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



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



Delayed presentation of visceral leishmaniasis (VL)a

Reactivation of VL in the context of future immunosuppression

Post-kala-azar dermal leishmaniasis


Clinical relapse

Late presentation or recrudescence of disease

Hematologic manifestations

Ophthalmologic manifestations

Nephrologic disease

Neurologic and neuropsychiatric disease

Coxiella burnetii infection (Q fever)

Chronic hepatitis



Post-Q fever fatigue syndrome

Vascular infection

Salmonella (nontyphoid) infection

Reactive arthritis

Shigella infection

Hemolytic uremic syndrome

Reactive arthritis


Activation of latent tuberculosis infection

Late manifestations of pulmonary and extrapulmonary tuberculosis

West Nile virus infectionc

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

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