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Leishmaniasis

Cutaneous, Visceral, Mucocutaneous

In 1988 this is a word that even tourist barely heard from

the State Department as a travel warning. A little known third

world disease that was quite misunderstood. All the way back

to its Scottish origin of Sir William Boog Leishman in 1903.

Physicians Leishman, and Donovan discovered the cause

of a tropical disease known as Kala-Azar, caused by a

parasite spread by sandfly bites. It was a stained slide that

showed Leishmania donovani for the first time.

Even though Leishmania tropica and other variants had

been seen before 1903, it wasn't really understood until

the public explanation by Leishman and Donovan.

Leishmaniasis is commonly seen in tropical / sub-tropical

regions of Africa, Mediterranean, Southern Europe, Asia,

and South & Central America. Its estimated that 12 million

people are currently infected. 367 million are at risk of getting

leishmaniasis in 88 countries.

During the first Gulf War, it was claimed that only 20 cases

of L. Major ( Cutaneous Leishmaniasis ) surfaced among the

soldiers coming back. That 12 cases of L. Tropica ( Visceral

Leishmaniasis ) were diagnosed up to 1993.

To understand the strains and types, there are a few technical

notes that have to be spelled out. The disease has two parts in

its lifespan, the Zoonosis and the Anthroponotic. The

Promastigotes with tails starts in the Sandflies, and the

small internal round amastogote version thrives in human's.

The three different strains listed as Cutaneous, Visceral, and

Mucocutaneous exhibit different symptoms. Cutaneous is

skin, Visceral in internal organs, and Mucutaneous as related

to nasal or other mucous regions of the body.

At the point of contact of the sandfly in Cutaneous Leishmaniasis,

the Sandflies saliva is ejected onto the bite - in that saliva the

L. Tropica promastigotes burrow into the wound. From there

they swarm in the wound until the ulceration becomes visible.

Which becomes a long festering wound that doesn't seem to

heal for several months. This type of external wound will heal

in a year or so, but its uncertain if the person ever is completely

free of the organism. Scarring is a factor, and wounds by eyes

or other sensitive areas is a serious concern. The disease can

also lay dormant for many years before recurring in a later cut

or infection. But most of the time it resolves in a non-threatening

manner. The persons immune system is able to suppress it.

Visceral Leishmaniasis is much less understood, and a much

darker version of this parasite. Its transmitted also by the same

Sandflies, and in the bite wounds like Cutaneous. After that its

different in its lifecycle. It burrows deep into the organs, bone,

of the host. The early stages of the disease are so subtle

that a person might not know for several years they have it. It

so small that it doesn't show up in normal blood test, or even

in early tissue biopsies. Then when the disease is in it latter

stage does it start to make itself known. Once the Spleen

becomes enlarged, and the belly extends does it start making

it presence noticed. The strains of Leishmaniasis are usually

noted to be L. Infantum ( Infant Syndrome ) or L. Donovani.

Incubation period is considered between 3 to 33 weeks.

That diagnosis being made largely though a bone marrow

biopsy, and or splenic asparate. ( tissue sample from bone

marrow or spleen ). PCR ( DNA enzyme ) testing is still

considered unreliable in confirming this disease in 2005.

The newest test being a dry PCR to the wet PCR. Today

its largely found as a stained gel slide where someone

sees the amastogote in a cell, same as 1903.

What does a L. Donovani amastogote usually look like, a

cell with several nucleus parts to it. The closest rough

description would be a clear sack with multiple nucleus

spheres in it instead of one. A clear marble with a clover

like center. Without the features of a expected parasite,

its often overlooked - and even missed by laboratories

looking for it specifically. Its when the parasite is in its

late stage at 10 to the 15th power number of parasites,

and swarming that researchers are able to diagnose it.

The only American institution dealing with this disease on a

regular basis is Walter Reed Army Hospital in Washington,

DC. They work in conjunction with the Armed Forces Institute

of Pathology to track, type, and treat this disease in troops

coming back from Afghanistan and or Iraq.

Suspected number of current cases of Cutaneous Leishmaniasis

in these regions in American troops from January 2003 to May

2005 has been 848. Visceral has been 4 cases of L. Infantum

in that same period.

However, more than 200,000 citizens of Kabul Afghanistan were

diagnosed with Cutaneous Leishmaniasis in 2003 by the World

Health Organization. So chance of contagion there is high.

In December 2003 the FDA held a blood banking seminar to

discuss the possibility of contamination of the nations blood

supply by Leishmaniasis. It was there that the FDA decided a

lifetime ban on blood donations from persons diagnosed with

Leishmaniasis from Iraq should be imposed. Later the Pentagon

would make the same policy of us troops. Why a lifetime ban?

Because at this time there is no guarantee of a 100% sterile

cure of any version of Leishmaniasis. That fact was eluded to

by Barbara Herwaldt of the CDC when she presented her Power

Point to the VA Advisory Committees on Gulf War Veterans

that I served on in 2008-2009. ACGWV CDC 2009 presentation

By 2004 more than 1,500 soldiers�contracted Leishmaniasis in
Iraq that was not reported correctly.� First they said 253, then 500,
then 600, then 1,000 and the story�changed much of 2004. At this
time the screening method was�mostly visual based on skin
lesions. Very few had blood samples�sent to Walter Reed for
examination.

