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  • Texas - Leishmaniasis Parasite Habitat Is Locally Advanced

    Leishmaniasis Parasite Habitat Is Locally Advanced



    By Michael Smith, Senior Staff Writer, MedPage Today
    Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
    September 14, 2007

    DALLAS, Sept. 14 -- The natural habitat of the parasite that causes leishmaniasis, the so-called Baghdad boil, is creeping north, doctors here have warned.

    <o:p></o:p> Action Points
    • Explain to interested patients that leishmaniasis is caused by a parasite and symptoms can range from relatively mild, although painful, to life-threatening, depending on the species.<o:p></o:p>
    • Note that this study reports nine cases of Leishmania mexicana in Texas, in a region where the parasite has not been thought to be endemic.<o:p></o:p>

    <o:p></o:p> Nine patients have been diagnosed with leishmaniasis in north Texas, way out of the parasite's normal range, according to Kent Aftergut, M.D., a clinical instructor of dermatology at the University of Texas Southwestern Medical Center and in private practice at Methodist Charlton Medical Center here.

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    Leishmaniasis is common in South America, Mexico and in the Middle East and many cases have been seen in troops returning from Iraq and Afghanistan. It has also been reported in south Texas.

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    But none of the nine patients here had traveled to areas where the parasite is endemic, leading Dr. Aftergut and colleagues to conclude they had acquired the disease locally.

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    Dr. Aftergut said he began to suspect something was amiss when a man from Waxahachie, south of Dallas, came to his office with sores that were refusing to heal and "looked clinically like leishmaniasis."

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    But because there had never been a report of locally acquired leishmaniasis and the man said he had not traveled in recent years, "we sort of ruled it out," Dr. Aftergut said.

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    Nevertheless, he said, he performed a biopsy and sent it to a pathologist to be cultured for the parasite, and the culture came back positive for Leishmania mexicana, a relatively benign parasite that affects only the skin.

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    Jolted by the discovery, Dr. Aftergut asked colleagues to look at their records, only to find another eight recent cases in the area around Dallas, in which none of the patients had traveled to endemic areas.

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    All of the patients had the relatively benign L. mexicana, he said.

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    "It makes skin sores, but the infection doesn't spread and become a full body disease like some of the others species of Leishmania," he said.
    "Usually, if patients have a normal immune system, the sores will resolve in six to 12 months and won't make the patients ill."<o:p></o:p>
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    On the other hand, the sores are painful and most patients would prefer not to wait it out.

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    For L. mexicana - because the sores are localized - a treatment option is to remove the lesions surgically and follow up with an antifungal medication, Dr. Aftergut said.

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    Waiting "was not an option," for his patient, so Dr. Aftergut removed the lesions and treated the man for three months with fluconazole (Diflucan) to achieve a cure.

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    Other forms of leishmaniasis - especially those that affect internal organs, such as L. braziliensis - may require treatment with infusions of sodium stibogluconate.

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    But that medication has several potential adverse effects - it is phlebotoxic, can cause pancreatitis, and patients must be monitored by electrocardiogram during the infusion to guard against cardiac conduction disturbances. It can also cause nausea, vomiting diarrhea, and anaphylaxis, among other things.

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    "It's not easy to take," Dr. Aftergut said.

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    He said most clinicians would suspect leishmaniasis if they had a patient with non-healing sores that were negative on culture for a bacterial culprit - as long as the patient had recently traveled to an endemic area.

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    "Most doctors would know -- it even has a nickname, Baghdad boil," he said.

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    The implication of this outbreak is that doctors should be aware of the possibility, even if there's no obvious route of exposure. "You need to suspect it," he said.

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    The parasite is passed to humans by the bite of a sandfly and the animal vector is the burrowing wood rat, Dr. Aftergut said.



    People in rural areas may be more at risk, he added, but using insecticides, bug repellant and protective clothing may afford some protection.

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    A report of the outbreak has been submitted to the Journal of the American Academy of Dermatology, he said.

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    Additional General Infectious Disease Coverage

  • #2
    Re: Leishmaniasis Parasite Habitat Is Locally Advanced

    Infectious Skin Disease Popping Up In Texas

    Chris Salcedo Reporting

    (CBS 11 News) DALLAS A rare infectious skin disease is popping up in North Texas, and there is no cure.

    It's called Leishmaniasis, or "Baghdad Boils" by the troops serving overseas. The disease is found in South America, Mexico and the Middle East. But now, it has made an appearance locally.

