Sand Flies Active-and Dangerous-in Iraq

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Sand Flies Active-and Dangerous-in Iraq

 

 

Service members in Iraq who fail to follow preventive measures risk the bite

of the tiny but fearsome sand fly. It's peak season for these pests through

the end of November, and their bite can carry a disease called

leishmaniasis.

 

There are two kinds of leishmaniasis-cutaneous and visceral.

 

People who get the cutaneous form have one or more sores on their skin that

do not heal after several weeks. The sores form on the skin several weeks or

more after an infected sand fly bites. The sores initially appear as papules

or bumps on the skin, but then form an open, flat, circular sore with raised

edges. Sometimes they have a scab, and sometimes they hurt. Untreated, the

skin sores can last for years and leave permanent scars, but are rarely life

threatening.

 

Visceral leishmaniasis, on the other hand, is a much more serious infection

of the liver, spleen and other internal organs that can be fatal if not

treated. People who get the visceral form of the disease become ill several

weeks up to six months after becoming infected. They will usually have high

fever, weight loss, and an enlarged spleen and liver. They also have other

symptoms that show up in blood tests (such as anemia, low white cell count

and low platelet count).

 

Leishmaniais occurs in tropical areas around the world. It is very common in

Iraq, Kuwait, Saudi Arabia, Afghanistan, Pakistan and other countries in

Southwest Asia.

 

To date, 52 cases of cutaneous leishmaniasis have been reported in DOD over

the last two years. All of the patients were infected in Southwest Asia; all

but two spent at least some time in Iraq. There have been no cases of

visceral leishmaniasis detected so far.

 

Prevention is the best defense against contracting leishmaniasis. There is

no vaccine and no medication that protects against leishmaniasis. Preventive

measures include taking steps to avoid or prevent sand flies from biting.

These include:

 

a.. Limiting outdoor activity at dusk and during the evening, when sand

flies are most active.

b.. Wearing protective clothing and insect repellent.

c.. Treating uniforms with permethrin.

d.. Using permethrin-treated bed netting.

Detailed information about prevention is available from the U.S. Army Center

for Health Promotion and Preventive Medicine.

 

While it's rare, leishmaniasis can be transmitted through blood transfusion.

Although there have been no cases of leishmaniasis transmitted through blood

transfusion in the United States, all personnel deployed to Iraq will be

deferred from donating blood for one year after departure from Iraq. The

deferral, put in place by the Armed Services Blood Program Office, is a

prudent precautionary measure to ensure the safety of the U.S. blood supply.

 

People who have been diagnosed with either cutaneous or visceral

leishmaniasis are permanently deferred from donating blood. But in most

cases, it takes two to six months for symptoms of the disease to show up.

Service members returning from Iraq may have been bitten by the sand fly

that causes the disease and may have the parasite in the blood stream, but

they may not know it. There is no FDA-approved test to screen blood for the

parasite. For these reasons, because service members are living in austere

conditions in Iraq, and because environmental surveillance data indicates a

particularly robust population of sand flies exists in Iraq, the

precautionary deferral was implemented.

 

More information on the Armed Services Blood Program's deferral is available

from the Department of Defense.

 

http://www.armymedicine.army.mil/news/releases/20031031LeishmaniasisWeb.cfm

 

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