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by Leslie Kumler
Health care professionals know that infectious disease goes hand in hand with military service. U.S. veterans serving in Operation Desert Shield (ODSh), Operation Desert Storm (ODSt), Operation Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF) are no exception and have experienced various insect-borne, respiratory, viral, parasitic, and bacterial infections during and after their service. Fast and accurate diagnosis is crucial to proper treatment of these diseases, which are seen less frequently in civilian Americans.
Campylobacter infections, salmonellosis, and shigellosis are foodborne bacterial illnesses that are likely to strike troops due to the temporary nature of their camps, close quarters, nearby latrine facilities, insect activity in dining facilities, eating locally prepared food, and dehydration due to strenuous activity.1 The incubation period for all three illnesses is quite short, usually three days or less. Campylobacter infections produce fever, diarrhea (bloody or non-bloody), and severe abdominal pain (right lower quadrant pain is common).2 Salmonellosis brings on a “low-grade fever, chills, nausea, vomiting, diarrhea, abdominal cramping, and headache that may last up to a week.”3 Shigellosis can be differentiated from other foodborne illnesses by symptoms of “fever, crampy abdominal pain, and watery, sometimes bloody diarrhea followed by 1-3 days of improvement and then sudden worsening.”4 Patients may become dehydrated. The average foodborne illness lasts 7 days, but infection can last up to 30 days without treatment. Troops were struck by all of these illnesses during ODSh, ODSt, OIF, and OEF, with shigellosis causing the greatest number of troops to become ill during the Gulf War and in Iraq and Afghanistan.
Respiratory diseases or infections such as pneumonia, influenza, or asthma are experienced by troops who deploy overseas for conflicts. This was noted during the rapid deployment for the Gulf War because troops “were crowded together in warehouses and tents at initial staging areas and then moved to isolated desert locations.”5 In 2003, over 60 cases of pneumonia were treated in Iraq, and 19 troops were hospitalized with acute eosinophilic pneumonia that caused 2 fatalities.6
Leishmaniasis is a parasitic infection resulting from the bite of a sandfly. There are different forms of leishmaniasis: cutaneous leishmaniasis, which causes skin lesions, and visceral leishmaniasis, which usually affects internal organs like the liver and spleen. Troops were infected with both forms of leishmaniasis during the Gulf War, OIF, and OEF. The cutaneous form of leishmaniasis was diagnosed in more than 1,000 military personnel stationed in Afghanistan, Iraq, and Kuwait as of 2005. It appears that fewer than 10 cases of the visceral form were diagnosed by the same year in those areas.7
The mosquito-borne diseases malaria and West Nile virus both begin with flu-like symptoms. Additional symptoms of malaria may include headache, back pain, sweating, myalgia, nausea, vomiting, diarrhea, and cough. The fever may be preceded for 1-2 hours by rigors, then followed by intense sweating. The incubation period is usually 9-18 days, but it can be longer for some forms of malaria.8 West Nile virus presents with a macular and papular rash on the upper body that can resemble measles. In some patients, West Nile affects the central nervous system (CNS). Severe frontal headache, backache, and anorexia may precede the CNS signs and symptoms of encephalitis.9 Relatively low numbers of soldiers were infected with malaria and West Nile virus during ODSh, ODSt, OIF, and OEF combined. The largest group of cases included 52 troops in Afghanistan in May 2002, all diagnosed after leaving the theater.10
Other illnesses that may be contracted in small numbers of troops are Q fever, tuberculosis, viral hepatitis, varicella, meningococcal disease, brucellosis, and gastrointestinal illnesses such as norovirus and Escherichia coli. All of these diseases were reported in some number during ODSh, ODSt, OIF, and OEF. Swift diagnosis by health care professionals in the field, proper treatment, and follow-up treatment after soldiers return to the United States ensures that troops have no long-term effects related to illnesses contracted during their service.
1, 5, 6, 7, 10. Institute of Medicine. Infectious diseases diagnosed in US troops who served in the Persian Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom. Eds: Mitchell, AE, Sivitz, LB, Black, RE. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press; 2007. URL: https://www.nap.edu/read/11765/chapter/6?term=campy#72. Accessed August 3, 2017.
2. Titi, MT, Anabtawi, A, El-Daher, N, et al. Campylobacter infections. In: Goldsmith L, editor. VisualDx Visual Clinical Support Tool [online]. Rochester, NY: Logical Images; 2017. Available from: https://www.visualdx.com/visualdx/diagnosis/campylobacter%20infections?moduleId=101&diagnosisId=50495. Accessed August 3, 2017.
3. Mendoza, N, Prasad, P. Salmonellosis. In: Goldsmith L, editor. VisualDx Visual Clinical Support Tool [online]. Rochester, NY: Logical Images; 2017. Available from: https://www.visualdx.com/visualdx/diagnosis/salmonellosis%20?moduleId=101&diagnosisId=50624. Accessed August 3, 2017.
4. Mendoza, N, Lane, DR, Min, Z, Prasad, P. Shigellosis. In: Goldsmith L, editor. VisualDx Visual Clinical Support Tool [online]. Rochester, NY: Logical Images; 2017. Available from: https://www.visualdx.com/visualdx/diagnosis/shigellosis%20?moduleId=101&diagnosisId=50431. Accessed August 3, 2017.
8. Larppanichpoonphol, P, Bonnez, W, Patel, M. Malaria. In: Goldsmith L, editor. VisualDx Visual Clinical Support Tool [online]. Rochester, NY: Logical Images; 2017. Available from: https://www.visualdx.com/visualdx/diagnosis/malaria?moduleId=101&diagnosisId=50577. Accessed August 3, 2017.
9. Papier, A, Van Stoecker, W. West Nile virus. In: Goldsmith L, editor. VisualDx Visual Clinical Support Tool [online]. Rochester, NY: Logical Images; 2017. Available from: https://www.visualdx.com/visualdx/diagnosis/west%20nile%20virus?moduleId=5&diagnosisId=52803. Accessed August 3, 2017.
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