. "5 Levels of Association Between Select Diseases and Long-Term Adverse Health Outcomes." Gulf War and Health: Volume 5. Infectious Diseases. Washington, DC: The National Academies Press, 2007.
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Gulf War and Health: Volume 5. Infectious Diseases
TABLE 5.1 The Nine Infectious Diseases Studied for Strength of Association with Specific Long-Term Adverse Health Outcomes
Infectious Disease
Long-Term Adverse Health Outcomes Evaluated for Strength of Association
Brucellosis
Arthritis
Cardiovascular system infections
Ophthalmologic manifestations
Genito-urinary tract manifestations
Hepatic abnormalities
Neurologic manifestations
Respiratory system infections
Other symptoms (fatigue, inattention, amnesia, depression)
Campylobacter infection
Guillain-Barré syndrome
Reactive arthritis
Uveitis
Leishmaniasis
Delayed presentation of visceral leishmaniasis (VL)a
Reactivation of VL in the context of future immunosuppression
Persistent deficits in cognition, movement, and daily functioning
a Viscerotropic leishmaniasis is considered a subset of VL for the purposes of this discussion.
b Tuberculosis (TB) does not meet inclusion criterion 1 (Box 5.1), because there have been no published reports of military personnel who developed active TB while deployed to the Gulf War, Operation Enduring Freedom (OEF), or Operation Iraqi Freedom (OIF). However, in a presentation to the committee, Kilpatrick (2005) indicated that 2.5% of military personnel deployed to OEF and OIF and given predeployment and postdeployment skin tests for TB seroconverted during their deployment; that is, they acquired new TB infections. Immunocompetent people who are infected with TB have a 10% lifetime risk of developing active TB; this risk increases dramatically in people who become immunosuppressed. Therefore, the committee decided to evaluate TB in depth.
c West Nile virus infection does not meet inclusion criterion 4 (Box 5.1), because its health outcomes usually are manifested at the time of the acute illness. However, dramatic changes in the epidemiology of West Nile virus infection since the middle 1990s led the committee to decide to review it in depth.
This chapter contains nine sections, with similar formats: one for each disease. Each begins with an introduction to the disease and its etiologic agent, which is followed by a brief description of the acute illness. Then, a summary of diagnostic criteria and methods and of treatment protocols is presented. Each section ends with an evidence-based discussion of the infection’s known long-term adverse health outcomes and their pathogenesis; this discussion is
