{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:23:22Z","timestamp":1787502202803,"version":"build-2736575974"},"reference-count":63,"publisher":"Oxford University Press (OUP)","issue":"12","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u201311.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201317). 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 \u03c72 test, Mann-Whitney U test, and logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>200 deployed subjects were enrolled, mostly males (84.0%), of white ethnicity (79.0%), and median age 41 (range 24\u201361) 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%\u201325.8%). Two (1.0%) PCR, 10 (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (P = .01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciy811","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T07:14:39Z","timestamp":1537168479000},"page":"2036-2044","source":"Crossref","is-referenced-by-count":29,"title":["Asymptomatic Visceral Leishmania infantum Infection in US Soldiers Deployed to Iraq"],"prefix":"10.1093","volume":"68","author":[{"given":"Rupal M","family":"Mody","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, William Beaumont Army Medical Center, El Paso, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Lakhal-Naouar","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Uniformed Services University of the Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E","family":"Sherwood","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, William Beaumont Army Medical Center, El Paso, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy L","family":"Koles","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Uniformed Services University of the Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dutchabong","family":"Shaw","sequence":"additional","affiliation":[{"name":"Clinical Research Unit, Uniformed Services University of the Health Sciences, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P","family":"Bigley","sequence":"additional","affiliation":[{"name":"DiLorenzo TRICARE Health Clinic-Pentagon, Washington, D.C"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgie-Mark A","family":"Co","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, William Beaumont Army Medical Center, El Paso, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathanial K","family":"Copeland","sequence":"additional","affiliation":[{"name":"Walter Reed Army Institute of Research, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda L","family":"Jagodzinski","sequence":"additional","affiliation":[{"name":"Walter Reed Army Institute of Research, Silver Spring, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami M","family":"Mukbel","sequence":"additional","affiliation":[{"name":"Department of Basic Veterinary Sciences, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A","family":"Smiley","sequence":"additional","affiliation":[{"name":"Department of Clinical Investigations, William Beaumont Army Medical Center, El Paso, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C","family":"Duncan","sequence":"additional","affiliation":[{"name":"Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaden","family":"Kamhawi","sequence":"additional","affiliation":[{"name":"Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selma M B","family":"Jeronimo","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Institute of Tropical Medicine at Rio Grande do Norte, Natal"},{"name":"National Institute of Science and Technology of Tropical Diseases, Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F","family":"DeFraites","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi E","family":"Aronson","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, Uniformed Services University of the Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,9,20]]},"reference":[{"key":"2019100102015245200_CIT0001","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1603\/033.046.0333","article-title":"Impact of phlebotomine sand flies on U.S. military operations at Tallil Air Base, Iraq: 4. 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