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Gulf War and Health: Volume 5: Infectious Diseases (2007)

Chapter: 3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes

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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

3
INFECTIOUS DISEASES ENDEMIC TO SOUTHWEST AND SOUTH-CENTRAL ASIA THAT HAVE LONG-TERM ADVERSE HEALTH OUTCOMES

In Chapter 2, the committee developed an extensive list of infectious diseases that are endemic to southwest and south-central Asia (Table 2.1) and then narrowed the list to diseases or syndromes with known long-term adverse health outcomes (Box 2.2). Although most diseases in that subset have not been reported in military personnel deployed to southwest and south-central Asia, they have historically been diagnosed in local populations and thus pose a theoretical risk to US troops deployed to the region. Also, given the nature and duration of Operation Iraqi Freedom and Operation Enduring Freedom, some of the diseases in Box 2.2 could be diagnosed after a person’s deployment or period of military service.

The committee decided that the most effective way to give additional information on the diseases listed in Box 2.2 would be to present them in tables containing

  • A description of the acute syndrome in adults,

  • A description of the potential long-term adverse health outcomes in adults with clinical disease,

  • The frequency with which the long-term adverse health outcomes occur in adults with clinical disease,

  • The delay, if any, between acute infection and onset of long-term adverse health outcomes.

Tables 3.1-3.4 categorize the infections of interest by type of pathogen (viral, bacterial, helminthic, or protozoan), and Table 3.5 describes sexually transmitted diseases. The infectious diseases with long-term adverse health outcomes that have been diagnosed in military personnel and that the committee reviewed in depth (see Chapter 5) are also included here.

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

TABLE 3.1 Bacterial Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

More Prevalent in Southwest and South- Central Asia Than in the United States

Anthrax

(Bacillus anthracis)

Abdominal anthrax: initially fever, acute gastroenteritis, vomiting, bloody diarrhea; hemorrhagic lesions of intestinal lumen followed by massive infected ascites, septicemia, death

Sepsis or infection-related organ damage

Frequent

No

 

Inhalational anthrax: fever, chills, malaise, cough, nausea or vomiting, dyspnea, sweats, chest discomfort or pleuritic pain, muscle aches, headache followed by respiratory distress due to hemorrhagic mediastinitis and mediastinal lymphadenitis with pleural effusions; often terminates in respiratory damage, shock, death

Sepsis or infection-related organ damage

Frequent

No

 

Oropharyngeal anthrax: fever, lesion in oral cavity, pharyngeal pain, cervical edema, local lymphadenitis

Sepsis or infection-related organ damage

Frequent

No

 

Cutaneous anthrax: eschar with surrounding edema, regional lymphadenopathy, fever, malaise, headache; bacteremia in 5% of untreated persons

Sepsis or infection-related organ damage

Rare

No

Brucellosisc

(Brucella spp)

(see Chapter 5 for detailed discussion)

Fever, headache, myalgia, hepatosplenomegaly, arthritis, meningoencephalitis

Arthritis

Common (if untreated)

Yes (weeks to years)

 

Fatigue

Common

Yes (weeks to years)

 

Hepatic abnormalities

Rare

Yes (weeks to years)

 

Mental inattention

Rare

Yes (weeks to years)

 

Neurologic disease

Rare

Yes (weeks to years)

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

 

Osteomyelitis; cardiovascular, splenic, renal, hepatic, respiratory, nervous system, other abscesses

Rare

Yes (weeks to years)

 

 

Sepsis or infection-related organ damage

Very rare

No

 

 

Chronic meningitis and meningoencephalitis

Very rare

Yes (weeks to years)

 

 

Eye involvement (including uveitis)

Very rare

Yes (weeks to years)

Enteric fever

(typhoid fever, Salmonella enterica serovar Typhi; paratyphoid fever, S. enterica serovars Paratyphi A, B, C)

Fever, bacteremia, headache, lymphadenopathy, enlarged liver or spleen, encephalopathy, intestinal rupture and hemorrhage

Endovascular infection

Rare

No

Postinfection enteropathyd

Rare

No

Sepsis or infection-related organ damage

Rare

No

Chronic intestinal carriage

Rare

Yes (months to years)

Infection of gall bladder or gall stones

Rare

Yes (months to years)

Focal infections or abscesses

Very rare

Yes (weeks to months)

Helicobacter pylori infection

Usually asymptomatic; occasionally gastritis

Atrophic gastritis

Common

Yes (years to decades)

 

 

Duodenal ulcer disease

Rare

Yes (months to years)

 

 

Gastric ulcer disease

Rare

Yes (months to years)

 

 

Gastric cancer

Very rare

Yes (years to decades)

Plague

(Yersinia pestis)

Bubonic plague: sudden onset of high fever, enlarged and tender lymph nodes; patchy bleeding under skin, may progress to pneumonia or septicemic forms

Sepsis or infection-related organ damage

Frequent

No

Pneumonic plague: headache, fever, malaise, muscle pain, pneumonia with cough and bloody sputum; often terminates in respiratory collapse, hemodynamic collapse, death

Sepsis or infection-related organ damage

Frequent

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

Septicemic plague: skin infection leads to bacteremia and severe endotoxemia, often followed by shock, disseminated intravascular coagulation, acute respiratory distress syndrome; fatal if untreated

Sepsis or infection-related organ damage

Frequent

No

Q feverc

(Coxiella burnetti)

(see Chapter 5 for detailed discussion)

