had wheezing. Pulmonary-function tests showed that forced vital capacity was 97% of predicted, and forced expiratory volume 94% of predicted. However, mean carbon monoxide diffusing capacity was 82% of predicted.
In many cases, IAEP has been associated with cigarette smoking and exposure to dust (Badesch et al. 1989; Pope-Harman et al. 1996; Rom et al. 2002). Shorr et al. (2004) found that the most common exposures in the IAEP-diagnosed military patients were cigarette-smoking (100%), exposure to dust or sand (94%), convoy operations (70%), and exposure to the local population (71%). However, cases were different from controls only in their tobacco exposure. All the patients were smokers and 14% were new smokers, whereas only 67% of controls were smokers and only two of seventy-two controls were new to smoking (OR 1.22, p < 0.001). Other investigators have related cigarette-smoking to IAEP (Badesch et al. 1989; Shintani et al. 2000; Watanabe et al. 2002).
Corticosteroids are the mainstay of therapy for IAEP and most patients respond quickly to it (Allen et al. 1989; Badesch et al. 1989; Philit et al. 2002). Some patients with IAEP require mechanical ventilation.
Eighteen soldiers deployed to OIF developed IAEP. By definition, no causative pathogens were detected or implied by the immune response of soldiers with IAEP (Allen et al. 1989; Shorr et al. 2004). Toxocara canis and other helminthic pathogens known to produce eosinophilic pneumonia were specifically excluded (Roig et al. 1992; Shorr et al. 2004). Survey results failed to identify a common source of environmental, drug, or toxin exposure (Shorr et al. 2004). Rapid detection of this condition is essential for a positive outcome. IAEP would not be expected to have long-term adverse health outcomes.
Soldiers can experience a wide variety of exposures to pathogens from explosives or combat (wound infections) or in health-care settings (nosocomial infections). Trends in casualty rates in modern US military warfare indicate rising wounded-to-killed ratios in the most recent wars (Department of Defense, 2005). Military personnel who might have been killed in an earlier era may now live to be hospitalized because of the use of body armor, better helmets, and more rapid emergency care. These soldiers with serious wounds can carry organisms of environmental origin (for example, from soil or water) into the hospital setting. Organisms of environmental origin that are prevalent in wound infections can colonize fomites and be transmitted to others via hospital personnel.
Nosocomial infections in military hospitals may have different microbial profiles from those in civilian hospitals in that they represent soil or water organisms prevalent in wounds suffered in explosions or combat. Nosocomial organisms that are familiar in civilian settings can