Sandfly-borne parasitic disease has affected at least 100 IDF troops in Gaza

Contracted in southern Israel before entering the Strip, cutaneous ​leishmaniasis causes deep, ugly skin lesions — but in most cases doesn’t affect a soldier’s ability to fight

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Illustrative: A sandfly under a microscope. (Public Domain/World Health Organization )
Illustrative: A sandfly under a microscope. (Public Domain/World Health Organization )

As Israel Defense Forces soldiers fight against Hamas terrorists in Gaza, some are suffering from cutaneous ​leishmaniasis, a disease caused by the bite of a protozoan parasite-carrying sandfly leading to skin lesions or ulcers.

Hebrew-language media reports several days ago said “dozens of soldiers” were affected by the disease. On Tuesday, the IDF confirmed for The Times of Israel that the number was around 100.

According to Prof. Eli Schwartz, head of the Molecular Lab for Tropical Diseases at Sheba Medical Center and the president of the Israeli Society of Parasitology and Tropical Diseases, the exact number would be hard to determine during a time of war.

“It could very well be higher, as soldiers with smaller lesions may not have sought treatment yet. They are engaged in battles and have other more urgent things to deal with,” Schwartz said.

Schwartz was quick to point out that the soldiers were in all likelihood bitten by disease-causing sandflies before entering Gaza, as cutaneous ​leishmaniasis (also known in Israel as “Rose of Jericho”) is endemic to Israel and not Gaza.

It takes up to a month for the unsightly red, crater-like skin lesions to appear after a person is bitten.

The parasite-carrying flies likely started biting troops in October as they amassed by the tens of thousands along the border with Gaza, training and preparing for the ground invasion that began on October 27.

Illustrative: Skin ulcer caused by leishmaniasis on the hand of a Central American adult. (CDC/Dr. D.S. Martin via Wikimedia Commons)

Cutaneous ​leishmaniasis is also found in other parts of the world, especially South America, where particularly aggressive strains require affected patients to undergo systemic treatments accompanied by side effects. According to Schwartz, the US military first encountered the disease as a significant problem for its troops when they fought in the Persian Gulf in the 1990s.

There are two different types of the disease in Israel, based on the parasite species, the parasite’s host, and the region in which both are found.

The first type of cutaneous ​leishmaniasis is caused by the leishmania tropica parasite. Rock hyraxes (also called rock badgers) living in the rocky areas of Judea, Samaria and the Galilee serve as reservoir hosts for this parasite.

The second type of the disease is caused by the leishmania major parasite. Various rodents like gerbils, psammomys, meriones and voles are the reservoir hosts for this version of the parasite, which is found in more sandy areas of the country. These include the Arava and Negev regions — including the Gaza Envelope.

A family of Rock Hyrax. (CC, BY-SA Siegmund K. M./Wikimedia)

In both cases, a female sandfly seeking a meal bites the host animal and draws blood infected with the parasite. The fly, seeking another meal, then bites a person and infects them with the parasite. The skin lesion or ulcer eventually develops at the site of the bite.

“The sandflies bite at night, so any exposed areas of skin are a target. It could be a soldier’s feet if they have taken off their boots and socks. Or it could be their face or hands,” Schwartz said.

Cutaneous ​leishmaniasis tends to be more of a problem in the warmer spring, summer, and early fall months when the sandflies are more active. There are always cases of the disease, but Schwartz chalks up the noticeable uptick among soldiers to the crowding of soldiers along the border after Hamas’s savage onslaught against southern Israel.

“We just finished compiling some data on this, and there are usually about 1,000 cases of the disease per year in all of Israel. So the cases tend to be more spread out and individual,” Schwartz said.

Sometimes there are local outbreaks within communities, such as when there were some 50 cases of cutaneous ​leishmaniasis in Tzofim in the northern West Bank and other nearby areas in the spring of 2016.

The best way to prevent being bitten by a parasite-carrying sandfly is to use mosquito repellant, fully cover up, and use netting and screens in windows from sundown to sunrise.

The damage caused by the versions of disease present in Israel is usually only skin-deep. The ulcers are temporarily disfiguring and may lead to infection or permanent scarring. They can also be painful or affect joint movement.

IDF Chief of Staff Lt. Gen. Herzi Halevi speaks to troops in southern Israel on October 15, 2023. (IDF)

However, cutaneous ​leishmaniasis is far less serious than visceral leishmaniasis, which attacks a person’s internal organs and is fatal in 95 percent of cases if left untreated, according to the World Health Organization.

“That version of the disease is from a different species of parasite than the ones found in Israel. It’s usually found in parts of Africa or India. Overall, ​leishmaniasis is a disease of poor and underdeveloped countries. Israel is really an exception, and the government could be doing more in terms of controlling the animals that serve as reservoirs for the parasites,” Schwartz said.

According to Schwartz, soldiers with leishmaniasis can generally be diagnosed and treated in the field by IDF doctors and continue fighting. Only very serious cases would need to be taken out of Gaza to Israeli hospitals.

“For most cases, there is no need for risky systemic drug treatment,” Schwartz said.

If necessary, drugs can be injected directly into the ulcer. In some instances, doctors use liquid nitrogen to freeze the lesion.

Illustrative: A boy receives liquid nitrogen treatment for leishmaniasis at the Bir Al-Ostah Milad Hospital for Dermatology in the Libyan capital, Tripoli on February 11, 2019. (Mahmud Turkia/AFP)

“For most patients, we used to use an anti-parasitic topical ointment called Leshcutan. It was made by [Israeli pharmaceutical company] Teva, but Teva stopped making it just recently,” Schwartz said.

This left the IDF scrambling for an alternative. According to Schwartz, it turned to a major Israeli pharmacy, which quickly produced a similar preparation for use exclusively by the IDF.

“What’s clear from this and everything else we know is that we really need a better treatment for ​leishmaniasis,” Schwartz said.

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