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Gulf War and Health: Volume 5. Infectious Diseases
Sufficient Evidence of an Association
The evidence from available studies is sufficient to conclude that there is an association. A consistent association has been observed between exposure to a specific agent and a specific health outcome in human studies in which chance and bias, including confounding, could be ruled out with reasonable confidence. For example, several high-quality studies report consistent associations and are sufficiently free of bias, including adequate control for confounding.
The committee concludes that there is sufficient evidence of an association between
Arthritis and spondylitis; arthritis usually is manifest within 12 months of the acute illness, and spondylitis might be manifest later.
Hepatic abnormalities, including granulomatous hepatitis.
Chronic meningitis and meningoencephalitis.
Orchioepididymitis and infections of the genitourinary system.
Cardiovascular, nervous, and respiratory system infections.
Campylobacter jejuni infection and Guillain-Barré syndrome (GBS) if GBS is manifest within 2 months of the infection.
Campylobacter infection and reactive arthritis (ReA) if ReA is manifest within 3 months of the infection; most cases of ReA are manifest within 1 month of the infection.
Coxiella burnetii infection (Q fever) and
Endocarditis years after primary infection.
Vascular infection years after primary infection.
Chronic hepatitis years after primary infection.
Plasmodium malariae infection and manifestation of immune-complex glomerulonephritis years to decades later.
Plasmodium falciparum infection and recrudescence weeks to months after the primary infection, but only in the case of inadequate therapy.
Nontyphoid Salmonella infection and ReA if ReA is manifest within 3 months of the infection.
Shigella infection and
Hemolytic-uremic syndrome (HUS) if HUS is manifest within 1 month of the infection; most cases of HUS are manifest within 10 days of the infection.
ReA if ReA is manifest within 3 months of the infection; most cases of ReA are manifest within 1 month of the infection.
Active TB and long-term adverse health outcomes due to irreversible tissue damage from severe forms of pulmonary and extrapulmonary TB.
Visceral leishmaniasis (kala-azar) and
Delayed presentation of the acute clinical syndrome.
Reactivation of visceral leishmaniasis in the context of future immunosuppression.
Post-kala-azar dermal leishmaniasis (PKDL) if PKDL occurs generally within 2 years of the initial infection.