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File: 970207_aadcs_003.txtwith suggestive signs and symptoms of this leishmania infection, a serum IFA equa1 to or greater than 1:32 suggests infection. Diagnosis can be confirmed by identifying the organism in tissue and culturing a bone marrow aspirate. Smears of the aspirate were negative by Giemsa stain, but the organism was detected at WRAIR using anti-leishmania monoclonal antibodies tagged with fluorescein. The treatment of choice is sodium stibogluconate (Pentostam), an investigational new drug (IND) produced by Wellcome Trust of Great Britain. It is available under protocol to military physicians at Walter Reed Army Medical Center through Walter Reed Army Institute of Research, Washington, DC and to civilian Physicians from the Centers for Disease Control (CDC), Atlanta, Georgia. Five of these seven cases were treated with sodium stibogluconate. In two of these five cases, treatment was discontinued early because of thrombocytopenia. Following treatment, all five patients recovered, returned to duty and are being followed. A sixth case was asymptomatic, therefore, not treated with sodium stibogluconate and is being followed closely. The seventh and most recent case is still under care at Walter Reed Army Medical Center. The military Medical Departments are actively increasing their case finding efforts by heightening awarenese of both military and civilian physicians to this clinical situation. Since many of our military personnel who deploy to the Gulf were reservist who, if i11, would visit their persona1 civilian physician in the private sector, the COC and FDA arc participating in this effort. Transmission of the organism is by the bite of a sandfly. Man is an incidental host. Person-to-person transmission of this form has not been reported. There have been five cases reported in the world literature of visceral leishmaniasis (L, donovani) transmitted through blood transfusions. No case of transfusion-associated transmission has been reported with L. tropica but a theoretical risk exists. Therefore, as a conservative safety precaution due to this theoretical risk and the absence of a simple screening test, the Assistant Secretary of Defense (Health Affairs) has directed the military services to deter, until further notice, all personnel form blood donation who were stationed in Saudi Arabia, Kuwait, Iraq, Bahrain, Qatar, United Arab Emirates, Oman and Yemen from August 1990 and thereafter. Blood products already collected from Gulf War returnees currently in the inventory are not being withdrawn because of the very low risk of contamination balanced against the risk of a sudden shortfall of critical blood supplies. Under current procedures, donors who were symptomatic or blood units with an elevated ALT level would have already been excluded. None of the identified cases have donated blood and all patient with any form of leishmaniasis are permanently deferred from future donations.
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