VISCERAL INFECTION CAUSED BY LEISHMANIA-TROPICA IN VETERANS OF OPERATION DESERT STORM

Background. visceral leishmaniasis, usually caused by Leishmania donov ani, has rarely been reported from eastern Saudi Arabia, so it was not expected to affect the soldiers of Operation Desert Storm. Methods. W e evaluated eight soldiers with visceral leishmanial infection, examin ing their serum with an immunofluorescent-antibody assay, examining th eir marrow or biopsy tissue for amastigotes with an indirect immunoflu orescent-monoclonal-antibody assay, and culturing the parasites. Cultu red promastigotes were isolated and characterized by isoenzyme analysi s. Results. None of the eight soldiers had classic signs or symptoms o f visceral leishmaniasis (kala-azar). Seven soldiers had unexplained f ever, chronic fatigue, malaise, cough, intermittent diarrhea, or abdom inal pain that began up to seven months after they returned to the Uni ted States; one had no symptoms. Five had adenopathy or mild, transien t hepatosplenomegaly. None had cutaneous manifestations. Diagnoses wer e 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 wi th 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 thi s organism is endemic.