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ARLINGTON, Va. — They look like flecks of pepper and they love to come out at night to play. They live in the dirt and they bite like you’re their last meal.

Sand flies.

Anyone who’s been deployed to Southwest Asia and lived in “bare base” conditions there knows these little buggers all too well. When they munch, the fierce itching that results can drive you almost nuts before it finally goes away.

But when sand flies attack your skin, they can give you more than just the Mother of All Itches. Sand flies can also give you a disease called leishmaniasis, which is caused by microscopic parasites that are transmitted via sand fly saliva.

“LEASH-man-eye-asis,” as it’s pronounced, is pretty rare: Defense Department officials said they have seen only 52 confirmed cases in two years. But it’s serious enough that servicemembers need to know about the disease and its prevention [see box at right].

“Leish,” as medical experts call it for short, comes in two forms: cutaneous (“affecting the skin”) and visceral (“affecting internal organs”).

The cutaneous form is more disgusting to look at, but less serious in the long run.

The first sign of pending trouble is when one or more of the tiny, hard bumps caused by the bite won’t heal. Instead, after several weeks the bumps start looking red and infected. Then they form an open, flat, circular sore with raised edges. Sometimes the sore scabs over and sometimes it hurts, but not always.

If they aren’t treated, the sores can last for years and leave permanent scars.

The good news is that while cutaneous leish is ugly, it is rarely fatal.

Visceral leish, on the other hand, is fatal if not treated.

Visceral leish infects the liver, spleen and other internal organs. But because the infection is internal, it doesn’t come with any handy warning signs, like cutaneous sores.

To make things even tougher for doctors, it can take two to six months after someone is infected before its giveaway symptoms do begin: high fevers, weight loss and anemia. Other symptoms require medical tests to spot, such as an enlarged spleen and a low white blood cell count.

Both forms of leishmaniasis occur in tropical areas around the world, but it is most common in Iraq, Kuwait, Saudi Arabia, Afghanistan, Pakistan and other countries in Southwest Asia.

Iraq’s sand flies are among the world’s busiest carriers. In fact, of the 52 cases of cutaneous leishmaniasis detected in U.S. servicemembers over the past two years, 50 were diagnosed from members who spent time in Iraq, defense officials said.

There have been no cases of visceral leishmaniasis detected so far, defense officials said.

Prevention tips

There’s only one way to prevent leishmaniasis: Keep sand flies from biting. Here are some tips:

¶ Try to limit outdoor activity at dusk and during the evening, when sand flies are most active.

¶ Wear protective clothing, with uniform sleeves turned down and buttoned, and pant legs properly bloused.

¶ Apply insect repellent with N, N-diethylmetatoluamide (DEET) to exposed skin and under the edges of clothing, such as under the ends of sleeves and pant legs. Reapply according to directions (the more you sweat, the more you may need to reapply, but check the bottle first).

¶ Keep uniforms properly treated with permethrin. Make sure to apply after every five washings.

¶ Use permethrin-treated bed netting and screens on doors and windows. Fine-mesh netting (at least 18 holes to the linear inch) is required for an effective barrier against sand flies, which are about one-third the size of mosquitoes.

¶ In the field, try to get your sleeping bag off the ground. If you can’t do that, at least use a ground pad.

¶ If sleeping under cover, sweep all loose dust and dirt from concrete, tile or linoleum floors. The cleaner your quarters, the fewer the flies.

¶ Do not wear flea collars designed for dogs and cats, even over boots, medical experts warn. The collars are designed to repel common house fleas and there is no evidence they work against sand flies. Meanwhile, the chemicals in the collars have not been tested for safety with humans, and can cause allergic reactions and sores that may become infected.

Sources: U.S. Army, Centers for Disease Control

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