‘Baghdad Boil’ Found in NE Tarrant
By Jan Jarvis, Fort Worth Star-Telegram, Texas
Sep. 15–A skin infection nicknamed the Baghdad boil because it sometimes shows up on soldiers in Iraq, has been identified in nine North Texas residents, including one from North Richland Hills.
The disease, leishmaniasis has never been reported in North Texas among people who have not traveled to places where the disease is found, including the Middle East, Central America and India, said Dr. Erin Welch, assistant professor of dermatology at University of Texas Southwestern Medical Center at Dallas.
“The fact that they haven’t traveled and yet clearly have leishmaniasis is really noteworthy,” she said.
Doctors suspect that sand flies, which are infected after biting burrowing wood rats, have brought the single-celled parasite to North Texas.
“But that’s purely speculation,” said Dr. Kent Aftergut, a clinical instructor of dermatology at Southwestern. “It could be something like a change in the environment where they live, global warming or development in the south.”
The disease is spread to people when an infected sand fly bites them. It is not spread person-to-person.
But because the sore does not show up for months, people may not even remember they were bitten by a sand fly, which is one-third the size of a mosquito, Welch said.
Once the infection develops, it’s hard to overlook.
“It looks like a big boil that doesn’t go away for months,” she said.
Doctors are concerned that people will mistake the disease for a staph infection or spider bite.
Several months ago, a Waxahachie man came to him with sores on his back that would not heal, Aftergut said. The man had worked shirtless in his back yard.
After discussing the case at a conference, doctors began identifying similar cases around North Texas, including North Richland Hills, Hillsboro, Glenn Heights, Tom Bean, Anna, Savoy and Nevada.
People who frequent heavily wooded rural areas where sand flies and wood rats live may be more at risk, Aftergut said. But the disease can occur anywhere, as in the case of the unidentified victim from North Richland Hills.
The skin infection can be treated with medications or in some cases by draining the boil or surgically removing it.
“It can also resolve on its own in a year or two even if you don’t do a thing to treat it,” Aftergut said.
All of the North Texas cases are Leishmania mexicana, which is less dangerous than other forms of the parasite.
Several years ago, a few cases of leishmaniasis were reported in Tarrant County but the disease was contracted in other countries, said Vanassa Joseph, a spokeswoman for Tarrant County Public Health.
Some cases have been reported in South Texas but no cases have been reported this far north before, Welch said. That’s what makes the cases so interesting.
“They haven’t even been to South Texas,” Welch said.
The fact that they haven’t traveled and yet clearly have leishmaniasis is really noteworthy.
Understanding the disease
What is leishmaniasis?
A parasitic disease spread by the bite of an infected sand fly. Cutaneous leishmaniasis causes skin sores and visceral leishmaniasis affects internal organs.
What are the symptoms?
A sore that changes in size and appearance over time and often looks like a volcano with a raised edge and central crater. The sores can be the size of a dollar coin or larger.
How common is it?
Each year there are 1.5 million new cases of cutaneous leishmaniasis worldwide.
Where is it found?
In 88 countries, ranging from rain forests in Central America to deserts in West Asia. More than 90 percent of the world’s cases of visceral leishmaniasis are in India, Bangladesh, Nepal, Sudan and Brazil.
How is it spread?
Sand flies become infected after biting an infected rodent. The sand fly then bites a person. Because sand flies do not make noise, people may not realize they are present.
If I am bitten by an infected sand fly, how quickly will I get sick?
Sores usually develop within a few weeks.
How is it treated?
There are medications.
Is it serious if not treated?
The sores can last for months and leave ugly scars. Visceral leishmaniasis can cause death.
How is it prevented?
Avoid outdoors activities from dawn to dusk when sand flies are more active.
Apply insect repellents on uncovered skin.
Spray clothing with permethrin-containing insecticides.
Source: Centers for Disease Control and Prevention and Tarrant County Public Health
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jjarvis@star-telegram.com Jan Jarvis, 817-548-5423
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