BOX 2.3

Infectious Diseases with Long-Term Adverse Health Outcomes Studied for Strength of Association

Brucellosis

Campylobacteriosis

Leishmaniasis

Malaria

Q fever

Salmonellosis

Shigellosis

Tuberculosis

West Nile fever

Reasons for Excluding E. coli and Sand Fly Fever from In-Depth Study

Two of the infectious diseases named in PL 105-277 and PL 105-368—E. coli and sand fly fever—do not fulfill the above criteria for in-depth evaluation.

E. coli

Diarrheal infections were among of the most common ailments diagnosed in military personnel in regional theaters, and pathogenic E. coli is a well-recognized cause of diarrheal syndromes. The committee considered various infections related to pathogenic E. coli, focusing its attention on the role of pathogenic E. coli in diarrheal diseases. The unifying clinical syndrome associated with the various E. coli infections is a diarrheal illness that in healthy adults is usually transient without long-term adverse health outcomes. Therefore, the committee summarizes the health outcomes of E. coli infections in Chapter 3.

Sand Fly Fever

There are no published reports of sand fly fever in military personnel who served in the Gulf War; however, results from a search, requested by the Institute of Medicine (IOM), of a Department of Defense Gulf War hospitalization database identified five cases of this disease (the database and the search results are described in Chapter 4). As of December 2005, sand fly fever has not been found in military personnel serving in OIF and OEF. Sand fly fever is associated with a long-term adverse health outcome; however, the onset of the health outcome typically occurs during the acute illness. Therefore, the committee summarizes the health outcomes of sand fly fever in Chapter 3.

Comments on Diseases and Agents of Special Interest to Gulf War, OEF, and OIF Veterans

Several diseases and agents are of special interest to veterans of the Gulf War, OEF, and OIF. There is concern among Gulf War veterans that their symptoms might be connected to infection with Mycoplasma fermentans from contaminated vaccines (Nicolson et al. 2003) or exposure to biologic-warfare agents. In addition, during the Gulf War, troops stationed at Al Eskan Village, Saudi Arabia, developed respiratory illnesses at a high rate (Korenyi-Both et al. 1997; Korenyi-Both et al. 1992). The disease was termed Al Eskan disease and it has been hypothesized that a pathogen might be the cause. More recently, idiopathic acute eosinophilic pneumonia (IAEP) has been diagnosed in 18 military personnel serving in OIF or OEF (Shorr et al. 2004). IAEP is a syndrome characterized by febrile illness, diffuse pulmonary infiltrates, and pulmonary eosinophila (Allen et al. 1989; Badesch et al. 1989; Philit et al. 2002). There is also a



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