Fever, headache, myalgia, pneumonitis, hepatosplenomegaly, meningoencephalitis

Neurologic residua of meningoencephalitis

Very rare

No

Endovascular infections, osteomyelitis

Very rare

Yes (weeks to months)

Chronic hepatitis

Very rare

Yes (weeks to months)

Post-Q fever fatigue syndrome

Unknown

Unknown

Tuberculosisc

(Mycobacterium tuberculosis)

(see Chapter 5 for detailed discussion)

Initial infection asymptomatic (positive tuberculosis skin test or gamma interferon release assay); progression to active tuberculosis in 1-5%

Tuberculosis of lungs, pleura, lymph nodes; meningitis; musculoskeletal, genitourinary, other system effects

Common

Yes (months to decades)

Long-term adverse health outcomes of active tuberculosis

Common

Yes (months to decades)

Enteric infections

 

 

 

 

Campylobacter infectionc

(Campylobacter jejuni)

(see Chapter 5 for detailed discussion)

Diarrhea, fever, abdominal pain

Postinfection enteropathyd

Very rare

No

Guillain-Barré syndrome

Very rare

Yes (weeks)

Reactive arthritis

Very rare

Yes (weeks)

Uveitis

Very rare

Yes (weeks)

Ankylosis spondylitis

Very rare

Yes (months)

Cholera

(Vibrio cholerae)

Watery diarrhea, may be severe

Shock-related organ damage

Rare

No

Escherichia coli gastroenteritis

 

 

 

 

Enterohemorrhagic E. coli

Bloody diarrhea, low or absent fever, hemolytic uremic syndrome, 5-10 days after onset of gastroenteritis

Renal damage

Common

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Other pathogenic strains of E. coli

Watery diarrhea, may be severe

Postinfection enteropathyd

Very rare

No

Shock-related organ damage

Very rare

No

Melioidosis

(Burkholderia pseudomallei)

Fever, chills, pneumonia, cellulitis, osteomyelitis, abscesses, bacteremia

Sepsis or infection-related organ damage

Rare

No

Abscesses, osteomyelitis

Rare

Yes (weeks to years)

Relapses of pulmonary disease

Rare

Yes (weeks to years)

Plesiomonas shigelloides infection

Intestinal manifestations—watery diarrhea or colitis-like dysentery; fever

Chronic diarrhea

Rare

No

Sepsis or infection-related organ damage

Very rare

No

Salmonellosis (nontyphoid)c

(Salmonella spp.)

(see Chapter 5 for detailed discussion)

Diarrhea, abdominal pain, nausea, fever

Endovascular infection

Very rare

No

Postinfection enteropathyd

Very rare

No

Prosthesis infection

Very rare

No

Sepsis or infection-related organ damage

Very rare

No

Reactive arthritis

Very rare

Yes (weeks)

Reiter’s syndrome

(inflammatory arthritis, conjunctivitis, urethritis)

Very rare

Yes (weeks)

Abscesses, local infection

Very rare

No

Chronic intestinal colonization

Very rare

No

Gall bladder infection

Very rare

No

Shigellosisc

(Shigella spp.)

(see Chapter 5 for detailed discussion)

Diarrhea (may be bloody), fever, abdominal pain

Postinfection enteropathyd

Very rare

No

Sepsis or infection- related organ damage

Very rare

No

S. dysenteriae: hemolytic uremic syndrome (HUS)

Renal failure (HUS-related)

Very rare

Yes (days)

 

Reactive arthritis

Very rare

Yes (weeks)

 

Uveitis

Very rare

Yes (weeks)

 

Ankylosis spondylitis

Very rare

Yes (months)

Yersinia enterocolitica infection

Diarrhea, abdominal pain, fever, mesenteric lymphadenopathy, intestinal obstruction,

Reactive arthritis

Common

Yes (weeks)

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

hemorrhage perforation, sepsis

 

 

 

 

 

Abscesses, local infections

Very rare

No

 

Sepsis or infection-related organ damage

Very rare

No

 

Reiter’s syndrome

Very rare

Yes (weeks)

 

Ankylosing spondylitis

Very rare

Yes (weeks to months)

Rickettsioses

 

 

 

 

Boutonneuse fever

(Rickettsia conorii and related species)

Dermal eschar followed by fever; headache; myalgias; rash on trunk, extremities, and face; disseminated vascular infection and vascular leakage; focal hepatocellular necrosis; granuloma-like lesions

Shock or infection-related organ damage

Rare

No

Ehrlichiosis

(Ehrlichia chaffeensis) and anaplasmosis

(Anaplasma phagocytophilum)

Abrupt onset of fever, severe headache, myalgia, vomiting, nausea, rash, lymphadenopathy, confusion, decreased blood counts, liver abnormalities

Shock or infection-related organ damage

Very rare

No

Louse-borne typhus

(R. prowazekii)

Abrupt onset of headache, fever, chills, myalgia; rash begins at axillary folds of trunk and spreads to extremities; sometimes also nonproductive cough, deafness, tinnitus; high fever causes altered mental state

Shock or infection-related organ damage

Rare

No

Recurrence of acute symptoms, sometimes without rash (Brill-Zinnser disease)

Very rare

Yes (years to decades)

Murine typhus

(R. typhi)

Abrupt onset of fever, severe headache, chills, myalgia, nausea, rash, enlarged liver and spleen, cough, confusion, mental-status changes

Shock or infection-related organ damage

Rare

No

Spirochetal illnesses

 

 

 

 

