Mystery Pneumonia Hits Troops Overseas
2 Dead -- New Smokers Most Affected
Sept. 11, 2003 -- Severe mystery pneumonia has killed two U.S. soldiers in Iraq and sent 17 others deployed around the globe to the hospital.
The disease isn't tied to any one place, time, or military unit. And in 1997 -- before the current Iraq deployment -- it struck two U.S. soldiers training in California's Mojave Desert. This suggests it isn't related to enemy biological or chemical weapons, according to a report in the Sept. 12 issue of the CDC's Morbidity and Mortality Weekly Report.
What it is, exactly, remains a mystery. The disease is a very severe pneumonia that develops quickly in both lungs. Those who get it soon need mechanical ventilation in a hospital. Patients' lung fluids are full of immune cells called eosinophils -- white blood cells that engulf germs and parasites, but which are also common during allergic reactions.
According to the CDC, only four of the 19 cases are confirmed and another six are considered "probable." The other nine cases are "suspect."
Interestingly, nine of the 10 confirmed and probable cases involved soldiers who started smoking after deployment. None of the nine suspected cases were beginner smokers. The Department of Defense has issued a warning to troops that cigarette smoking -- particularly beginning smoking -- is a risk factor for the pneumonia.
For now, the disease is being called "severe acute pneumonitis with elevated eosinophils." However, it's a lot like another mysterious disease: Acute eosinophilic pneumonia or AEP. AEP is an acute pneumonia with fever but without identifiable infectious cause. It starts rapidly and soon progresses to respiratory failure. And AEP is linked to cigarette smoking -- particularly beginner smoking.
The disease is not an epidemic. The 19 cases happened in various locations in Iraq (13 patients), Kuwait (three patients), Djibouti (one patient), Qatar (one patient), and Uzbekistan (one patient). Only two patients came from the same unit -- and they got sick four months apart.
The soldiers don't even have the same jobs, although 17 of the 19 cases are in the Army. Specialties included combat arms (eight patients), engineering (three patients), transportation (two cases), signal corps (two cases), medical services (two cases), supply (one case), and military police (one case).
"Initial data analysis suggests that medications, vaccines, and biologic weapons are not associated with the disease," the CDC report states.
In an editorial comment, the CDC notes that while two U.S.-based soldiers came down with a similar disease in 1997, no U.S.-based troops have come down with the disease within the time frame of this outbreak -- March through August 2003. Still, the editorial asks doctors to obtain a travel history from anyone with a rapidly progressing pneumonia and to alert the Army and state health departments if any returning troops have unexplained respiratory failure.
SOURCE: Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Sept. 12, 2003; vol 52: pp 857-859.