Asymptomatic Visceral Leishmania infantum Infection in US Soldiers Deployed to Iraq

Rupal M. Mody*, Ines Lakhal-Naouar, Jeffrey E. Sherwood, Nancy L. Koles, Dutchabong Shaw, Daniel P. Bigley, Edgie Mark A. Co, Nathanial K. Copeland, Linda L. Jagodzinski, Rami M. Mukbel, Rebecca A. Smiley, Robert C. Duncan, Shaden Kamhawi, Selma M.B. Jeronimo, Robert F. Defraites, Naomi E. Aronson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Visceral leishmaniasis (VL), due to Leishmania infantum, is a persistent intracellular parasitic infection transmitted by the bite of infected sand flies. Symptomatic VL has been reported in U.S. soldiers with Iraq deployment. Untreated symptomatic VL can be fatal; asymptomatic VL (AVL) may establish a lifelong risk of reactivation. We report prevalence and AVL risk factors in Operation Iraqi Freedom (OIF) deployers during 2002-11. Methods: Healthy soldiers exposed to VL endemic areas in Iraq and 50 controls who never traveled to endemic regions were recruited through military healthcare facilities (2015-17). Responses to a risk factor survey and blood samples were obtained. Leishmania research diagnostics utilized included enzyme-linked immunosorbent assay (ELISA), rk39 test strips, quantitative polymerase chain reaction (PCR), and interferon gamma release (IGRA) assays. Statistical analyses included Fisher exact test, Pearson χ2 test, Mann-Whitney U test, and logistic regression. Results: 200 deployed subjects were enrolled, mostly males (84.0%), of white ethnicity (79.0%), and median age 41 (range 24-61) years. 64% were seropositive for Phlebotomus alexandri saliva antibodies. Prevalence of AVL (any positive test result) was 39/200 (19.5%, 95% confidence interval 14.4%-25.8%). Two (1.0%) PCR, 10 (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (P =. 01). Conclusion: AVL was identified in 19.5% of OIF deployers; travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in US veterans and to target additional blood safety and surveillance measures.

Original languageEnglish
Article numberciy811
Pages (from-to)2036-2044
Number of pages9
JournalClinical Infectious Diseases
Issue number12
StatePublished - Jun 2019
Externally publishedYes


  • Iraq
  • US soldiers
  • asymptomatic
  • deployed
  • visceral leishmaniasis


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