Leptospirosis

(Leptospira interrogans and

Wide range of symptoms from subclinical to severe; abrupt onset of flu-like illness,

Sepsis or infection-related organ damage

Rare

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

others)

lymphadenopathy, jaundice, hepatosplenomegaly, conjunctival suffusion, aseptic meningitis, uveitis, pneumonitis, bleeding, diathesis, sepsis

 

 

 

Rat-bite fever

(Spirillum minus)

Painful, swollen, ulcerated bite site; swollen lymph nodes, fever, headache, rash, relapses if untreated

Relapses (if acute syndrome untreated)

Rare

No

Sepsis or infection-related organ damage

Rare

No

Endocarditis

Very rare

No

Relapsing fever

(Borrelia recurrentis louse-borne; other species, tick-borne)

Range of severity; fever, headache, myalgia, jaundice, enlarged liver and spleen, rash, central nervous system infection, iritis, iridocyclitis, hemorrhage, mycocarditis, relapses

Sepsis or infection-related organ damage

Rare

No

Yaws (nonvenereal treponemal infection, Treponema pertenue)

Rash, osteitis

Rash (if untreated)

Very rare

No

Of special concern to US troops or veterans

Mycoplasmal infection

(primary atypical pneumonia)

Fever, malaise, cough, headache, rash, cryoglobulinemia, myocarditis, arthritis, meningitis, myelitis, encephalitis, hemolytic anemia, glomerulonephritis, Stevens-Johnson syndrome, arthritis

Sepsis or infection-related organ damage

Very rare

No

Bacterial diseases against which all military personnel were immunized and vaccines are highly or fully protective

Diphtheria

(Corynebacterium diphtheriae)

Pharyngeal or wound infection with necrotic membrane formation, respiratory damage, myocarditis

Sepsis or infection-related organ damage

Frequent

No

Haemophilus influenzae type B infection

Meningitis, epiglottitis, arthritis, osteomyelitis

Sepsis or infection-related organ damage

Rare

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Tetanus

(Clostridium tetani)

Wound infection leading to muscle spasm, respiratory damage, autonomic instability

Sepsis or infection- related organ damage, lockjaw

Frequent

No

Bacterial diseases against which all military personnel were immunized and vaccines are partly protective

Meningococcal disease

(Neisseria meningitidis)

Meningitis, sepsis

Sepsis or infection-related organ damage

Frequent

No

Pertussis (whooping cough, Bordetella pertussis)

Respiratory tract infection, secondary infections, encephalopathy

Trauma from severe cough

Rare

No

Bacterial diseases not more prevalent in Southwest and South-Central Asia than in the United States

Actinomycosis

(Actinomyces)

Abscesses, soft-tissue infection

Orofacial, pulmonary, genitourinary disease; osteomyelitis

Common

Yes (months)

Bartonellosis

(Bartonella)

Cat-scratch disease, systemic infection, encephalopathy, retinopathy

Sepsis or infection-related organ damage

Rare

No

Capnocytophaga infection

Bite-site infection (dogs), bacteremia, sepsis

Sepsis or infection-related organ damage

Rare

No

Chlamydia pneumoniae infection

Respiratory tract infections

Sepsis or infection-related organ damage, focal infection

Rare

No

Botulism

(Clostridium botulinum)

Neurotoxicity, cranial nerve palsies, respiratory damage

Sepsis or infection-related organ damage

Rare

No

Gas gangrene

(Clostridium perfringens)

Gas gangrene, wound infection

Sepsis or infection-related organ damage

Rare

No

Tularemia

(Francisella tularensis)

Pneumonia, typhoidal illness, sepsis

Sepsis or infection-related organ damage

Rare

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Haemophilus influenzae infection

Exacerbation of chronic obstructive pulmonary disease

Pneumonia

Common

No

Acute maxillary sinusitis

Chronic sinusitis

Common

No

Empyema, brain abscess, cavernous sinus thrombosis

Very rare

No

Community-acquired pneumonia

Infection-related organ damage

Very rare

No

Middle-ear infection

Meningitis, brain abscess, sinus thrombosis, mastoiditis, acute petrositis, facial paralysis

Very rare

No

Purulent conjunctivitis

Keratitis

Very rare

No

Legionnaire’s disease

(Legionella)

Respiratory tract infections

Sepsis or infection-related organ damage

Rare

No

Listeriosis

(Listeria monocytogenes)

Diarrhea, meningoencephalitis, endocarditis

Sepsis or infection-related organ damage

Very rare

No

Lyme disease

(Borrelia burghdorferi)

Fever, flu-like illness, arthritis, rash, myocarditis, meningoencephalitis

Chronic arthritis

Common (if untreated)

Yes (weeks to months)

Moraxella catarrhalis infection

Respiratory tract infection

Sepsis or infection-related organ damage

Common

No

Nocardiosis

(Nocardia)

Soft-tissue infection, pneumonia, brain infection

Chronic and progressive tissue damage (Madura foot)

Rare

Yes (months)

Noncholera Vibrio infection

Wound infections, diarrhea, bacteremia, sepsis

Sepsis or infection-related organ damage

Rare

No

Nontuberculosis mycobacteria infection

Chronic soft-tissue infections

Chronic focal infections

Common

No

Pasteurella infection

Bite-site soft-tissue infection (from cats, dogs), bacteremia, sepsis

Sepsis or infection-related organ damage

Rare

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Staphylococcus infection

Focal infections, pneumonia, bacteremia

Sepsis or infection-related organ damage

Rare

No

Streptococcus infection

Pharyngitis, bacteremia, pneumonia, focal infections

Sepsis or infection-related organ damage

Rare

No

Glomerulonephritis

Very rare

No

Rheumatic fever

Very rare

No

Streptococcus pneumoniae infection

Respiratory tract infection, meningitis, bacteremia, sepsis

Sepsis or infection-related organ damage

Rare

No

Antibiotic-resistant or common nosocomial bacterial infections

Acinetobacter infectionc

(multiple-drug-resistant)

