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File: 970207_aadcs_002.txtINFORMATION PAPER This is to inform you of a viscerotropic form of leishmaniasis due to the parasite Leishmania tropica among military personne1 who deployed to Southwest Asia (SWA) during the Gulf War. To date, seven cases have keen diagnosed at Walter Reed Army Medical Center. Normally, an infection with Leishmania tropica results in cutaneous lesions only; however, all of these cases were free of cutaneous lesions and, in each case, the parasite was recovered fron the bone marrow. These new cases are distinct from the traditional cutaneous form of 1eishmaniasis of which 15 Gulf related cases have been diagnosed and treated at Walter Reed Army Medical Center. Epidemiologic risk factors for this viscerotroplc form are not well defined at this time. Thesa seven soldiers were members of several different Army units widely scattered throughout the SWA theater of operations in both field and urban settings. Navy, Marine, Air Force and civilian personnel who were stationed within the theater of operations are also considered at rtsk of exposure . The natura1 history of this viscerotropic form of L. tropica is not known. The fact that it has not been clinically apparent in the many travelers to and inhabitants of that region suggests that infections are rare, and/or largely subclinical. Based on the current cases, the clinical appearance is much less severe than that sean in classical viscera1 leishmaniasis (Xala Azar) caused by L. donovani. As with other parasitic and infectious diseases in the immunosuppressed patient, L. tropica has the potential for causing serious illness. The clinical spectrum for these cases was variable and nonspecific. Four of the six symptomatic cases had an acute syndrome which included a high fever with rigors and malaise, accompanied by mild anemia and low grade elevation of 1iver enzymes (AST and ALT). Two cases had a subacute onset, presenting with gastrointestinal complaints which included watery, facal-leucocyte-negative diarrhea (of snall volumes), nausea, and non-focal abdomina1 pain that evolved over time to left upper quadrant pain with hepatosplenomegaly. Headaches and chronic irritating cough were also seen in some cases. One of the seven cases was completely asymptomatic and diagnosed on the basis or epidemiologic follow-up of an index case. Tha incubation period is difficult to accurately measure. However, in these cases, the onset of symptoms varied from weeks to months after leaving SWA. A serum Indirect Immunofluorescent Antibody (IFA) test is available at Walter Reed Army Institute of Research (WRAIR) through the Walter Reed Army Medica1 Center, however, there is no commercially available seroloqic test currently available in the United States to confirm infection. With this test, in patients
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