At the May 2005 Institute of Medicine Infectious Disease

meeting, Dr. Alan Magill of Walter Reed Army Hospital had

pointed out to the committee the dark sides of Leishmaniasis.

Part of which has been outlined in this over view.

The average American has never heard of this disease and general
medicine is not prepared to deal with foreign diseases. So as
these people developed symptoms that had no recourse. I heard
from one person who approached Walter Reed for blood testing
only to find them disinterested in identifying it. You need a genome
type of the strain to identify which species as there are several
in Iraq. L. Tropica and L. Major are the dominate ones. Oddly enough
we introduced L. Mexicana from troops that brought it to Iraq. It
seems Walter Reed doesnt want to know the exact strains, maybe
because identifying its point of origin would make the Pentagon
responsible for its spread.

Here is a snippet of a 2006 WRAMC publication:

Transfusion.

2006 Sep;46(9):1641-5.

Leishmania: risk to the blood supply.
Cardo LJ1.
Author information
� 1Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, USA. Lisa.Cardo@us.army.mil

Operation Iraqi Freedom and Operation Enduring Freedom
present a much greater Leishmania threat than did Operation
Desert Storm. Because most transmission by transfusion
occurs in endemic areas, and visceral infection is asymptomatic
in healthy individuals such as blood donors, it is difficult to
determine the absolute risk of transmission by transfusion, but
review of the literature provides many clues as to the appropriate
measures to be taken for blood donor deferral.

We at DSBR believe there are many more cases of Leishmaniasis

undiagnosed in America. That American contractors serving

in Iraq are coming home with it, soldiers, tourist. That the

diagnostic system in place across America are missing this

outbreak, and that in time it will be spread here through

transfusion, intimate contact, and possibly mosquito vectors.

Further, between troops from Iraq and Afghanistan that served

upwards of 5 tours - how many of those might have been infected

with any form of this parasite that was never seen by any medic

or reported. Could it be for every case there was one that didnt

report? 3, 5 or more. These people are donating blood any time

they want the rest of there lives. Meaning every time is like adding

another person to mix. Thousands of possible tainted blood

samples randomly mixed with health and no screening system

in place to detect this.

Once infected the medical system wont point back to tainted

blood but imply some other vector. Leishmaniasis positive people

in America are treated the same as third world individuals, and

have no rights under the current system. Once you have it, they

dont care how you got it. You pay out of your own pocket to

treat it, live with it, and even be mocked you claim to have it. This

is a orphan disease and why its ignored in America.

The Pentagon simply is hoping it will resolve itself when the

small number of infected people in America die off. Exceptable

loses versus owning up to the infiltration. But, there is no public

tracking system or effort to follow this so the number spreading

are uncertain for up to 40 years.

Testing can be done for the military at Walter Reed Army

Hospital, through Peter Weina at 301.319.9956 or email

peter.weina@na.amedd.army.mil http://www.pdhealth.mil/downloads/Leishmaniasis_DS_04272004.pdf

There is also the Armed Forces Institute of Pathology,

which has a Leishmaniasis Registry. Point of Contact

is Colonel Peter McEvoy mcevoy@afip.osd.mil

http://www.afip.org/leishsurvey.html

If you are a civilian contractor, you can go through; Parasitic Disease Consultants; http://parasiticdiseaseconsultants.com; A Clinical Laboratory for the Diagnosis of Parasitic,; Viral and Other Infectious Diseases.


At the IOM May 2005, Dr. Alan Magill said he did not know a
Arvid Brown of Michigan. Here is a copy of the July 12th 1998
WRAMC letter to VAMC Ann Arbor Michigan of the first ELISA
test results on Arvid Brown. From the book:
"Bloodmeal: ignored to death"

The independent lab "Parasitic Disease Consultants"
confirmation of Arvid Browns Leishmaniasis in 1998
"Bloodmeal: ignored to death" page 2

IOM:
Gulf War and Health: Infectious Diseases
Project Identification Number: HPDP-H-04-06-A
http://www.gulflink.org/iom4/iom4.htm
Slides of Richard Reithinger, Craig Hyams,
Mike Kilpatrick, Alan Magill

CDC:
Barbara Herwaldt slides to
December 2003 FDA Blood bank committee
CDC Leishmaniasis Slides

Kirt Love slides to the
December 2003 FDA Blood bank committee
Kirt Love Leishmaniasis Slides

Letters to DHSD from DSBR before the was
in Iraq of March 2003

August 3rd, 2002
Response to Kirt Love on Leishmaniasis - page 1
Response to Kirt Love on Leishmaniasis - page 2

September 20th, 2002
Janyce Brown to DHSD, 3 pages
November 15th, 2002
response letter from DHSD
DHSD response letter
May 2003
response from DHSD
Response to Kirt Love May 2003 page 1
Response to Kirt Love May 2003 page 2
Freedom Magazine
Volume 35 issue 1
Desert Storm Blows Back with a Fury

Deployment Quarterly Spring 2005
Quick Testing Approved For Leishmania Parasite