Skin and soft-tissue infections, abscesses, pneumonia, bacteremia, urinary tract infections

Sepsis or infection-related organ damage

Rare

No

Enterococcus infection

(vancomycin resistant)

Skin and soft-tissue infections, abscesses, bacteremia, urinary tract infections

Sepsis or infection-related organ damage, endocarditis

Rare

No

Klebsiella infection (multiple-drug-resistant)

Skin and soft-tissue infections, abscesses, pneumonia, bacteremia, urinary tract infections

Sepsis or infection-related organ damage

Rare

No

Pseudomonas aeruginosa infection

Skin and soft-tissue infections, abscesses, pneumonia, bacteremia, urinary tract infections

Sepsis or infection-related organ damage

Rare

No

Staphylococcus aureus infection (methicillin-resistant)

Skin and soft-tissue infections, abscesses, pneumonia, bacteremia

Sepsis or infection-related organ damage, endocarditis

Rare

No

Osteomyelitis

Rare

Yes (months)

Stenotrophomonas maltophilia infection

Respiratory tract infection, bacteremia

Sepsis or infection-related organ damage

Very rare

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

NOTE: The term infection refers to a primary infection that leads to disease.

aProbability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5-50% of cases; rare, 1-5% of cases; very rare, <1% of cases.

bDelay defined as adverse health outcome not evident at time of acute illness.

cReported in military personnel in Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom as of December 2005.

dPostinfection enteropathy: syndrome of chronic or intermittent diarrhea and/ or constipation that follows elimination of previous infectious enteropathy; poorly defined etiology and pathogenic mechanism; often self- limited over months to years.

SOURCE: GIDEON 2006; Heymann 2004; Mandell et al. 2005; Nester et al. 2004; Wilson 1991.

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

TABLE 3.2 Viral Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

More Prevalent in Southwest and South-Central Asia Than in the United States

Crimean-Congo hemorrhagic fever

(Nairovirus spp.)

Severe hemorrhagic fever with shock, disseminated intravascular coagulation, frequent extensive bleeding, severely decreased number of platelets

Organ failure

Common

No

Dengue fever

(Flavivirus spp.)

Sudden onset of fever, intense headache, myalgia, arthralgia, retro-orbital pain, anorexia, nausea, vomiting, rash; lymphadenopathy and leukopenia with relative lymphocytosis

Prolonged fatigue and mental depression

Common

No

In some cases: minor bleeding, early onset of generalized erythema

 

 

 

In some adults with underlying conditions: major bleeding phenomena

 

 

 

Rarely: increased transaminases

 

 

 

Dengue hemorrhagic fever (DHF) and Dengue shock syndrome

(Flavivirus spp.)

Fever, hemorrhagic manifestation, thrombocytopenia, evidence of plasma leakage; preceded by intense, continuous abdominal pain with persistent vomiting

Severe liver damage, sepsis, hemorrhage, disseminated intravascular coagulation

Common

No

In severe cases: marked weakness, restlessness, facial pallor, often diaphoresis, severe abdominal pain, circumoral cyanosis, signs of shock

 

 

 

Hepatitis B

(hepatitis B virus [HBV])

Severe cases: acute hepatic necrosis

Clinically evident cases:

 

 

Most cases: no clinical signs

Chronic infection

Rare

Yes (months to years)

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long- Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

Clinically evident cases: insidious onset with anorexia, vague abdominal discomfort, jaundice, nausea, vomiting; sometimes arthralgias and rash

Cirrhosis

Rare

Yes (years)

Hepatocellular carcinoma

Very rare

Yes (years to decades)

Hepatitis C

(hepatitis C virus [HCV])

Asymptomatic or acute hepatitis; rarely, associated with arthritis when virus induces cryoglobulinemia

Cirrhosis

Common

Yes (years to decades

Hepatocellular carcinoma

Rare

Yes (years to decades)

Rift Valley fever

(Phlebovirus spp.)

Acute, undifferentiated, febrile illness; retinitis; vasculitis; hepatitis (may be fulminant); encephalitis

Fulminant disease with infection-related organ dysfunction

Rare

No

Macular and perimacular retinitis and blindness

Very rare

No

Severe encephalopathy

Very rare

No

Sand fly fever

(Phlebovirus spp.)

Headache, fever, injected sclerae, malaise, nausea, pain in limbs and back, leukopenia

Prolonged mental depression

Rare

No

Sindbis virus infection

(Alphavirus spp.)

Fever, often with shaking chills; severe polyarticular arthralgia; rash with headache, photophobia, retro-orbital pain, sore throat, pharyngitis, nausea, vomiting

Arthralgia and myalgia

Frequent

No

Potentially More Prevalent Among Troops in Southwest and South-Central Asia Than Among US Population

Adenovirus infection

(Adenovirus spp.)

