Leishmaniasis among Desert Storm veterans: a diagnostic and therapeutic dilemma

Troops stationed in the Middle East during Operations Desert Shield/Storm were potentially exposed to leishmaniasis, a parasitic infection transmitted by sandflies. In this region, infection primarily causes cutaneous and, less often, visceral disease. Visceral leishmaniasis, which typically has an incubation period of several months, can be a difficult diagnosis as it presents with a wide range of symptoms and there are no non-invasive, reliable diagnostic tests. Cutaneous leishmaniasis is more easily diagnosed using culture and stained smears of biopsy and aspirate samples from skin lesions. Pentavalent antimonials are most often used to treat leishmaniasis; however, treatment is potentially toxic and not recommended except in cases of documented disease.