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Will The Baghdad Boil Burst?
Toward a prevention strategy on the ground.


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–”It feels like being hit with a truck, and that’s just the treatment,” said Zachary Lasiter. Private Lasiter, of the 4th Mechanized Infantry Division is safely home in his native Alaska and is recovering from “Baghdad Boil,” a very nasty disease. Others are still hospitalized in Iraq and the rest of Southwest Asia where the disease, more properly called Leishmaniasis, flourishes. In its most unpleasant form, visceral Leishmaniasis, organ failure, and death can result, and tens of thousands of young children die of it every year.

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Private Lasiter is unlucky in having been one of the 170 American troops, in the past year, who have fallen victim to this disease spread by the bite of the tiny sandfly. But thousands of American servicemen, as well as the other allies, including the Poles, Australians, and Brits are being bitten. The incubation period for the disease is up to six months, so thousands could have the disease without yet knowing it. Even the naturally conservative Army medic, Lt. Colonel Peter Wiena, a Leishmaniasis expert, considers there will be over 400 cases by the end of April.

Troops can prevent themselves from being bitten, but for many, their deployment was done in such a hurry that Leishmaniasis prophylaxis was not high on the agenda. That decision is coming back to bite (so to speak) allied servicemen. Given that our troops risk their lives everyday from terrorist attacks, more should be done to combat entirely preventable diseases. Being slack about prevention is also a false economy because each case leads to hospitalization, which may in the future cost more than the preventative measures required for all troops.

The main methods of prevention are bug spray and thinly meshed bed nets, as well as staying in tents through the night–when the flies are most active. Uniforms can also be sprayed with the insecticide permethrin, but re-spraying has to be done every four to five washes and that’s not routine in most hostile environments.

According to former Navy surgeon general, Vice Admiral Harold Koenig, it would be better to spray the clothes with DDT, which persists longer and is better at combating most bugs, including malarial mosquitoes, than permethrin. Unfortunately, while the military was prepared to take on Saddam Hussein it isn’t prepared to take on the domestic Green movement, which would allege all sorts of nasty effects on the troops if DDT were to be widely deployed. DDT has never harmed anyone; only fear of bad publicity stops the military from using it. But as Admiral Koenig points out, 22 percent of the U.S. Marines who went to Liberia last year contracted malaria. Deploying a safe insecticide like DDT would make sense when an age-old and easily preventable disease like malaria has a far greater attrition rate on troops than conflict.

WHAT IS BAGHDAD BOIL?

Leishmaniasis is a parasitic protozoan, transmitted by the phlebotomine sandfly, an insect no weightier than an eyelash. The sandfly’s bites lead to nasty lesions up to one and a half inches in diameter (hence the name, “Baghdad Boil”) and can take months to heal. The bites are always a nuisance, but in Iraq about 1.2 percent of sandflies carry Leishmaniasis. In some places, however, like Baghdad, the percentage is close to zero, while in places like Tikrit and Nasiriyah, it’s nearer 3 percent and 2 percent, respectively. For those who contract Leishmaniasis weeks of hospital treatment with some very strong drugs is required. Nearly all patients experience side effects from the drug, which include debilitating fevers and headaches, incredible fatigue, and other conditions including chemical pancreatitis.

The best drug for treating Leishmaniasis is called Pentosam, registered in Britain since 1978. This drug, which is based on the heavy metal, antimony, is not registered in the United States. U.S. servicemen are being treated with it because the surgeon general of the Army has a special arrangement with the Food and Drug Administration for “Investigational New Drug Protocols,” and the Centers for Disease Control maintain a supply. INDP is an odd way of describing a drug that was originally developed in the 1950s, but at least the troops are able to get it. If a civilian like me were to find himself with the “Baghdad Boil,” I’d have to fly to England to buy the drug or hope the CDC in Atlanta looked kindly on me.

The Marines in Liberia were not so lucky. The lack of registration of the best anti-malarial (Coartem, an artemisinin-based combination therapy) meant that those with malaria had to undergo more protracted and painful treatment than would otherwise have been necessary.

For those troops returning home who were bitten by sandflies and who develop fevers, being tested for Leishmaniasis will not be that easy. Few U.S. Army doctors (and probably no civilian doctors) will have ever seen a case, and if it is of the visceral variety, then long-term organ damage can result if the disease remains untreated. Those men most at risk will probably be servicemen who quit the army after returning home since they will not have regular medical checkups as a result.

For those troops still on the ground, the nuisance continues. “One night I was bitten over 200 times,” said Stephen Jones, a British Army corporal. “I hope I don’t develop the boil,” he added. It remains to be seen how many of Corporal Jones’s colleagues develop the disease. The allied armies are aware of the problem, they have the best experts there to advise, and no one is likely to die. But the allies should not just make an exception for unregistered drugs, but unregistered insecticides too. For preventing the Baghdad Boil is far preferable to treating it.

Dr. Roger Bate is a fellow of the American Enterprise Institute and a director of health-advocacy group Africa Fighting Malaria.



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