Usually: asymptomatic

Chronic hemorrhagic cystitis

Very rare

Yes (weeks to months)

Sometimes: acute respiratory disease (most often tracheobronchitis) and atypical pneumonia, hemorrhagic cystitis

Keratitis

Rare

No

Sometimes: epidemic keratoconjunctivitis

 

 

 

Avian influenza (H5N1)

Fever, cough pneumonia, myalgia, headache, respiratory failure, encephalitis

Infection-related organ damage

Unknown

Unknown

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Hantaviral hemorrhagic fever with renal syndrome

(Bunyaviridae spp.)

Severe form (due to Hantaan virus): toxic fever, severe shock, bleeding; sometimes renal failure, death

Renal failure: sepsis or hypertension-related organ dysfunction

Common

No

Chronic hypertensive renal failure

Rare

No

Renal insufficiency: can include anuria, oliguria, mucosal bleeding diathesis, electrolyte and acid-base abnormalities, hypertension, pneumotitis complicated by pulmonary edema

Renal failure, thrombocytopenia

Common

No

Mild to moderately severe (due to Seoul virus): fever, bleeding, abdominal pain, hyposphenuria

 

 

 

Mild (due to Puumala virus): asymptomatic (90%); abdominal pain, hyposphenuria (10%) Headache, backache, myalgia, diarrhea, vomiting, conjunctivitis, hemorrhage, azotemia, proteinuria, decreased number of platelets

 

 

 

Hantavirus pulmonary syndrome

(Hanta spp.)

Fever of sudden onset and generalized myalgia, sometimes with abdominal pain, gastrointestinal disturbances

Renal failure

Very rare

No

Within 1-10 days: onset of respiratory symptoms; these can progress from modest cough and dyspnea to florid pulmonary edema with respiratory failure in hours

 

 

 

Shock

 

 

 

In patients who survive shock, vascular leak reverses in a few days; recovery is apparently complete

 

 

 

Influenza

(influenza A, B, C spp.)

In healthy adults, infection may be asymptomatic, mild illness, or classic influenza

Exacerbation of chronic pulmonary disease (for example, asthma, cystic fibrosis, chronic

Common

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

Classic uncomplicated influenza:

Systemic symptoms: abrupt onset of fever, chills, headache, myalgia, malaise, anorexia Common: arthralgias

bronchitis)

 

 

 

More severe cases: prostration

Respiratory symptoms (overshadowed by systemic symptoms): dry cough, severe pharyngeal pain, nasal obstruction and discharge

 

 

 

 

 

Lower respiratory tract infection

Common

No

 

 

Cardiac complications

Common (in patients with cardiac disease)

Yes (days to months)

 

 

Encephalitis

Rare

No

 

 

Myositis and myoglobinuria with tender leg muscles and increased serum creatine kinase

Rare

No

 

 

Secondary bacterial pneumonia

Rare

No

 

 

Guillain-Barré syndrome

Rare

Yes (days to weeks)

 

 

Transverse myelitis

Rare

Yes (days)

 

 

Toxic shock syndrome

Very rare

No

Varicella

(Varicella- zoster virus)

Generalized exanthemous rash, low-grade fever, malaise

In all cases:

Herpes zoster (shingles)

Common

Yes (years to decades)

In complicated cases: acute cerebellar ataxia, encephalitis, pneumonitis, meningitis, transverse myelitis, Reye’s syndrome, myocarditis, nephritis, bleeding diatheses, hepatitis

Posttherapeutic neuralgia

Common

No delay after herpes zoster

Ophthalmicus

Rare

No delay after herpes zoster

Ramsey-Hunt syndrome

Very Rare

No delay after herpes zoster

Meningoencephalitis or encephalitis

Very Rare

No delay after herpes zoster

Guillain-Barré syndrome

Very Rare

No delay after herpes

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

 

 

 

zoster

 

 

Varicella pneumonitis

Very Rare

No delay after herpes zoster

 

 

Hepatitis

Very Rare

No delay after herpes zoster

 

 

In complicated cases:

Infection-related organ damage

Rare

No

Viral enteritis

(Enterovirus spp.)

Fever and pharyngitis, rash, aseptic meningitis, epidemic conjunctivitis, herpangina, hand-foot-and-mouth disease, myocarditis, pericarditis, pleurodynia, acute flaccid paralysis, conjunctivitis

Heart failure due to myocarditis

Very rare

No

Chronic meningoencephalitis

Very rare

No

West Nile feverc

(Flavivirus spp.)

(see Chapter 5 for detailed discussion)

Usually: asymptomatic

If symptomatic:

West Nile neurologic disease

Very rare

No

Sometimes: fever, headache, body aches, nausea, vomiting, swollen lymph glands, rash

Acute flaccid paralysis

Very rare

No

Cognitive, physical, or functional impairment

Very rare

No

Uncommon: high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis

 

 

 

NOTE: The term infection refers to a primary infection that leads to disease.

aProbability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases.

b Delay defined as adverse health outcome not evident at time of acute illness.

c Reported in military personnel in Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom as of December 2005.

SOURCE: GIDEON 2006; Heymann 2004; Mandell et al. 2005; Nester et al. 2004; Wilson 1991.

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

TABLE 3.3 Protozoan Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Feature

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Amebiasis

(Entamoeba histolytica)

Diarrhea, fever, abdominal pain, intestinal perforation and hemorrhage, fulminant colitis, hepatomegaly, liver abscesses, fistulae, rarely amebic empyema or amebic pericarditis

Postinfection enteropathyc

Rare

No

Liver abscesses

Rare

Yes (weeks to years)

Empyema, pericarditis

Very rare

Yes (weeks to years)

Intra-abdominal and cutaneous fistulae

Very rare

Yes (weeks to years)

Cryptosporidiosis

(Cryptosporidium spp.)

