Wednesday, April 16, 2014

Toxic Hitchhikers - Parasites from War Zones

The parasites and diseases of Southeast Asia—most of which are unknown to American physicians—have long worried Vietnam Veterans of America. VVA first expressed concern in 1981, led by Lynda Van Devanter. VVA continued pushing the VA on this issue. Then, in 1999, George Duggins, who served as president from 1997-2001, worked with Bob Maras, who chaired the Veterans Affairs Committee, to convince the VA Undersecretary for Health to incorporate these concerns into a curriculum on parasites and diseases of Southeast Asia as part of the VA’s Veterans Health Initiative. In this article, health writer Claudia Gary examines the dangers to which American men and women serving in Indochina and the Middle East may have been unwittingly exposed.
Veterans of all wars must contend with exotic parasites. These insidious stowaways find human hosts through soil, water, food, or airborne “vectors”—insects such as mosquitoes and sand flies. Although the parasites may be hidden, they can be detected. In some cases, once they are, a cure can be quick and uncomplicated. In other cases, treatment takes time. In still others, the years without detection can create a tragedy.
Parasitic infections are one focus of Tropical Medicine (also called Travel Medicine), an Infectious Disease subspecialty with a history intertwined with war and colonization. Some of these infections—such as leishmaniasis, lymphatic filariasis, schistosomiasis, and soil-transmitted helminth infections—are termed “neglected tropical diseases.”
Dr. Daniel S. Caplivski, director of the Travel Medicine program at New York’s Mount Sinai Medical Center, explained that the “neglected” status of many parasitic infections is largely a result of history and economics. “There was a certain amount of investment in treatment and cures when British colonials were getting sick,” Caplivski said. “That’s where Tropical Medicine was born, and that’s where a lot of our knowledge came from. Over the last one hundred years we’ve had limited advances in research and treatment.”
Two of the most devastating and lasting parasitic infections Vietnam veterans have suffered are those caused by mosquito-borne filarial worms and by foodborne liver flukes (Opisthorchis viverrini). Lymphatic filariasis, while generally not fatal, can be disfiguring and debilitating. Liver fluke infection, on the other hand, can go virtually undetected for decades and then cause a deadly cancer, cholangiocarcinoma.

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