Treatment

Korenyi-Both et al. (1992) indicate that cephalosporin antibiotics and expectorants were useful and that no response to the quinolone antibiotic ciprofloxacin was observed. Supporting data were not presented.

Summary

There is no evidence that the syndrome or disease observed in troops in Al Eskan village was caused by a communicable microbial pathogen. Indeed, Koryeni-Both et al. have argued that the disease is caused by exposure to the unique sand dust of the central and eastern Arabian Peninsula and in particular to the silica in the sand. They note that given the sand-mediated damage to helicopters in the fields and silicosis in Somali camels, sand-mediated disease in humans would be expected. More than 13 years have passed since the initial description of Al Eskan disease appeared in the literature, but little progress has been made in linking chronic respiratory diseases in military personnel to exposure to Persian Gulf sand.

IDIOPATHIC ACUTE EOSINOPHILIC PNEUMONIA

Idiopathic acute eosinophilic pneumonia (IAEP) is a syndrome characterized by a febrile illness, diffuse pulmonary infiltrates, and pulmonary eosinophila (Allen et al. 1989; Badesch et al. 1989; Philit et al. 2002). Patients with IAEP have no history of asthma, allergy, or chronic lung disease and no discernable infection. Relapse is uncommon after recovery.

Severe pneumonia was reported in 19 military personnel deployed in OIF, 10 of whom had IAEP (Shorr et al. 2004). Prospective surveillance from March 2003 to March 2004 led to detection of eight additional cases of IAEP (Shorr et al. 2004). Twelve patients required mechanical ventilation, and two died. Given that 183,000 personnel were deployed in Iraq during the study period, the incidence rate of IAEP was calculated as 9.1/100,000 person-years. Of the 18 patients, 15 were in the Army, two in the Navy, and one in the Marines; 16 were men. The peak incidence of IAEP was in the summer months.

Description of Acute Illness

Patients with IAEP present with fever, diffuse pulmonary infiltrates, cough, shortness of breath, and, not infrequently, respiratory failure. The case definition of IAEP requires recovery of pulmonary eosinophils in high concentration in bronchial lavage (Allen et al. 1989; Badesch et al. 1989; Philit et al. 2002). In six lavage specimens recovered from military recruits, eosinophils made up 24-75% of the cells recovered (Shorr et al. 2004). Peripheral blood eosinophilia may or may not be present and may increase during the course of illness (Shorr et al. 2004). Lung biopsies reveal acute and organizing alveolar damage with eosinophils filling alveolar and interstitial air spaces (Tazelaar et al. 1997).

Long-Term Adverse Health Outcomes

Most IAEP patients who survive the acute illness make a complete recovery. Twelve of 16 military IAEP survivors were evaluated 1-4 months after diagnosis; none required corticosteroid therapy (Shorr et al. 2004). Three patients reported mild residual dyspnea and one



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