Diarrhea (may last 1-4 weeks), nausea, fever, myalgia

Chronic diarrhea (in people immunocompromised at time of infection, diarrhea may be persistent despite treatment)

Rare

No

Postinfection enteropathyc

Rare

No

Cryptosporidial cholangitis and acalculous cholecystitis (only in people immunocompromised at time of initial infection)

Very rare

Yes (weeks to months)

Cyclosporiasis

(Cyclospora cayetanensis)

Diarrhea, nausea

Postinfection enteropathyc

Rare

No

Giardiasis

(Giardia lamblia)

Diarrhea, abdominal cramps, bloating, flatulence, malaise, nausea, anorexia

Chronic diarrhea, malabsorption, weight loss

Common (if untreated)

No

Postinfection enteropathyc

Rare

No

Isosporiasis

(Isospora belli)

Diarrhea, nausea, eosinophilia

Persistent diarrhea (if untreated)

Rare

No

Postinfection enteropathyc

Rare

No

Leishmaniasisd

(Leishmania spp.)

(see Chapter 5 for detailed discussion)

Cutaneous leishmaniasis (CL): any of variety of skin lesions ranging from small, dry, crusted areas to large, deep, disfiguring ulcers

CL:

Lesions may persist 3-24 months

Common

No

Scarring

Common

No

Contractures over joints

Very rare

Yes (weeks to months)

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Feature

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

Visceral leishmaniasis (VL [kala-azar]): fever, chills, weight loss, hepatosplenomegaly, anemia, leukopenia, hypergammaglobulinemia

VL:

Reactivation (if immunosuppressed)

Common

Yes (months to years)

 

Delayed presentation of acute syndrome

Rare

Yes (months to years)

 

Viscerotropic leishmaniasis: fever, chills, weight loss, headache, splenomegaly, lymphadenopathy

Post-kala-azar dermal leishmaniasis (disseminated nodular infiltration of skin with parasites after treatment of visceral leishmaniasis)

Very rare

Yes (weeks to years)

Malariad

(Plasmodium spp.)

(see Chapter 5 for detailed discussion)

P. falciparum: fever, chills, anemia, headache, myalgia, cerebral malaria (including seizures, coma, neurologic complications), hypoglycemia, acidosis, severe anemia, splenic disease, renal failure, respiratory failure

P. falciparum:

Anemia

Common

Yes (months)

Shock or hypoperfusion-related organ damage

Rare

No

Recrudescence

Rare

Yes (months)

Ophthalmologic manifestations

Very rare

Yes (months to years)

P. ovale and P. vivax: fever, chills, headache, myalgia, anemia, splenic disease, rarely respiratory failure

Persistent neurologic deficits (consequence of cerebral malaria)

Very rare

Yes (months to years)

P. malariae: Fever, chills, headache, myalgia, anemia, splenomegaly; if untreated, infection may be chronic

P. ovale and P. vivax:

Relapse of acute syndrome

Common (if untreated)

Yes (weeks to years)

Splenic rupture

Very rare

Yes (weeks to months)

P. malariae:

Late presentation

Rare

Yes (years)

Glomerulonephritis/nephrotic syndrome

Very rare

Yes (months to decades)

Myelodysplastic syndrome

Very rare

Yes (months to decades)

Microsporidiosis

(Microsporidia spp.)

Diarrhea (usually self-limited), kerato-conjunctivitis

Postinfection enteropathyc

Rare

No

If immunocompromised: persistent diarrhea, sinusitis, acalculous cholecystitis, pneumonitis, nephritis, systemic infection

Self-limited diarrhea, unless immunocompromised at time of infection

Very rare

No

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Feature

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Toxoplasmosis

(Toxoplasma gondii)

Range of symptoms: may be asymptomatic, fever, cervical lymphadenopathy, myositis, mononucleosis-like syndrome (pharyngitis, fever, hepatosplenomegaly, lymphadenopathy), encephalitis, myocarditis, chorioretinitis, rarely pneumonitis; congenital infection can occur if acute infection occurs during pregnancy

Reactivation of disease (if immunocompromised)

Common (if immuno-compromised)

Yes (years)

 

Toxoplasmic brain abscesses (only in severely immunocompromised)

Rare

Yes (years)

 

Chorioretinitis

Very rare (if infected as adult);

Common (if infected in utero)

Yes (years)

a Probability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases.

b Delay defined as adverse health outcome not evident at time of acute illness.

c Postinfection enteropathy: syndrome of chronic or intermittent diarrhea and/or constipation that follows elimination of previous infectious enteropathy; poorly defined etiology and pathogenic mechanism; often self-limited over months to years.

d Reported in military personnel in the Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom as of December, 2005.

SOURCE: GIDEON 2006; Heymann 2004; Mandell et al. 2005; Nester et al. 2004; Wilson 1991.

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

TABLE 3.4 Helminthic Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Feature

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Nematodes

 

 

 

 

Ascariasis

(Ascaris spp.)

