each seen in 6% of patients. Wound infections were seen in 14% of the men, and chronic osteomyelitis in 11%, most often in the femur or tibia. No microbiologic data or infection-treatment outcomes were reported.

Those experiences from non-Americans in Afghanistan, Iraq, and neighboring nations suggest that the experience of US military with A. baumannii and combat-related wound infections in southwest and south-central Asia is not unique.

Summary

Both wound infections and nosocomial infections are hazards for US personnel deployed to OEF and OIF. Given modern medical and surgical treatment and the ability to evacuate injured military personnel rapidly, most infections will be seen within days or weeks of wounds. Longer-term adverse health outcomes are possible but unlikely.

MYCOPLASMAS

Mycoplasmas are ubiquitous microorganisms found as commensal colonizers and as pathogens in plants, insects, and animals. They are the smallest known free-living organisms (150-250 nm) (Baum 2005; Murray et al. 2005). They are pleomorphic and filamentous and have a deformable membrane, which allows them to pass through filters that retain bacteria. They are fastidious and difficult to culture on cell-free media; at the same time, because of their common presence as nonpathogenic colonizers, they are common contaminants of cell cultures. The propensity for contamination of cell cultures can lead to false conclusions about the association of mycoplasmas with a variety of clinical syndromes (Baum 2005). Furthermore, the major antigenic determinants of mycoplasmas are glycolipids and proteins in the cell membrane, which are serologically cross-reactive with bacteria and human tissues (Murray et al. 2005). Mycoplasmas lack a cell wall, so they are resistant to antibiotics that inhibit cell-wall synthesis, such as penicillins, cephalosporins, and glycopeptides, for example, vancomycin. However, they have been shown to be sensitive to a variety of antibiotics that act at sites other than the cell wall, such as doxycycline, clindamycin, and quinolones (Hayes et al. 1993).

Taxonomically, mycoplasmas are assigned to their own class, Mollicutes. Mycoplasmas that can infect humans are members of the family Mycoplasmataceae. Sixteen species of mycoplasma have been found to colonize humans, and five of them have been associated with disease. Mycoplasma pneumoniae is a common cause of tracheobronchitis and pneumonia and can cause outbreaks in crowded settings such as would be found in military deployments (McDonough et al. 1996). M. pneumoniae has also been associated with numerous extrapulmonary manifestations, including a variety of rashes, cardiac abnormalities, aseptic meningitis and meningoencephalitis, and arthralgias. M. hominis has been associated with a variety of genitourinary infections (primarily pelvic inflammatory disease). M. fermentans (incognitus strain) and M. penetrans have been associated with a severe multisystem disease in both healthy people and people with AIDS (Lo et al. 1989). Culture of M. fermentans on cell-free media (which decrease the risk of contamination) has been extremely difficult, and this has led to controversy over whether the organisms are true pathogens or merely contaminants. M. fermentans has been found in the blood of 11% of HIV-seropositive patients but not in seronegative patients (Hawkins et al. 1992). Although Montagnier, codiscoverer of HIV, at one time postulated that M. fermentans and other mycoplasmas were cofactors for progression to



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