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Clin Infect Dis. 2018 Sep 20. doi: 10.1093/cid/ciy811. [Epub ahead of print]

Asymptomatic Visceral Leishmania infantum Infection in U.S. Soldiers Deployed to Iraq.

Author information

1
Infectious Diseases Department, William Beaumont Army Medical Center, El Paso, TX.
2
Infectious Diseases Division, Uniformed Services University of the Health Sciences, Bethesda MD.
3
M.T.M&H, Infectious Diseases Department, William Beaumont Army Medical Center, El Paso, TX.
4
Clinical Research Unit, Uniformed Services University of the Health Sciences, Bethesda MD.
5
DiLorenzo TRICARE Health Clinic-Pentagon, Washington DC.
6
Internal Medicine Department, William Beaumont Army Medical Center, El Paso, TX.
7
M.T.M&H, Walter Reed Army Institute of Research, Silver Spring MD.
8
Walter Reed Army Institute of Research, Silver Spring, MD.
9
Department of Basic Veterinary Sciences, Jordan University of Science and Technology, Irbid, Jordan.
10
Department of Clinical Investigations, William Beaumont Army Medical Center, El Paso, TX.
11
Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD.
12
Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville MD.
13
Department of Biochemistry and Institute of Tropical Medicine at Rio Grande do Norte, Natal, RN, Brazil and National Institute of Science and Technology of Tropical Diseases, Salvador, BA, Brazil.
14
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda MD.

Abstract

Background:

Visceral leishmaniasis (VL), due to Leishmania infantum, is a persistent intracellular parasitic infection transmitted by the bite of infected sand flies. Symptomatic VL has been reported in U.S. soldiers with Iraq deployment. Untreated symptomatic VL can be fatal; asymptomatic VL (AVL) may establish a lifelong risk of reactivation. We report prevalence and AVL risk factors in Operation Iraqi Freedom (OIF) deployers during 2002-11.

Methods:

Healthy soldiers exposed to VL endemic areas in Iraq and 50 controls who never traveled to endemic regions were recruited through military healthcare facilities (2015-17). Responses to a risk factor survey and blood samples were obtained. Leishmania research diagnostics utilized included ELISA, rk39 test strips, quantitative PCR, and interferon gamma release (IGRA) assays. Statistical analyses included Fisher's exact test, Pearson's Chi square test, Mann-Whitney U test, and logistic regression.

Results:

200 deployed subjects were enrolled, mostly males (84.0%), of white ethnicity (79.0%), and median age 41 (range 24-61) years. Vector exposure was high with 64% seropositive for Ph. alexandri saliva antibodies. Prevalence of AVL (any positive test result) was 39/200 (19.5%, 95% CI 14.4%-25.8%). No subjects had positive rK39 test results. Two (1.0%) PCR, ten (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (p=0.01).

Conclusion:

AVL was identified in 19.5 % of OIF deployers and travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in U.S. veterans and to target additional blood safety and surveillance measures.

PMID:
30239631
DOI:
10.1093/cid/ciy811

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