Largely asymptomatic

Transient respiratory symptoms associated with pulmonary infiltration and peripheral blood eosinophilia, intestinal obstruction or blockage

Biliary duct obstruction, ascending cholangitis, acute pancreatitis, obstructive jaundice, peritonitis

Very rare

Yes (months to years)

Enterobiasis (pinworm infection, Enterobius vermicularis)

Largely asymptomatic

Appendicitis

Very rare

Yes (months to years)

Pelvic infection

Very rare

Yes (months to years)

Symptomatic: perianal or perineal pruritus

 

 

 

Occasionally: abdominal pain

 

 

 

Filariasis

(Wuchereria bancrofti)

Lymphangitis, lymphadenitis, eosinophilia

Episodes of fever and lymphangitis, may recur over several years

Rare

Yes (years)

Lymphedema

Rare

Yes (years)

Persistent adenopathy

Rare

Yes (years)

Epididymitis

Very rare

Yes (years)

Chyluria

Very rare

Yes (years)

Orchitis

Very rare

Yes (years)

Hookworm disease

(Ancylostoma duodenale and Necata americanus)

Largely asymptomatic

Pruritus at dermal site of larval penetration

Iron-deficiency anemia

Common

Yes (months to years)

Onchocerciasis (river blindness, Onchocerca volvulus)

Dermatitis, keratitis

Skin hyperpigmentation, depigmentation, chronic dermatitis, dermal atrophy

Common

Yes (years to decades)

Sclerosing keratitis

Common (if untreated)

Yes (years to decades)

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Feature

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

 

Visual loss

Common (if untreated)

Yes (years to decades)

 

 

Iridocyclitis

Rare

Yes (years to decades)

Strongyloidiasis

(Strongyloides stercoralis)

Diarrhea, intestinal irregularities, gluteal or perineal pruritus and rash, eosinophilia

Hyperinfection syndrome, generalized strongyloidiasis

Common (in immunosuppressed patients on steroids)

Yes (months to decades)

Cestodes

 

 

 

 

Cysticercosis (Taenia solium larvae [cysticerci])

Cerebral, ocular, or subcutaneous cysts usually without eosinophilia; involvement of central nervous system may present as seizures, increased intracranial pressure, altered mental status, eosinophilic meningitis, focal neurologic deficits, spinal-cord mass, or encephalitis

Chronic seizure disorder

Common

Yes (years)

Recurrence of acute symptoms

Very rare

Yes (months to years)

Echinococcosis (Echinococcus multilocularis)

Usually: asymptomatic

Rarely: abdominal pain with or without apalpable mass in right upper quadrant, fever, pruritus, urticaria, eosinophilia, anaphylactic shock, cough, hemoptysis, chest pain

Hepatic and metastatic cysts

Common

Yes (years to decades)

Trematodes

 

 

 

 

Schistosomiasis

(Schistosoma haematobium)

Often asymptomatic

Bladder inflammation, urinary obstruction, scarring, eosinophilia

Recurrent urinary tract infection

Common (if untreated)

Yes (years)

Cerebral mass, generalized encephalopathy, or focal epilepsy

Very rare

Yes (weeks to years)

Transverse myelitis

Very rare

Yes (weeks to years)

Bladder cancer (squamous

Very rare

Yes (decades)

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Feature

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

 

cell)

 

 

 

 

Urinary obstruction (hydronephrosis)

Very rare

Yes (decades)

Schistosomiasis (S. mansoni)

Often asymptomatic

Gastrointestinal symptoms, colonic polyps, hepatosplenomegaly, jaundice, cirrhosis, eosinophilia

Fatigue, abdominal pain, intermittent diarrhea or dysentery, moderate anemia

Common

Yes (weeks to years)

Gastrointestinal symptoms

Common

Yes (weeks to years)

Hepatosplenomegaly and variceal hemorrhage

Rare

Yes (years)

Cirrhosis

Rare

Yes (years to decades)

Portal hypertension

Rare

Yes (years to decades)

Transverse myelitis

Very rare

Yes (weeks to years)

Right ventricular congestion or cor pulmonale

Very rare

Yes (years)

Cerebral masses

Very rare

Yes (years to decades)

a Probability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases.

b Delay defined as adverse health outcome not evident at time of acute illness.

SOURCE: GIDEON 2006; Heymann 2004; Mandell et al. 2005; Nester et al. 2004; Wilson 1991.

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

TABLE 3.5 Sexually Transmitted Diseases That Are Endemic to Southwest and South-Central Asia and Have Potential Long-Term Adverse Health Outcomes

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

More prevalent in Southwest and South-Central Asia Than in the United States

Chancroid

(Haemophilus ducreyi)

Genital ulcers, inguinal lymphadenopathy

Scarring

Very rare

Yes (weeks)

Hepatitis A

(hepatitis A virus [HAV])

Acute hepatitis (jaundice, nausea, anorexia, fever) if symptomatic

Liver failure

Very rare

No

Hepatitis B

(hepatitis B virus [HBV])

Severe cases: acute hepatic necrosis

Chronic infection

Rare

Yes (months to years)

Cirrhosis

Rare

Yes (years)

Most cases: no clinical signs

Hepatocellular carcinoma

Very rare

Yes (years to decades)

Clinically evident cases: insidious onset with anorexia, vague abdominal discomfort, nausea, vomiting Sometimes arthralgias and rash Jaundice: 30-50% of cases

 

 

 

Lymphogranuloma venereum

(Chlamydia trachomatis serovars L1-L3)

Genital ulcers, inguinal lymphadenopathy, proctitis

Genital scarring and fistulae; perirectal abscess

Unknown, but presumably rare

Yes (month to years)

Syphilis

(Treponema pallidum)

Genital ulcers (primary stage)

Rash, fever, meningitis, stroke, nephrotic syndrome, hepatitis (secondary stage)

Spontaneous abortion (any stage)

