Leishmaniasis Donovani (I believe it is named after the two guys that discovered it Leishman and Donovan, but don't hold me to that) is a parasite that can be transmitted into the skin by the bite of an infected sandfly.  These sandflies are endophagic nighttime feeders - that means they like to get people indoors at night when they are sleeping.  The parasite can get into the blood stream and affect the spleen and liver and cause a systemic disease, but this is quite rare.  Cutaneous (or skin) Leish is the most common manifestation, and presents as non-healing ulcerated wounds, which sometimes can get very large.  Leishmaniasis does not exist in the US, but is fairly prevalent in SW Asia which includes Iraq and Afghanistan.  Of note, it also has a prevalence in South America.

This soldier who had spent quite a bit of time in rural areas here in Northern Iraq had some non-healing lesions on his L arm for several months.  While on the way home for his R and R he was seen at the CSH in Kuwait and they appropriately biopsied the lesions (which typically is the most fun part for the doctors).  A few weeks later the biopsies came back positive, confirming their suspicions of Leishmaniasis.

Now the soldier was here to see me to get AIREVAC'd back to Walter Reed for his treatment.  The current US military treatment for Leish is 20 days of intravenous Pentostam (sodium stibogluconate).  Because Leish is not found in the US, this treatment is not FDA approved.  However, the FDA has granted permission for the military to use this therapy to treat US military personnel who contract Leish while deployed.  Currently the only two medical centers authorized to use Pentostam are Walter Reed in Washington, DC, and Brooke Army Medical Center in San Antonio, Texas.

So, there you have a little education on tropical diseases.

Goodnight, don't let the sandflies bite.