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Previous Volume 328:1383-1387 May 13, 1993 Number 19 Next

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ABSTRACT

Background Visceral leishmaniasis, usually caused by Leishmania donovani, has rarely been reported from eastern Saudi Arabia, so it was not expected to affect the soldiers of Operation Desert Storm.

Methods We evaluated eight soldiers with visceral leishmanial infection, examining their serum with an immunofluorescent-antibody assay, examining their marrow or biopsy tissue for amastigotes with an indirect immunofluorescent-monoclonal-antibody assay, and culturing the parasites. Cultured promastigotes were isolated and characterized by isoenzyme analysis.

Results None of the eight soldiers had classic signs or symptoms of visceral leishmaniasis (kala-azar). Seven soldiers had unexplained fever, chronic fatigue, malaise, cough, intermittent diarrhea, or abdominal pain that began up to seven months after they returned to the United States; one had no symptoms. Five had adenopathy or mild, transient hepatosplenomegaly. None had cutaneous manifestations. Diagnoses were made by bone marrow aspiration (seven patients) or lymph-node biopsy (one patient). Six isolates have been identified as L. tropica, which usually causes only cutaneous disease. Of the six patients treated with sodium stibogluconate, five improved and one remained symptomatic.

Conclusions L. tropica can produce visceral infection that can cause unexplained systemic illness in persons returning from areas where this organism is endemic.

Source Information

From the Infectious Disease Section, Walter Reed Army Medical Center (A.J.M., R.A.G., W.S., C.N.O.), and the Division of Experimental Therapeutics, Walter Reed Army Institute of Research (M.G.), both in Washington, D.C. The opinions or assertions herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army or the Air Force or the Department of Defense.

Address reprint requests to Dr. Magill at the Department of Immunology, Walter Reed Army Institute of Research, Washington, DC 20307-5100.

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Visceral Leishmaniasis in Desert Storm Veterans
Boyer M. H., Magill A. J., Grogl M., Gasser R. A., Oster C. N.
Extract | Full Text  
N Engl J Med 1993; 329:1503-1504, Nov 11, 1993. Correspondence

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