Visceral leishmaniasis: clinical observations in 4 US army soldiers deployed to Afghanistan or Iraq, 2002-2004.

P eople who traveled to Central or Southwest Asia in support of Operation Enduring Freedom and Operation Iraqi Freedom may have been exposed to various diseases endemic to this region. Some of these conditions have long incubation periods and may not present for weeks or months after travelers have returned to the United States. Among such diseases is visceral leishmaniasis (VL). Visceral leishmaniasis is a chronic systemic disease caused by parasites of the Leishmania donovani–Leishmania infantum complex. It is classically described as a syndrome of fever, progressive spleen and/or liver enlargement, weight loss, pancytopenia, and, if untreated, possible death. Most cases are acquired via the bite of infected female sand flies, but on rare occasions, disease has been acquired by other means, most notably by blood transfusions. This case series describes 4 cases of VL and is intended to alert clinicians to the possibility of VL in patients who develop a febrile illness after returning from deployment to Central or Southwest Asia.