Troops' Pneumonia Outbreak Spurs Medical Hunt

[HARDCORE]

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.

[Margaret Diann]

I appreciate this detailed information.

This is the kind of response that some of the Exxon Valdez oil spill cleanup workers had. As this woman - who didn't last one day

Another woman shared the same for her son and because she could order help for him quickly he survived; however there were about 5 others that didn't

Does it look like the military has Corexit 9527 somewhere? That only said it contained ethylene oxide when I saw the first MSDS; now all they say is 2-butoxyethanol... at 38% NOT SAFE! The former causes pulmonary edema; and too much exposure to 2-butoxythanol - can cause death all by itself.

Looks to me like there could be some of the Corexit 9527 in Jet fuel - Isn't it odd that there are several jet fuels with pesticide labeling - and comments like 2-butoxyethanol would give - 'defatted skin' wash eyes with plenty of water ... etc.

What can we learn about JP-5?

Let's check a sample of JP4

This is one bad use of jet fuel

This is my letter to the editor that only a small town paper was brave enough to print

Check for damaged blood for 2-butoxyethanol damage; for ethylene oxide what?

So why is one person affected and the soldier next to him not? Well, what jobs did the first one have? What exposure to freshly sprayed pesticides in living & work areas? What overexposure to gun cleaner? Add up the exposures to these chemicals ... and you might have your answer.

Here is more info

more research

And, yes, studies checking for the RIGHT stuff are needed!
If something does get studied that will find the harm of these chemicals
... count me in as a helper!

Margaret
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