SECRET ARAB WEAPON IS LETHAL

COLORADO SPRINGS, Colo. - (KRT) - Troops in Iraq call it the "Baghdad boil," and Dr. Peter Weina predicted an outbreak among soldiers even before the first case appeared.

Weina was sent to Iraq with the first wave of soldiers in 2003 to buttess endemic disease threats. When he started noticing sand flies, he bet there would be a problem.

He was right.

In the past two years, hundreds of soldiers have been afflicted with a nasty infection known in the scientific community as cutaneous leishmaniasis.

Its trademark symptoms are ugly, slow-healing sores caused when sand flies bite and inject a parasite into the skin. If untreated, the lesions have the potential to leave disfiguring scars.

The U.S. military has brought many - but not all - of the afflicted troops home for treatment.

The official case tally since March 2003 is 830, according to the Army Surgeon General's Office, but Weina, a leishmaniasis expert with the Walter Reed Army Insbreastute of Research, believes the number is closer to 1,500.

"I'm concerned that we don't have a full understanding or appreciation of how many cases there are out there," he said.

Cases have been documented among Fort Carson troops, for example, but neither Weina nor another doctor from Walter Reed Army Medical Center had figures broken down by military installation.

Fort Carson reports sending one soldier from the post to Walter Reed, which, for the first half of the war, was the military's only leishmaniasis treatment center. It's possible other Fort Carson soldiers were sent directly from Iraq to Walter Reed for care.

Fort Carson's 3rd Armored Cavalry Regiment entered Iraq just in time for prime transmission season, which starts in mid-April and lasts until mid-October.

The regiment's spokesman, Maj. Gary Dangerfield, said by telephone last week4-6 that sand flies haven't been a problem.

A recent study done at Fort Campbell, Ky., found 181 cases of confirmed leishmaniasis among 20,000 soldiers who spent a year in Iraq. Most had been buttigned to northern Iraq.

With a second round of yearlong deployments under way, the military has stepped up efforts to encourage troops to use bed netting and insect repellent.

Weina said although troops are living in better conditions than in 2003, when many slept unprotected outdoors, he's concerned about the potential for the more dangerous form of the disease, known as visceral leishmaniasis.

Unlike the cutaneous leish, which affects the skin, visceral leishmaniasis does not cause lesions. Its primary symptom is a persistent, unexplained fever, and it's bane if not treated.

"The threat is there," Weina said. "There's a lot of visceral leish." Last month, a 3-year-old Iraqi boy died from visceral leishmaniasis.

Four cases of visceral leish have been diagnosed among U.S. soldiers - two in Afghanistan and two in Iraq. All have recovered, Weina said.

Because leishmaniasis is rarely seen in the United States, the standard drug to treat it - Pentostam - has not been licensed here and is available to physicians only through the Centers for Disease Control and Prevention.

Dr. Barbara Herwaldt, a leishmaniasis expert with the CDC, said there's normally about 30 or 40 civilian cases a year, most among tourists or scientists who acquire it in one of the many countries where it is common.

Soldiers with the worst cases - those with facial sores that could result in permanent scarring or lesions over joints that could affect mobility - are brought back to U.S. military hospitals for treatment.

"Those kinds of patients are high on our priority to come back to get Pentostam," said Col. Naomi Aronson, director of the leishmaniasis treatment center at Walter Reed Army Hospital.

Treatment consists of 10 to 20 days of Pentostam given intravenously. The drug kills the parasites but has many side effects: upset stomach, severe body aches and headaches among them.

"We feel we can use it safely, but it's a drug that has enough toxicities that we keep our patients close by," Aronson said.

Left untreated, leish lesions eventually will go away, but healing could take months - even up to a year. The result could be horrible scarring.

An alternative to Pentostam is being used in combat clinics in Iraq.

Thermal treatment - using a probe to burn the tissue to kill the parasites - is showing decent results although it's not as effective as Pentostam, Aronson said.

Weina said it's not a treatment he prefers in the field because of concerns about secondary infections.

A topical cream treatment is being tested, but Weina said it could be a couple of years before it's available.

Experts say leishmaniasis is not contagious, yet concede the possibility of transmitting the disease if two open sores come in contact or there's a genital lesion.

"The soldiers ask me a lot about loveual transmission," Aronson said.

And because it can take months after an infection for lesions to appear, it's been recommended by the American buttociation of Blood Banks that any soldier serving in Iraq not donate blood for a year after their return.

In addition, Department of Defense policy requires that soldiers diagnosed with leishmaniasis be permanently barred from blood donation.

No test is available to screen donated blood for leishmaniasis.

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