Gummas, tabes dorsalis, dementia, meningovascular disease, generalized paresis, aortitis (tertiary stage)

Common (if untreated)

Yes (months to years)

Potentially More Prevalent Among Troops in Southwest and South-Central Asia Than Among US Adult Population

Chlamydia

(Chlamydia trachomatis serovars D-K)

Usually: asymptomatic

Chronic pelvic pain, tubal infertility, ectopic pregnancy

Common in untreated women

Yes (months to years)

Sometimes: cervicitis, pelvic inflammatory

In infants born to infected

 

 

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

 

disease, urethritis, conjunctivitis

mothers:

 

 

 

In infants born to infected mothers: pneumonia, conjunctivitis

Reactive airways disease

Unknown

Yes (years)

Gonorrhea

(Neisseria gonorrhoeae)

Usually: asymptomatic

Chronic pelvic pain, tubal infertility, ectopic pregnancy

Common in untreated women

Yes (months to years)

Sometimes: cervicitis, pelvic inflammatory disease, urethritis, conjunctivitis

 

 

 

Uncommon: disseminated gonococcal infection (arthritis, tenosynovitis, rash, meningitis, endocarditis)

 

 

 

Of Concern to US troops, but No Evidence of Increased Frequency or Association with Service in Southwest or South-Central Asia

Genital herpes

(herpes simplex virus [HSV])

Usually: asymptomatic

Recurrent genital herpes

Common

Yes (weeks to years)

Sometimes: genital ulcers

(HSV-2)

 

 

 

Uncommon: meningitis, radiculitis

Recurrent meningitis

(Mollaret’s)

Very rare

Yes (weeks to years)

Human immunodeficiency virus Type 1 (HIV-1)

Asymptomatic

Primary infection syndrome (acute retroviral syndrome)

Acquired immune deficiency syndrome (AIDS)

AIDS-related opportunistic infection

Frequent if untreated

Yes (years to decades)

HIV-related malignancies

Common

Yes (years to decades)

Human papillomavirus infection

Asymptomatic

Cervical neoplasia

Rare

Yes (months to years)

Genital warts

Genital squamous cell cancers (penis, anus)

Rare

Yes (years)

Tracheal infection in newborns of infected mothers

Very rare

Yes (months to years)

Human T-cell lymphotropic virus infection (I)

(HTLV-I)

Asymptomatic

Chronic persistent oligoarthritis

Adult T-cell leukemia or lymphoma

Rare

Yes (years)

HTLV-I-associated myelopathy

Rare

Yes (years)

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

 

 

Potential Long-Term Outcomes in Adults with Clinical Disease

Disease or Syndrome

Acute Syndrome(s) in Adults

Disease(s), Syndrome(s), or Clinical Features

Frequency of Occurrence of Outcomesa

Delay Between Acute Infection and Onset of Outcomesb

Trichomoniasis

(Trichomonas vaginalis)

Asymptomatic

Preterm delivery

Rare

No

Vaginitis

 

 

 

Urethritis

 

 

 

NOTE: The term infection refers to a primary infection that leads to disease.

aProbability calculated as percentage of acute cases. Frequent, >50% of cases; common, >5- 50% of cases; rare, 1-5% of cases; very rare, <1% of cases.

bDelay defined as health outcomes not evident at time of acute illness.

SOURCE: Baum 2005; Holmes et al. 1999.

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

REFERENCES

Baum S. 2005. Introduction to Mycoplasma diseases. Mycoplasma Diseases. In: Mandell G, Bennett J, Dolin R, Editors. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Churchill Livingstone. Pp. 2269-2271.

GIDEON. 2006. Global Infectious Disease and Epidemiology Network. [Online]. Available: http://www.gideononline.com [accessed April 12, 2006].

Heymann DL. 2004. Control of Communicable Diseases Manual. Washington, DC: American Public Health Association.

Holmes KK, Sparling PF, Mardh P, Lemon SM, Stamm WE, Piot P, Wasserheit JN. 1999. Sexually Transmitted Diseases. 3rd ed. New York: McGraw-Hill.

Mandell GL, Bennett JE, Dolin R. 2005. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone.

Nester EW, Anderson DG, Roberts JCE, Pearsall NN, Nester MT. 2004. Microbiology: A Human Perspective. 4th ed. New York: McGraw-Hill.

Wilson ME. 1991. A World Guide to Infections: Diseases, Distribution, Diagnosis. New York: Oxford University Press.

Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
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Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
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Page 47
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 48
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 49
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 50
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 51
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 52
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 53
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 54
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 55
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 56
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 57
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 58
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 59
Suggested Citation:"3 Infectious Diseseases Endemic to Southwest and South-central Asia the have Long-Term Adverse Health Outcomes." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page 60
Next: 4 Infectious Diseases Diagnosed in U.S. Troops Who Served in the Persian Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom »
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Infectious diseases have been a problem for military personnel throughout history. The consequences in previous conflicts have ranged from frequent illnesses disrupting daily activities and readiness to widespread deaths. Preventive measures, early diagnosis, and treatment greatly limit the exposures and acute illnesses of troops today in comparison with those in armies of the past, but infections and consequent acute illnesses still occur.

Thousands of US veterans of the Persian Gulf War have reported an array of unexplained illnesses since the war ended in 1991. Many veterans have believed that the illnesses were associated with their military service in southwest Asia during the war. This volume of Gulf War and Health evaluates the scientific literature on chemical, biologic, and physical agents to which military personnel in the gulf were potentially exposed and possible long-term adverse health outcomes.

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