    The nine cases found in North Texas over the past 18 months did not originate in the Middle East. The particular strain that doctors are finding is called Leishmaniasis Mexicana, and it originated here.

    Dr. Doug Hardy, an infectious disease specialist at U.T. Southwestern, described the disease. "They can look kind of like an abscess, but they're not really an abscess. They can look like an ulcer," he explained. "It might look kind of wet, but it doesn't really drain. It's a little parasite, and it doesn't respond to antibiotics. It doesn't respond to the standard treatments that we might use on a fungal skin infection."

    The disease is typically transmitted by infected biting sand flies, not human-to-human.

    Although there is no cure, the boils will go away by themselves within 6 to 12 months.

    According to Hardy, there is not a cure in the United States because the disease had not been prevalent here.

    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

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    • #3
      Re: Texas - Leishmaniasis Parasite Habitat Is Locally Advanced

      Dermatologists Identify North Texas Leishmaniasis Outbreak

      <!-- BODY BEGIN --> Science Daily ? A team of dermatologists and dermatopathologists at UT Southwestern Medical Center has identified nine North Texas cases of an infectious skin disease common in South America, Mexico and in the Middle East, where it is sometimes referred to as a "Baghdad boil."<!-- Originally posted on ScienceDaily 2007-09-17 -->


      Numerous cases of the disease, called leishmaniasis, have been reported in troops returning from Iraq and Afghanistan. But for the first time, cases of this dangerous infection are appearing in North Texas in patients who have not traveled to endemic areas.

      The infection causes nonhealing sores that can be the size of a half-dollar or larger and that look like boils. These sores usually last for 6 to 12 months and because they are often mistaken for a staph infection, patients may have been given multiple courses of standard antibiotics without success.
      The disease is caused by a single-celled parasite called Leishmania, and special cultures must be done in order to confirm the diagnosis of leishmaniasis.

      The identified cases were from Waxahachie, Hillsboro and Glenn Heights, all areas south of Dallas; Tom Bean, Anna, Savoy and Nevada, all north of Dallas; and North Richland Hills.

      North Texas doctors must have a high index of suspicion and understand that this organism must now be considered endemic in this area, said Dr. Kent Aftergut, a clinical instructor of dermatology at UT Southwestern and in private practice at Methodist Charlton Medical Center.

      "Luckily, all of the leishmaniasis cases in North Texas that have been cultured have grown Leishmania mexicana, which is less dangerous than other forms of the parasite," he said. "It makes skin sores, but the infection doesn't spread and become a full body disease like some of the others species of Leishmania. Usually, if patients have a normal immune system, the sores will resolve in six to 12 months and won't make the patients ill."

      In North Texas, doctors suspect that the process leading to human infection begins when a sand fly bites a rodent called the burrowing wood rat, which carries the parasite. When the sand fly later bites a person, the sores may develop, said Dr. Aftergut, who began tracking cases in North Texas after identifying the ailment in a patient who had been simply working outside in his yard and had no travel history to areas of infection.

      "If a patient has been in Iraq or another known endemic area, we are very used to looking for leishmaniasis. But in the past, you just would not have suspected it in a patient living in North Texas with no travel history. This is why I think it's important to get the word out to other health-care professionals," Dr. Aftergut said.

      For many years sporadic cases have been seen in South Texas. But no one has ever reported cases this far north, Dr. Aftergut said. He said this may be due to a movement in either the burrowing wood rat or the sand flies that transmit the infection to humans, although the reason for this movement is unclear.

      "There are nine cases of leishmaniasis in North Texas residents who had no travel history in the last two years," said Dr. Aftergut. "This is very strong evidence that the areas we need to consider endemic are moving north."Dr. Aftergut said he believes that rural areas are more at risk due to their proximity to wooded areas, where the burrowing wood rat and sand flies are more likely to be found.

      Dr. Aftergut said using insecticides, bug repellant and protective clothing while working in areas where sand flies might be present should help reduce exposure. Once bitten, there are two types of medicines to treat the infection; however, one treatment can be toxic to some patients.

      Doctors who identify a possible case of leishmaniasis should contact the Centers for Disease Control and Prevention, which can assist with the special tests needed to verify it. The federal agency also is tracking cases, Dr. Aftergut said.

      Note: This story has been adapted from a news release issued by UT Southwestern Medical Center.
      Learn about dental savings plans and dental insurance, how to save money on dental care and maintain a healthy smile on the DentalPlans.com blog.

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