I was wondering about this for our current troops in Iraq -
they say the rates are higher than expected?
I was also wondering about whether 'pneumonia' deaths of
troops in Iraq were not really pneumonia, but an exposure to too
strong a concentration of this chemical or ethylene oxide ...
which is said to cause pulmonary edema (your lungs fill up with
fluid) www.valdezlink.com/pages/unclear.htm
quote:
Here is a comment on the Patriot Files: Troops' Pneumonia
Outbreak Spurs Medical Hunt
Received this by e-mail!
From Mrs. Hardcore
____________________________________________
Snip: "This picture is more typical of an out-of-control
immune system reaction than an infection".
Snip: "Occasionally, exposure to chemicals or specific
drugs can cause such cells to proliferate. When large numbers
turn up in the blood -- a condition called eosinophilia -- in
someone taking many medicines, it is usually chalked up as a
drug reaction."
"There didn't appear to be any drug that had been taken
by the 10 patients, but they did have one thing in common. All
were smokers, and nine, including one who died, had started or
resumed smoking during the deployment."
Randi's Note: Though it's not mentioned in the article, one
last thing they had in common.... all were vaccinted. One
might think that instead of searching for new problems
stemming from weakened immune systems and smoking, one might
look at weakened immune systems and continuing to receive
biological vaccines. But, that just might lead to some actual
investigation, and God forbid pet projects to stop.
----- Original Message -----
From: Lacklenj@aol.com
Washington Post
September 12, 2003
Pg. 1
Troops' Pneumonia Outbreak Spurs Medical Hunt
By David Brown, Washington Post Staff Writer
Lt. Col. Janice M. Rusnak, recently arrived at the U.S.
military hospital in Landstuhl, Germany, for a tour as
infectious-diseases specialist, walked into the third-floor
intensive care unit. She didn't know the name of the patient
she wanted to see. But she had what she considered a fairly
good description.
Can you point me to the soldier from Iraq who's on a
ventilator? she asked a nurse. The one with acute respiratory
distress syndrome.
Which one? the nurse answered. We have three.
Three cases in one place -- pretty strange, the 50-year-old
Rusnak remembers thinking.
Rusnak's observation that morning in late July was the
opening chapter of a medical whodunit -- the end of which
still hasn't been written. Although it has identified a
surprising suspect, the military is still in the midst of a
full-scale investigation to trace the source of a rare, and
occasionally fatal, illness.
What's clear so far is this: Since early March, about 100
soldiers deployed to the Persian Gulf region and Central Asia
have contracted pneumonia. About 30 have been ill enough to be
sent to hospitals in Europe or the United States. In medical
slang, 19 "crashed" within hours of getting sick,
not responding to antibiotics and requiring mechanical
ventilators to breathe for them. Two have died.
On the day she walked into the Landstuhl hospital, Rusnak
was looking for a patient about whom she had been told several
days earlier in an e-mail from doctors at the Army's 28th
Combat Support Hospital in Iraq. They had a soldier with
severe pneumonia whom they were thinking of evacuating to
Germany. They were worried, and a little spooked. They had
recently had a similar patient -- a 24-year-old sergeant with
pneumonia who also needed a ventilator. He had gone into
cardiac arrest and died while being prepared for a flight out.
There's a saying in medicine that an "outbreak"
is when you see one more case of a disease than you expect.
Here were four young soldiers from Iraq sick enough with
pneumonia to need machines to breathe for them, and one had
died. This was not something Rusnak could easily pass by.
And she didn't.
Before the day was over, she and colleagues at Landstuhl
notified Army epidemiologists in the United States that they
might be looking at some sort of outbreak. What or how
extensive it was, they weren't sure.
Nothing obviously links the cases, the severe ones in
particular. There is no evidence the illness is passed person
to person. The 19 people -- 18 men and one woman -- were
stationed across 2,600 miles, from Djibouti in the Horn of
Africa to Uzbekistan in Central Asia, with most in Iraq. They
had a variety of military occupations. Only two were in the
same unit, and they became ill six months apart.
Overall, the incidence of pneumonia in deployed troops has
not been wildly out of line with what is expected. It's the
number of severe cases that's unusual -- that and the fact
that 10 of them showed proliferation of uncommon immune system
cells called eosinophils.
