in Iraq from the Gulf War to OIF

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Leishmaniasis
Cutaneous, Visceral, Mucocutaneous
In 1988 this is a word that even tourist barely heard from
the State Department as a travel warning. A little known third
world disease that was quite misunderstood. All the way back
to its Scottish origin of Sir William Boog Leishman in 1903.
Physicians Leishman, and Donovan discovered the cause
of a tropical disease known as Kala-Azar, caused by a
parasite spread by sandfly bites. It was a stained slide that
showed Leishmania donovani for the first time.
Even though Leishmania tropica and other variants had
been seen before 1903, it wasn't really understood until
the public explanation by Leishman and Donovan.
Leishmaniasis is commonly seen in tropical / sub-tropical
regions of Africa, Mediterranean, Southern Europe, Asia,
and South & Central America. Its estimated that 12 million
people are currently infected. 367 million are at risk of getting
leishmaniasis in 88 countries.
During the first Gulf War, it was claimed that only 20 cases
of L. Major ( Cutaneous Leishmaniasis ) surfaced among the
soldiers coming back. That 12 cases of L. Tropica ( Visceral
Leishmaniasis ) were diagnosed up to 1993.
To understand the strains and types, there are a few technical
notes that have to be spelled out. The disease has two parts in
its lifespan, the Zoonosis and the Anthroponotic. The
Promastigotes with tails starts in the Sandflies, and the
small internal round amastogote version thrives in human's.
The three different strains listed as Cutaneous, Visceral, and
Mucocutaneous exhibit different symptoms. Cutaneous is
skin, Visceral in internal organs, and Mucutaneous as related
to nasal or other mucous regions of the body.
At the point of contact of the sandfly in Cutaneous Leishmaniasis,
the Sandflies saliva is ejected onto the bite - in that saliva the
L. Tropica promastigotes burrow into the wound. From there
they swarm in the wound until the ulceration becomes visible.
Which becomes a long festering wound that doesn't seem to
heal for several months. This type of external wound will heal
in a year or so, but its uncertain if the person ever is completely
free of the organism. Scarring is a factor, and wounds by eyes
or other sensitive areas is a serious concern. The disease can
also lay dormant for many years before recurring in a later cut
or infection. But most of the time it resolves in a non-threatening
manner. The persons immune system is able to suppress it.
Visceral Leishmaniasis is much less understood, and a much
darker version of this parasite. Its transmitted also by the same
Sandflies, and in the bite wounds like Cutaneous. After that its
different in its lifecycle. It burrows deep into the organs, bone,
of the host. The early stages of the disease are so subtle
that a person might not know for several years they have it. It
so small that it doesn't show up in normal blood test, or even
in early tissue biopsies. Then when the disease is in it latter
stage does it start to make itself known. Once the Spleen
becomes enlarged, and the belly extends does it start making
it presence noticed. The strains of Leishmaniasis are usually
noted to be L. Infantum ( Infant Syndrome ) or L. Donovani.
Incubation period is considered between 3 to 33 weeks.
That diagnosis being made largely though a bone marrow
biopsy, and or splenic asparate. ( tissue sample from bone
marrow or spleen ). PCR ( DNA enzyme ) testing is still
considered unreliable in confirming this disease in 2005.
The newest test being a dry PCR to the wet PCR. Today
its largely found as a stained gel slide where someone
sees the amastogote in a cell, same as 1903.
What does a L. Donovani amastogote usually look like, a
cell with several nucleus parts to it. The closest rough
description would be a clear sack with multiple nucleus
spheres in it instead of one. A clear marble with a clover
like center. Without the features of a expected parasite,
its often overlooked - and even missed by laboratories
looking for it specifically. Its when the parasite is in its
late stage at 10 to the 15th power number of parasites,
and swarming that researchers are able to diagnose it.
The only American institution dealing with this disease on a
regular basis is Walter Reed Army Hospital in Washington,
DC. They work in conjunction with the Armed Forces Institute
of Pathology to track, type, and treat this disease in troops
coming back from Afghanistan and or Iraq.
Suspected number of current cases of Cutaneous Leishmaniasis
in these regions in American troops from January 2003 to May
2005 has been 848. Visceral has been 4 cases of L. Infantum
in that same period.
However, more than 200,000 citizens of Kabul Afghanistan were
diagnosed with Cutaneous Leishmaniasis in 2003 by the World
Health Organization. So chance of contagion there is high.
In December 2003 the FDA held a blood banking seminar to
discuss the possibility of contamination of the nations blood
supply by Leishmaniasis. It was there that the FDA decided a
lifetime ban on blood donations from persons diagnosed with
Leishmaniasis from Iraq should be imposed. Later the Pentagon
would make the same policy of us troops. Why a lifetime ban?
Because at this time there is no guarantee of a 100% sterile
cure of any version of Leishmaniasis.
At the May 2005 Institute of Medicine Infectious Disease
meeting, Dr. Alan Magill of Walter Reed Army Hospital had
pointed out to the committee the dark sides of Leishmaniasis.
Part of which has been outlined in this over view.
We at DSBR believe there are many more cases of Leishmaniasis undiagnosed in America. That American contractors serving
in Iraq are coming home with it, soldiers, tourist. That the
diagnostic system in place across America are missing this
outbreak, and that in time it will be spread here through
transfusion, intimate contact, and possibly mosquito vectors.
Testing can be done for the military at Walter Reed Army
Hospital, through Peter Weina at 301.319.9956 or email
peter.weina@na.amedd.army.mil http://www.pdhealth.mil/downloads/Leishmaniasis_DS_04272004.pdf
There is also the Armed Forces Institute of Pathology,
which has a Leishmaniasis Registry. Point of Contact
is Colonel Peter McEvoy mcevoy@afip.osd.mil
http://www.afip.org/leishsurvey.html

