title: Visceral infection caused by Leishmania tropica in veterans of Operation Desert Storm.
abstract: BACKGROUND
  Visceral leishmaniasis, usually caused by Leishmania donovani, has rarely been reported from eastern Saudi Arabia, so it was not expected to affect the soldiers of Operation Desert Storm.
  
  
  METHODS
  We evaluated eight soldiers with visceral leishmanial infection, examining their serum with an immunofluorescent-antibody assay, examining their marrow or biopsy tissue for amastigotes with an indirect immunofluorescent-monoclonal-antibody assay, and culturing the parasites. Cultured promastigotes were isolated and characterized by isoenzyme analysis.
  
  
  RESULTS
  None of the eight soldiers had classic signs or symptoms of visceral leishmaniasis (kala-azar). Seven soldiers had unexplained fever, chronic fatigue, malaise, cough, intermittent diarrhea, or abdominal pain that began up to seven months after they returned to the United States; one had no symptoms. Five had adenopathy or mild, transient hepatosplenomegaly. None had cutaneous manifestations. Diagnoses were made by bone marrow aspiration (seven patients) or lymph-node biopsy (one patient). Six isolates have been identified as L. tropica, which usually causes only cutaneous disease. Of the six patients treated with sodium stibogluconate, five improved and one remained symptomatic.
  
  
  CONCLUSIONS
  L. tropica can produce visceral infection that can cause unexplained systemic illness in persons returning from areas where this organism is endemic.
authors.affiliation: Infectious Disease Section, Walter Reed Army Medical Center, Washington, DC 20307-5100.
authors.forename: A J
authors.initials: AJ
authors.lastname: Magill
authors.forename: M
authors.initials: M
authors.lastname: Grögl
authors.forename: R A
authors.initials: RA
authors.lastname: Gasser
authors.forename: W
authors.initials: W
authors.lastname: Sun
authors.forename: C N
authors.initials: CN
authors.lastname: Oster
mesh_terms: D000328:Adult; D000818:Animals; D003937:Diagnosis, Differential; D006801:Humans; D007893:Leishmania donovani / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000469:parasitology; D008297:Male; D008889:Military Personnel; D012529:Saudi Arabia; D014481:United States