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Laboratory technologist Juan Mendez examines , the parasite which causes leishmaniasis, in cultures under a microscope at Walter Reed Army Institute of Research in Silver Spring, Md.

Laboratory technologist Juan Mendez examines , the parasite which causes leishmaniasis, in cultures under a microscope at Walter Reed Army Institute of Research in Silver Spring, Md. (Courtesy of Walter Reed Army Institute of Research)

ARLINGTON, Va. — U.S.-based military doctors are bracing for a wave of servicemembers returning from Iraq this spring whose treatment for a skin disease has been delayed by the dangerous security situation there.

The soldiers who may be infected with cutaneous leishmaniasis are mostly from the 1st Brigade of the 25th Infantry Division, the Army’s “Stryker Brigade,” according to Dr. Alan McGill, infectious disease specialist at Walter Reed Army Institute of Research in Silver Spring, Md.

“We’ve heard rumors of a couple hundred cases in the Stryker Brigade,” McGill said Friday.

But travel in Iraq is so perilous for U.S. troops that health care staff there are choosing to let suspected cases of the disease go, rather than risk a trip to the large medical facilities for diagnosis, said McGill, the U.S. military’s leading leishmaniasis expert.

“Doctors in the field are making some hard choices, because any movement in Iraq places your life in jeopardy,” he said.

McGill said he agrees with that decision, because the sores caused by cutaneous leishmaniasis eventually go away without treatment.

“If I were over there, I wouldn’t take the risk of sending [a soldier] to [a large medical facility] to treat a skin lesion that’s going to get better anyway,” McGill said.

Although treatment for some may have been delayed, troops whose skin lesions are serious will be accommodated once their deployments are over, McGill promised.

“The security situation may have prevented a timely evaluation by stateside standards, but as soon as these guys get home, we are going to take care of them,” McGill said.

Leishmaniasis takes hold when infected sand flies bite humans who sleep on the ground or work in very dirty, sandy environments.

Human cases of leishmaniasis mostly fall into one of two categories: cutaneous, which causes skin lesions that vary from the size of a pencil head to larger than the bottom of a soda can; and visceral, a far more serious variation which leaves no external marks, instead attacking the internal organs.

Untreated visceral leishmaniasis can be fatal, according to the Centers for Disease Control and Prevention in Atlanta.

But sores from cutaneous leishmaniasis “heal on their own, [although] this can take months or even years … and leave ugly scars,” according to CDC spokesman Llelwyn Grant.

U.S. military doctors diagnosed about 750 cases of leishmaniasis among troops who participated in the first rotations of Operations Iraqi Freedom or Enduring Freedom in Afghanistan, McGill said.

Of those, only four cases of visceral leishmaniasis have been diagnosed, two from Iraq, and two from Afghanistan, he said.

Military physicians are expecting fewer cases among troops deployed in the second rotations of OIF and OEF, because most troops now stay in screened, air-conditioned facilities — one of the CDC’s primary recommendations for avoiding infection.

To date, WRAIR has received confirmed reports of about 20 cases of leishmaniasis from OIF2 and OEF2 troops, all of which are cutaneous, McGill said.

Nevertheless, “we think that we’ll see a delayed bubble of cases in March and April,” when second rotation troops begin coming home in large numbers, McGill said. “If we see 100 cases that need [treatment], I would not be surprised.”


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