WASHINGTON (Army News Service, Oct. 28, 2003)--Service members in Iraq who fail to follow preventive measures risk the bite of the tiny, but fearsome, sand fly, Army medical officials said.

It's peak season for these pests through the end of November, doctors said, 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 sores on their skin that do not heal after several weeks. The sores form weeks after an infected sand fly bites. The sores initially appear bumps on the skin, 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 from several weeks to six months after becoming infected, medical officials said. Those infected 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 officials said. They said it’s very common in Iraq, Kuwait, Saudi Arabia, Afghanistan, Pakistan and other countries in Southwest Asia.

In the past two years, 52 cases of cutaneous leishmaniasis have been reported in the Department of Defense. 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 the disease, medical officals said. There is no vaccine and no medication to protect against leishmaniasis. Preventive measures include taking steps to avoid or prevent sand flies from biting. These include:

* Limiting outdoor activity at dusk and during the evening, when sand flies are most active.

* Wearing protective clothing and insect repellent.

* Treating uniforms with permethrin.

* Using permethrin-treated bed netting.

Detailed information about prevention is available from the U.S. Army Center for Health Promotion and Preventive Medicine, http://chppm-www.apgea.army.mil/news/Leishmaniasis.asp.

While it's rare, leishmaniasis can be transmitted through blood transfusion, medical officials said. Although there have been no cases transmitted through blood transfusion in the United States, 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 precautionary measure to ensure the safety of the blood supply, officials said.

People 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.

More information on the Armed Services Blood Program's deferral is available at www.defenselink.mil/news/Oct2003/n10212003_200310211.html.

(Editor’s note: Information provided by the U.S. Army Medical Command.)