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          with suggestive signs and symptoms of this leishmania infection,
          a serum IFA equa1 to or greater than 1:32 suggests infection.
          Diagnosis can be confirmed by identifying the organism in tissue
          and culturing a bone marrow aspirate. Smears of the aspirate were
          negative by Giemsa stain, but the organism was detected at WRAIR
          using anti-leishmania monoclonal antibodies tagged with
          fluorescein.

          The treatment of choice is sodium stibogluconate (Pentostam),
          an investigational new drug (IND) produced by Wellcome Trust of
          Great Britain. It is available under protocol to military
          physicians at Walter Reed Army Medical Center through Walter Reed
          Army Institute of Research, Washington, DC and to civilian
          Physicians from the Centers for Disease Control (CDC), Atlanta,
          Georgia. Five of these seven cases were treated with sodium
          stibogluconate. In two of these five cases, treatment was
          discontinued early because of thrombocytopenia. Following
          treatment, all five patients recovered, returned to duty and are
          being followed. A sixth case was asymptomatic, therefore, not
          treated with sodium stibogluconate and is being followed closely.
          The seventh and most recent case is still under care at Walter
          Reed Army Medical Center.

          The military Medical Departments are actively increasing their
          case finding efforts by heightening awarenese of both military and
          civilian physicians to this clinical situation. Since many of our
          military personnel who deploy to the Gulf were reservist who, if
          i11, would visit their persona1 civilian physician in the private
          sector, the COC and FDA arc participating in this effort.

          Transmission of the organism is by the bite of a sandfly. Man
          is an incidental host. Person-to-person transmission of this form
          has not been reported.

         There have been five cases reported in the world literature of
         visceral leishmaniasis (L, donovani) transmitted through blood
         transfusions. No case of transfusion-associated transmission has
         been reported with L. tropica but a theoretical risk exists.
         Therefore, as a conservative safety precaution due to this
         theoretical risk and the absence of a simple screening test, the
         Assistant Secretary of Defense (Health Affairs) has directed the
         military services to deter, until further notice, all personnel
         form blood donation who were stationed in Saudi Arabia, Kuwait,
         Iraq, Bahrain, Qatar, United Arab Emirates, Oman and Yemen from
         August 1990 and thereafter.  
         Blood products already collected from Gulf War returnees
         currently in the inventory are not being withdrawn because of the
         very low risk of contamination balanced against the risk of a 
         sudden shortfall of critical blood supplies. Under current
         procedures, donors who were symptomatic or blood units with an
         elevated ALT level would have already been excluded. None of the
         identified cases have donated blood and all patient with any form
         of leishmaniasis are permanently deferred from future donations.

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