Sgt. Eric DiVona didn't notice the small bumps
on his face and left earlobe until he returned from serving nine
months in Iraq. Nothing much, he thought, probably just a spider
But soon those bumps erupted into open sores, one growing to the
size of a half dollar. The left side of his face puffed up, a
swelling that wouldn't go away. And he noticed he was not the only
one in his unit with such symptoms.
"A lot of people started coming down with sores," he said,
sitting at Walter Reed Army Medical Center with an IV taped to his
right arm. "It was like, 'You ain't cool unless you got it."'
What DiVona thought was a spider bite was actually caused by a
tiny sand fly with a fierce parasite stewing in its gut, an
organism that causes stubborn and ugly sores that linger for
Scientists and doctors refer to the disease caused by the
parasite as cutaneous leishmaniasis. But soldiers serving in
sand-fly rich Iraq call it, with little affection, the "Baghdad
The sores are not painful or contagious, but left untreated they
can last up to 18 months and leave permanent, burn-like scars.
Since the flies bite exposed areas, many soldiers have sores on
their necks, faces and arms.
Doctors at Walter Reed have seen 653 cases of leishmaniasis, and
the hospital's infectious disease wards until recently overflowed
with soldiers undergoing a 20-day treatment regimen.
"We see a few cases every year, but not the numbers we saw come
out of Iraq," said Col. Dallas Hack, chief of preventive medicine
at Walter Reed.
The military has made a big effort to treat leishmaniasis, even
pulling soldiers out of the field who have confirmed cases and
flying them back to Washington for medical care.
But Walter Reed doctors say it was almost inevitable that they
would see a high number of cases this year.
Leishmaniasis occurs in hot and tropical countries where sand
flies dwell, Hack said. Still, only about 20 soldiers got
leishmaniasis during the first Gulf War, and a handful more
contracted it in Afghanistan.
This time, though, American forces arrived in Iraq during the
peak season for sand flies and were in the field much longer. Many
slept outside at night, exposing themselves at the sand fly's
favorite feeding time.
Iraqis have also done little to control the problem, such as
using insecticide to kill off the flies, Hack said. Local residents
have come to accept the disease, he said, exposing young children
to sand flies in hopes of building immunity.
Doctors have told soldiers in Iraq what to look for and implored
them to wear bug spray. Medical teams with front-line combat troops
have tested sand flies for the parasite.
But with enemy bullets flying, the first concern of most
soldiers was not slathering on bug spray every morning.
"You didn't think about leishmaniasis too much," said Maj.
Eric Moore, who contracted the parasite on the Iran-Iraq border
with the 4th Infantry Division.
The lesions will eventually go away on their own and would not
affect a soldier's ability to serve. Even so, the military thought
it was important that soldiers with bad cases be flown out of Iraq
for treatment so they wouldn't be disfigured.
"For most soldiers, it isn't a war stopper," said Lt. Col.
Glenn Wortmann, an infectious disease physician at Walter Reed.
"But most patients want treatment so the thing will go away."
Walter Reed is one of only two hospitals where patients are sent
because the treatment can only be done in a clinical trial setting.
With domestic cases a rarity, Pentostam is not licensed in the
United States. However, the Army is developing a treatment that can
be used in the field.
Many soldiers didn't realize they had the boils until weeks
after exposure. DiVona remembers being bitten constantly by flies,
but he and other members of his unit didn't see any sores until
after they got home in November to Fort Campbell, Ky.
In Moore's unit of about 750 men, more than 200 came down with
leishmaniasis during a 10-month tour that ended in March. He was
relatively lucky - he has only one quarter-sized sore on his left
arm. Others had lesions all over their bodies, he said.
Moore isn't too worried about scarring. He predicts it will
delight his children, especially his 3-year-old, who has a
fascination with Band-Aids.
"They will probably think it's cool," he said while getting
his daily dose of a drug called Pentostam. "They'll probably say,
'Daddy has an ouchie."'