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Skin disease takes toll on Colombian soldiers
Leishmaniasis is rarely fatal, but leaves its victims with open sores
, Copyright 2008 Houston Chronicle South America Bureau |
October 17, 2008
Photo By MARCELO SALINAS/FOR THE CHRONICLEColombian soldiers face threats from rebels and a flesh-eating parasite during operations in Colombian jungles.
BOGOTA, COLOMBIA — A tiny but debilitating enemy is stalking Colombian soldiers as they hunt for Marxist rebels deep in the jungle: the sand fly.
The insect carries a parasite that causes a flesh-eating disease called leishmaniasis.
Though rarely fatal, the disease (pronounced LEASH-ma-NYE-a-sis) produces rotting open sores on the skin. Infected troops must be evacuated to hospitals in urban areas for treatment and lengthy convalescences.
Amid a military offensive that has vastly improved security in Colombia, soldiers are spending longer periods in rain-forest zones swarming with sand flies, provoking a huge new caseload.
"The numbers have gone way up," said Lt. Col. Hugo Mosos, commander of the army's health battalion, which operates a sprawling clinic in Bogota. "It affects morale because in a company of 60 men, 20 or 30 might come down with leishmaniasis."
In fact, far more troops are evacuated for treatment of the disease than for wounds from bullets or landmines. One officer recalled a mission last year when 115 soldiers in a battalion of 250 came down with the disease and had to be pulled out of the jungle.
Last year, 14,000 cases were reported, mostly among soldiers.
Experts say that the true infection rate is much higher because leishmaniasis is common among the guerrillas, people displaced by the war, and families living in remote communities far from clinics.
"Like dengue fever or malaria, it's an extraordinarily under-reported disease," said Dr. Edward R. Rensimer, director of the International Medicine Center in Houston, who has treated cases of leishmaniasis among American soldiers and civilian contractors returning from the Iraq war.
Leishmaniasis is transmitted by tiny, sand-colored flies. The female requires the protein in blood to develop her eggs and, while feeding, picks up leishmania parasites from infected humans, dogs or rodents. She transmits the parasites the next time she bites.
The disease is less common than malaria or dengue fever, which are transmitted by mosquitoes, partly because the sand flies are incapable of flying long distances — they often hop rather than fly. The flies also require heat, humidity and organic matter for their larvae.
Even so, the World Health Organization warns that 350 million people in 88 countries — mainly in Latin America, Asia and the Middle East — are at risk and that 2 million new cases are reported each year. Researchers at the University of Hull in England told the Web site Science Daily that global warming could increase the number of countries colonized by the sand fly.
Although the disease is not endemic to the United States, more than 2,500 U.S. troops have been infected in Afghani-stan and Iraq, where it is sometimes called "Baghdad Boil."
One manifestation of the disease can destroy the mucous membranes of the mouth, nose and throat. Visceral leishmaniasis, the rarest form, attacks the liver and spleen and can be fatal if left untreated.
Cure worse than diseaseUnlike malaria and other tropical diseases that can be treated fairly rapidly with pills, leishmaniasis requires a series of toxic booster shots over one or two months that can provoke severe body aches and leave patients weak and bedridden.
"The cure is worse than the disease," said Dr. Maria Consuelo Miranda, an expert in leishmaniasis in Cali, Colombia.
Luis Eladio Perez, a Colombian politician held hostage by the guerrillas for seven years, suffered several bouts of leishmaniasis, which was often called "jungle cancer."
Although he managed to escape at one point, the booster shots administered by the rebels left him too weak to hike through the wilderness, and he was recaptured.
Until recently, leishmaniasis wasn't much of a factor for the Colombian army. Troops were based in towns and cities and rarely spent much time in the jungle.
Ignorance, superstitionBut under President Alvaro Uribe, who was first elected in 2002, the army has been on an almost permanent offensive. Soldiers now spend months in the jungle tracking guerrillas. One army officer said that the rebels sometimes purposely lure troops into areas teeming with sand flies.
Part of the problem is lack of awareness about the disease and superstition. Some soldiers believe that by praying or by carrying a dead mosquito in their wallet they can ward off the disease, said Maj. Marta Robago, who treats leishmaniasis at the army medical center in Bogota.
The drug used to treat the disease, Glucantime, is expensive and tightly controlled by the government to keep it from falling into the hands of the guerrillas.
Nonetheless, the rebels often buy the drug in Venezuela or Brazil and sometimes steal it from rural clinics or from ambulances. More rustic remedies include exploding gun powder over the skin ulcers in order to kill the parasites.
The army has launched an education campaign, including pamphlets reminding troops to use bed nets and bug spray while soldiers heading into the jungle are issued uniforms impregnated with insect repellent.