Identified

Enteropathogen or Enterotoxin

Yes (No. patients)

No (No. patients)

Salmonella spp. (not S. typhi)

x (7)

x (425)

Salmonella typhi

 

x

Shigella spp.

x (113)

x (319)

Vibrio cholerae

--

x

Yersinia spp.

--

x

Enterotoxins

 

 

Circulating Clostridium perfringens enterotoxins

--

x

Circulating staphylococcal enterotoxins

--

x

Parasites

 

 

Entamoeba histolytica

--

x

Giardia lamblia

--

x

Viruses

 

 

Adenovirus

--

x

Astrovirus

--

x

Calicivirus

--

x

Coronavirus-like agents

--

x

Norovirusa

x (1-9)b

x (17)

Rotavirus (group A)

x (1)

x (431)

aStool contained particles that were morphologically similar to norovirus.

bMultiple tests for viral enteropathogens were conducted on subsets of stool and serum samples, and the number of samples that tested positive for norovirus varied by test from 1 to 9 (Table 4.2).

SOURCE: Adapted with permission from Hyams et al. 1991.

Only 19 of the 432 soldiers in the study reported vomiting as a primary symptom. These cases were clustered temporally (in November and December) but not geographically. The testing of stool samples and paired serum samples suggested that norovirus was the principal etiologic agent in troops with vomiting (Table 4.2). Various investigators later conducted studies specifically on norovirus in the Gulf War context, as discussed below.

TABLE 4.2 Summary of Test Results for Viral Enteropathogens and Enterotoxins in Stool or Serum from Subsetsa of US Military Personnel with Gastroenteritis During Operation Desert Shield

 

Identified

Enteropathogen

Yes (No. patients)

No (No. patients)

In stool samples from 19 patients with vomiting as a primary symptom, November-December 1990

Enzyme immunoassay results:

 

 

Adenovirus

--

x

Norovirus

x (3)

x (16)

Rotavirus (group A)

--

x

Immune electron microscopy results (in 13 of 19 specimens):

 

 

Adenovirus

--

x

Astrovirus

--

x

Calicivirus

--

x

Coronavirus-like agents

--

x



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