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Leishmaniasis. December 11th, 2003 Kirt P. Love Director, DSBR Contamination of American Blood supply, Gulf War I & II. Introduction. The 1990 -1991 Gulf War conflict was fought primarily during the winter season, so the issue of Sand Fly exposure was minimal. Still, what

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leishmaniasis
Leishmaniasis

December 11th, 2003

Kirt P. Love

Director, DSBR

Contamination of American

Blood supply, Gulf War I & II.

introduction
Introduction

The 1990 -1991 Gulf War conflict was fought primarily during the winter season, so the issue

of Sand Fly exposure was minimal. Still, what

has been overlooked by the military medical monitoring was that Leishmaniasis also flourishes

in wet pools, and then burrows into the feet of

their host.

dhsd wramc dhcc
DHSD – WRAMC - DHCC

Our organization met with the

Pentagons Deployment Health

Support Directorate on the

medical fate or troops

Deploying to Iraq in 2002.

September – December 2002

dhsd wramc dhcc4
DHSD – WRAMC - DHCC

Mike Kilpatrick of DHSD

stated that the indecisive PCR

test for Leishmaniasis still

needed work, and wasn’t

reliable.

September – December 2002

cutaneous vs l tropica
Cutaneous vs L. Tropica

Even though a directive was sent out

by the Army Surgeon General on

December 23rd, 2002 to monitor

Leishmaniasis during the present War.

Diagnosis in the feild was exclusively visual

observation for lesions. PCR labs or Splenic

asparate / Bone marrow were not available

in the desert for non-visual symptoms.

unicef outbreak
UNICEF - Outbreak

Outbreak of Kala-Azar (Visceral Leishmaniasis) in Iraq

UNICEF has announced an outbreak of Kala-Azar (Visceral Leishmaniasis) in

Iraq. Though there have been outbreaks of the disease in Iraq in the past

around this time of year, it is particularly severe this time.

There are now more than 200 cases of Kala-Azar reported in Iraq. The

country does see regular outbreaks of the disease.

UNICEF has warned that this time the outbreak could be severe.

Kala-Azar is spread mainly by sand flies and causes malnutrition and

anaemia. When left untreated, the disease is fatal within 4 to 6 weeks.

[Byline: Kamini Sawhney (Baghdad)]

Thu 29 May 2003

pl 105 85 monitoring
PL 105-85, & monitoring

Pre and Post deployment medical tracking of

the troops in Afghanistan and Iraq were hastily

done. So many did not give blood samples

before leaving, stored by the AFIP.

pl 105 85 monitoring8
PL 105-85, & monitoring

That blood taken before and after is strictly HIV

testing, and is not used for other test. The

Naval Research Medical Center, and others

have used it for limited recent studies, but it is

still strictly a military medical operation.

civilian monitoring
Civilian monitoring

American Physicians are not ready for this Exotic

Endemic disorder, and will miss cases having little

previous experience.

September 12th 2003, William Winkenwerder:

Under Secretary for Health, Veteran Affairs

Memorandum to Joint Chiefs of Staff, Leishmaniasis

“It is also possible that deployed personnel may

re-deploy without knowing they are infected”

monitoring
Monitoring

USA TODAYDecember 4, 2003

Coleman and Army Lt. Col. Peter Weina, a leishmaniasis

expert still in Iraq, predicted in April that there would be 400

cases, based on the number of bites seen and tests that show

about one out of 70 sand flies carries the bug.

New York Times - December 6, 2003Dr. Coleman found soldiers who got

more than 200 bites in a single night.

major vs tropica

L. donovaniL. mexicana

  • L. tropicaL. major
  • L. aethiopeca
Major vs Tropica

L Major - 1,500,00 cases world wide each year

L Tropica- 500,00 cases world wide each year

The Pentagon recognizes 12 cases of L. Tropica from the 1991 Gulf War, and 20 cases of L. Major.

The Pentagon is also trying to say there is almost no L. Tropica present in Iraq. WRAMC goes as far as to imply the Iraqi L. Tropica is less virulent.

elisa pcr

Institute of Microbiology and Hygiene, Humboldt University, Charite, Berlin, Germany.

  • 113 cases (69.7%) were positive by PCR
ELISA / PCR

Current ELISA accuracy is still between 32%

to 67% with 3 part control under ideal conditions.

Visceral tissue biopsies are only good after infection

is severe to terminal.

Sept 2003

visceral untreated
Visceral untreated

Office of Clinical and Regulatory Affairs,

National Center For Complementary and

Alternative Medicine, National Institutes of

Health

“visceral disease is incurable if untreated.”

treatments
Treatments

Drug of Choice:

Amphotericin B,

Streptomyces nodosus

(photo sensitive – 4 to 6

times a day )

$48.60 500mg

Not as effective with

Visceral:

Pentostam - Diflucan

100 MG 50 TAB $300.00

Too

Expensive!!

Alternatives:

Fluconazole

100 MG 50 TAB $300.00

Miltefosine (Impavido®)

$32.00 100 mg

incubation
Incubation

With no compulsary reporting of Leishmaniasis around the world, It is still undetermined what long term incubations could remain in remission until turning visceral. One case at WRAMC showed 43 years after a old cutaneous scar was irritated, the case developed

to visceral.

summary
Summary

With DOD unable to track this, or unwilling to pay for expensive advanced labs – there is no way of knowing for sure how many troops coming home will be infected or with what strain.

Until the lab detection procedures are 100% conclusive,

and species specific – isnt the risk of Leishmaniasis to

the general public from the troops too high.

recommendations
Recommendations

With undetermined long term latency for Leishmaniasis

( Tropica )and the uncertainty of today’s labs, we at DSBR

recommend to the FDA a permanent blood ban on all troops

coming home From Iraq, Afghanistan from 1990 to present.

At a minimum the soldiers blood should not be used in

Vat blood products, or plasma serum based products.