Rupal M Mody1, Ines Lakhal-Naouar2, Jeffrey E Sherwood1, Nancy L Koles2, Dutchabong Shaw3, Daniel P Bigley4, Edgie-Mark A Co5, Nathanial K Copeland6, Linda L Jagodzinski6, Rami M Mukbel7, Rebecca A Smiley8, Robert C Duncan9, Shaden Kamhawi10, Selma M B Jeronimo11,12, Robert F DeFraites13, Naomi E Aronson2. 1. Infectious Diseases Department, William Beaumont Army Medical Center, El Paso, Texas. 2. Infectious Diseases Division, Uniformed Services University of the Health Sciences. 3. Clinical Research Unit, Uniformed Services University of the Health Sciences, Bethesda, Maryland. 4. DiLorenzo TRICARE Health Clinic-Pentagon, Washington, D.C. 5. Internal Medicine Department, William Beaumont Army Medical Center, El Paso, Texas. 6. Walter Reed Army Institute of Research, Silver Spring, Maryland. 7. Department of Basic Veterinary Sciences, Jordan University of Science and Technology, Irbid, Jordan. 8. Department of Clinical Investigations, William Beaumont Army Medical Center, El Paso, Texas. 9. Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring. 10. Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland. 11. Department of Biochemistry and Institute of Tropical Medicine at Rio Grande do Norte, Natal. 12. National Institute of Science and Technology of Tropical Diseases, Salvador, Bahia, Brazil. 13. Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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 enzyme-linked immunosorbent assay (ELISA), rk39 test strips, quantitative polymerase chain reaction (PCR), and interferon gamma release (IGRA) assays. Statistical analyses included Fisher exact test, Pearson χ2 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. 64% were seropositive for Phlebotomus alexandri saliva antibodies. Prevalence of AVL (any positive test result) was 39/200 (19.5%, 95% confidence interval 14.4%-25.8%). Two (1.0%) PCR, 10 (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (P = .01). CONCLUSION: AVL was identified in 19.5% of OIF deployers; travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in US veterans and to target additional blood safety and surveillance measures. Published by Oxford University Press for the Infectious Diseases Society of America 2018.
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 enzyme-linked immunosorbent assay (ELISA), rk39 test strips, quantitative polymerase chain reaction (PCR), and interferon gamma release (IGRA) assays. Statistical analyses included Fisher exact test, Pearson χ2 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. 64% were seropositive for Phlebotomus alexandri saliva antibodies. Prevalence of AVL (any positive test result) was 39/200 (19.5%, 95% confidence interval 14.4%-25.8%). Two (1.0%) PCR, 10 (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (P = .01). CONCLUSION: AVL was identified in 19.5% of OIF deployers; travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in US veterans and to target additional blood safety and surveillance measures. Published by Oxford University Press for the Infectious Diseases Society of America 2018.
Entities:
Keywords:
Iraq; US soldiers; asymptomatic; deployed; visceral leishmaniasis
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