Whatever the disease may be, it is clearly rare. It may
even be new. The military's interest, however, isn't academic.
It wants to learn what's going on so it can prevent future
cases.
The investigators are working in the long shadow of Gulf
War syndrome, a grab bag of illnesses and physical complaints
that emerged after the 1991 war against Iraq. The Pentagon was
accused of not paying enough attention to that problem, and
doesn't want a repeat of that experience.
Although the pneumonia outbreak and Gulf War syndrome
differ in nearly every important characteristic, the Army is
going after this one aggressively, deploying investigative
teams, searching old records for similar cases and consulting
civilian experts from the start.
"Whether that reflects some hypervigilance -- I would
say yes, it probably does. I would say I think we're much more
sensitive to it because of the Gulf War experience," said
Col. Robert F. DeFraites, an epidemiologist and senior
preventive medicine officer in the Army surgeon general's
office.
In many ways, it is a classic investigation of a rare
medical event. Unlike outbreaks of diarrhea and bronchitis,
where there's an unmistakable spike in cases and the issue is
what's causing them, outbreaks of rare conditions begin with a
more basic question. Is anything really happening here? Is
there a new signal coming out of the usual background noise?
Janice Rusnak thought she did hear a new signal. On the
other side of the Atlantic, at the Army's Center for Health
Promotion and Preventive Medicine at Aberdeen Proving Ground
outside Baltimore, Col. Bruno P. Petruccelli thought he heard
one, too.
"On one day, sitting here in my office, two things
happened," Petruccelli recalled recently.
First, he received a copy of several e-mails Rusnak had
sent from Germany to colleagues at the Army's infectious
disease research center at Fort Detrick in Frederick. She
described the rapid downhill course of several pneumonia cases
she had seen. Electronically clipped to one message was a
dramatically abnormal chest X-ray of a young soldier, the
lungs nearly "whited out" with fluid, a condition
often presaging death.
Then came another e-mail message, this one from a woman in
Kuwait working for the Army team that samples soil, air and
water at encampment sites. She had heard that the local
military hospital had seen an unusual number of pneumonia
cases. She even gave a number -- 17. The subject line of the
message was "mysterious disease."
Shortly after he had read both messages, Petruccelli got a
call from the doctor at Fort Detrick who had forwarded
Rusnak's e-mails. He wanted to talk about them.
"You couldn't have done it better in Hollywood. It all
kind of blows in on one day," Petruccelli recalled.
The military has a long history of making discoveries in
epidemiology and medicine. Its closely observed population of
mostly young healthy people is one in which the odd cases are
likely to be noticed -- if your eyes are open to them.
Already, doctors in the Iraq theater had noticed a number of
infections in both American and Iraqi casualties caused by
acinetobacter, a relatively rare microbe found in soil. The
pneumonias were another blip worthy of attention.
Over the next two weeks, Rusnak and a military
epidemiologist in Landstuhl tabulated cases of soldiers with
pneumonia who had been sick enough to be flown out for
treatment. They came up with 15 -- possibly an incomplete
count, they thought -- and described them to Petruccelli and
DeFraites in a conference call on July 3.
That afternoon, those two physicians held another
conference call with stateside military doctors, one of whom
suggested patching in Stephen M. Ostroff, an
infectious-diseases expert at CDC and head of a committee of
civilian advisers called the Armed Forces Epidemiological
Board.
"I remember telling them that in my experience, when
healthy young adults develop a typical bacterial pneumonia, if
they get a whiff of antibiotics they tend to turn around
fairly quickly. It's unusual for people this age to
deteriorate," Ostroff recalls. "I strongly conveyed
to them that this needed to be looked into, without
question."
There were hints these strange cases might not be
infections at all. Many of the sickest patients had
deteriorated with a speed rarely seen in bacterial or viral
pneumonias. The soldier for whom Rusnak went looking in the
Landstuhl ICU was a good example.
A soldier in his early twenties, he played volleyball the
afternoon he got sick and after dinner was watching a movie
when he suddenly became so breathless he thought he might pass
out. The only other thing unusual that evening was a slight
nosebleed. By the time he arrived by helicopter at the 28th
Combat Support Hospital near Baghdad, he had a 102-degree
fever and was struggling to breathe. Within six hours of his
first symptom, he was on a ventilator.
