Navy raced to identify illness as malaria

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Navy raced to identify illness as malaria





The number of ill service members in the Iwo Jima battle group rose to 46 on Wednesday. FIle photo by Yesenia Rosas / U.S. Navy.


By MATTHEW DOLAN, The Virginian-Pilot
? September 11, 2003

Under a microscope, red blood cells normally look like little pink doughnuts. But as an illness spread across two Hampton Roads-based ships last week, Petty Officer 3rd Class Igor Karyman saw slides of cells with grayish holes filled with a purple dot.

Could it be malaria?

Karyman and his fellow Navy laboratory technicians on the Iwo Jima needed to be sure. They had never seen the mosquito-borne parasite before.

``We had to take three or four reference books out,'' he said in a shore-to-ship interview Wednesday.

So began a race against the clock for a ship's medical staff to beat back a potentially deadly epidemic that has infected dozens of Marines and sailors who deployed to war-ravaged Liberia.

Today, Navy doctors remain perplexed by an unusually high rate of malaria among Marines who were in the West African nation last month on a peacekeeping mission.

Three more patients turned up with symptoms and are being treated aboard the amphibious assault ship Iwo Jima off the Liberian coast, bringing the number of ill service members Wednesday to 46, said Master Sgt. John V. Tomassi of the U.S. European Command.

That represents 20 percent of 225 Marines and sailors who went ashore last month, a surprising number since the anti-malarial drug they were given is normally highly effective in preventing the illness. The number of confirmed cases among the 46 is 18, up from 13 Tuesday, Tomassi said.

The outbreak surfaced on Friday with two laid-up Marines on the dock landing ship Carter Hall. They were so sick that doctors authorized their airlift to the Iwo Jima, then traveled to the ship themselves to search for answers.

``They were jaundiced. They were puking. They had diarrhea,'' said Lt. Cmdr. John B. Newman, ship surgeon for the Iwo Jima amphibious group.

The patients' heart rates raced, their blood pressure dropped and dehydration set in.

``We ordered blood counts . . . chest X-rays, blood smears,'' Newman said. ``We needed answers quickly.''

But uncertainty lingered. The medical staff worried that the illness could be one of a host of dangerous and contagious fevers common in West Africa. Hepatitis was also among the suspects, Newman said.

``We heard that they all stayed in the same warehouse,'' he said of the ill Marines. ``To clean it up, they removed rodent and human stool feces. Our concern was simply, `What have we just brought aboard?' ''

Two hours later, the doctor had his answer: Malaria.

The medical leadership had already started the ball rolling to transfer sick Marines and sailors ashore, Newman said. Just as the first two were being flown to Germany, another 15 Marines were on their way from the Carter Hall to the Iwo Jima, Newman said.

The next day, 30 more arrived.

Newman said that an unknown number of other Marines and sailors may have been infected but have responded to a change in their medication.

Doctors continue to closely watch the others who went ashore, an unknown number of whom also are reported to have complained of body aches, one of the symptoms, said Capt. Greg Martin of the National Naval Medical Center in Bethesda, Md.

Martin cited three possibilities: this strain of malaria has become resistant to the drug the troops were taking; troops didn't take it correctly; the drug had gone bad or there was a flaw in its manufacture.

Everyone going ashore is being switched to another antimalarial in case resistance is the problem, doctors said.

``It sounds like a reasonable course of action,'' said Dr. Peter Bloland, a malaria epidemiologist with the Centers for Disease Control, a national public health agency founded for malarial research among military forces.

Meanwhile, 16 of those hospitalized in Bethesda have been discharged, spokesman Lt. Cmdr. Chito Peppler said Wednesday. The three new patients remaining aboard the Iwo Jima are a Marine, an Army soldier and a civilian.

Previously, 43 Marines and sailors with more serious cases had been evacuated from their ships for hospitalization.

Five of those evacuated have serious cases, including two patients with cerebral malaria. But all are expected to recover, said Lt. Cmdr. David Blazes, a doctor who specializes in infectious disease and is caring for those brought to Bethesda.

Members of the 26th Marine Expeditionary Unit based at Camp Lejeune, N.C., were in Liberia in mid-August as part of a quick-reaction force of about 150 troops. They operated from an airport outside Monrovia, the capital, for about 10 days.

``Nothing is more demoralizing than to lose a Marine or sailor from here. So I know it's hurt spirits,'' Newman said. ``But for them to die would be horrific. So we have to say that the system is working and we're taking care of them.

``That's a comfort to everyone -- now that we know what's wrong.''

The Associated Press contributed to this report.

Reach Matthew Dolan at matthew.dolan@pilotonline.com or 446-2322.

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