Tiny Enemy Adds to War's Misery

Article excerpt

Byline: Eric Athas The Washington Post

Mason Alsaleh was sound asleep when he was attacked at a U.S. Army outpost in northwest Iraq.

What happened that August night last year left the 48-year-old interpreter disfigured and unable to sleep, his mind muddled with paranoia, his temper short.

But Alsaleh's injuries -- including what look today like third-degree burns on his neck and arm -- weren't caused by gunfire or an explosion. His enemy that night was a tiny insect that injected a flesh-eating parasite into his skin.

Alsaleh, a Jordanian-born military contractor who works for Falls Church, Va.-based Global Linguist Solutions, is a victim of leishmaniasis, a disease carried by sand flies that is sometimes called Baghdad Boil. He remembers that when he first got to his mattress in an old building on a contingency base, it was covered in sand flies. He brushed them away.

"It looked like a bug bite," Alsaleh said of the lesions he got on his neck and elbow while the brigade he was working with was based northwest of Mosul. "And it grew and grew and grew, and then started to ooze."

The disease, which the World Health Organization says affects 12 million people worldwide, received considerable media and political attention in 2003 during the U.S. invasion of Iraq, when

hundreds of soldiers began to spot red bumps on their skin that swelled for weeks before rupturing into seeping wounds. The number of cases dropped to a handful a month by last year, but as more U.S. troops make their way into Afghanistan, doctors and military personnel are warning that the number of cases could tick back up.

Although it's not commonly found in the United States, leishmaniasis is considered endemic in 88 countries and is most prevalent in Afghanistan, Brazil, Bangladesh, India, Nepal, Sudan, Bolivia, Peru, Saudi Arabia and Syria.

When an infected sand fly bites a human, it injects the parasite under the skin, where they multiply and eventually cause an ulcer in the skin, explains Col. Glenn Wortmann, chief of the Infectious Diseases Service at Walter Reed Army Medical Center.

Alsaleh discovered that the treatment was almost as traumatizing as the disease itself. The medication commonly recommended by doctors is Pentostam, which is administered in 20-injection doses and is "associated with a tremendous number of side effects," said Wortmann.

Most patients who use Pentostam are plagued for months by an aggravated pancreas and liver, as well as severe muscle and joint pains, said Wortmann. …