If you are a civilian contractor, you can go through

Parasitic Disease Consultants

http://parasiticdiseaseconsultants.com

A Clinical Laboratory for the Diagnosis of Parasitic,

Viral and Other Infectious Diseases.

The CDC has a Leishmaniasis testing department, which you
will go through Mr. Frank Steurer at 770-488-4475. http://www.cdc.gov/ncidod/dpd/parasites/leishmania/factsht_leishmania.htm
This is the VA protocol for dealing with Leishmanisis:

http://www1.va.gov/environagents/docs/USHInfoLetterIL10-2004-013.pdf
If you are a American Soldier, Contractor in or returning from
Iraq, or concerned party about Southwest Asia Leishmaniasis -
please contact us at leishmaniasis@gulflink.org .


At the IOM May 2005, Dr. Alan Magill said he did not know a
Arvid Brown of Michigan. Here is a copy of the July 12th 1998
WRAMC letter to VAMC Ann Arbor Michigan of the first ELISA
test results on Arvid Brown. From the book:
"Bloodmeal: ignored to death"

The independent lab "Parasitic Disease Consultants"
confirmation of Arvid Browns Leishmaniasis in 1998
"Bloodmeal: ignored to death" page 2

IOM:
Gulf War and Health: Infectious Diseases
Project Identification Number: HPDP-H-04-06-A
http://www.gulflink.org/iom4/iom4.htm
Slides of Richard Reithinger, Craig Hyams,
Mike Kilpatrick, Alan Magill
CDC:
Barbara Herwaldt slides to
December 2003 FDA Blood bank committee
CDC Leishmaniasis Slides
Kirt Love slides to the
December 2003 FDA Blood bank committee
Kirt Love Leishmaniasis Slides
Letters to DHSD from DSBR before the was
in Iraq of March 2003
August 3rd, 2002
Response to Kirt Love on Leishmaniasis - page 1
Response to Kirt Love on Leishmaniasis - page 2
September 20th, 2002
Janyce Brown to DHSD, 3 pages
November 15th, 2002
response letter from DHSD
DHSD response letter
May 2003
response from DHSD
Response to Kirt Love May 2003 page 1
Response to Kirt Love May 2003 page 2
Freedom Magazine
Volume 35 issue 1
Desert Storm Blows Back with a Fury

Deployment Quarterly Spring 2005
Quick Testing Approved For Leishmania Parasite