A case from Uzbekistan in April was similar: a young
soldier who felt well, then had 12 hours of mild chest
tightness and shortness of breath before he needed a machine
to keep him alive.
This picture is more typical of an out-of-control immune
system reaction than an infection.
On July 12, a second soldier died of multi-organ failure in
Landstuhl. He had had a day of chest pain and breathlessness
before being put on a ventilator on June 30.
On July 17, the Army surgeon general launched an
investigation.
Although the count of about 100 cases of pneumonia since
March 1 through mid-August turns out to be about what one
might expect, what was unusual were features of some -- but
not all -- of the severe cases.
Of the original 19, four had evidence of bacterial
infection. There was no evidence of other infectious
respiratory diseases -- no severe acute respiratory syndrome,
influenza, Legionnaire's disease, hantavirus, mycoplasma or
fungal infections. Even more peculiar was what laboratory
tests did show -- large numbers of the usually rare eosinophil
cells in the blood or lungs -- and sometimes both -- of 10
patients.
Occasionally, exposure to chemicals or specific drugs can
cause such cells to proliferate. When large numbers turn up in
the blood -- a condition called eosinophilia -- in someone
taking many medicines, it is usually chalked up as a drug
reaction.
There didn't appear to be any drug that had been taken by
the 10 patients, but they did have one thing in common. All
were smokers, and nine, including one who died, had started or
resumed smoking during the deployment.
One of the nine was Lt. Cmdr. Glen Todd. The 47-year-old
Navy nurse-anesthetist was working in a hospital in Djibouti
when he woke up in a breathless sweat the night of Aug. 6. His
condition worsened rapidly, and he was evacuated to Landstuhl,
where he was put on a ventilator Aug. 8.
Todd is the oldest of the 19 patients who became seriously
ill. He had smoked for several years in his twenties, but
quit. In May he started again, eventually getting up to a
half-pack of cigarettes a day and two cigars at night.
"Why does anybody smoke or why does somebody drink a
beer once in a while?" he asked rhetorically in a
telephone interview from his home in Great Lakes, Ill., where
he is recuperating. "I think I started smoking over there
mostly as a social thing."
Like many of the patients who needed ventilators, he turned
around quickly and was off the machine in a few days, with no
apparent lasting damage to his health.
Smoking predisposes a person to pneumonia, and of the
entire group of 19 people on ventilators, 15 smoked.
Nevertheless, the eosinophilia in new smokers seemed more than
just a coincidence to Maj. Andrew Shorr, a lung specialist in
Landstuhl. He found 12 intriguing papers published by Japanese
physicians in the past six years. They reported cases of the
rare disease, most of them in teenagers who had recently
started smoking. All recovered quickly, sometimes with the
help of steroids, which decrease inflammation. The researchers
had re-exposed several to cigarette smoke to see if the
eosinophilia returned, and it did.
There was also a 1999 paper published by two Army doctors
in the journal Military Medicine who reported two cases of
severe pneumonia with eosinophilia in soldiers at Fort Irwin
in Southern California. Both were smokers.
Speaking from a Baghdad rooftop on a satellite telephone
recently, Col. Bonnie L. Smoak, an Army physician leading the
investigation in Iraq, said an epidemiologist there is
surveying a sample of deployed soldiers to see how many
recently began smoking.
As to the ultimate explanation of the dangerous pneumonias,
there is no shortage of theories.
Although the investigators are still searching for and
reviewing the records of all pneumonia cases, at least some of
the 19 severe cases are sporadic, garden-variety cases caused
by infection. But the patients with eosinophilia are probably
a subgroup of their own.
If they were all smokers, what else might they share? Was
there a "second hit" they all got that hasn't yet
been identified? Was there some common environmental exposure?
Did it have something to do with the desert? Was there a
genetic predisposition that made them vulnerable?
Is it also possible that after a century in which hundreds
of millions of people started smoking that a brand-new disease
caused by the habit could turn up in 2003?
"I am skeptical about that," DeFraites said
recently. "The big question to me is -- why here and why
now?"
The last case occurred Aug. 19. The Army isn't convinced
it's the last. The search for the culprit is narrowing, but
it's not over.
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