Eric Eckert
2 more U.S. soldiers develop severe pneumonia
Sat Aug 2 20:25:27 2003
64.140.158.107

August 1, 2003

2 more U.S. soldiers develop severe pneumonia, put on ventilators

By Eric Eckert
News-Leader Staff
http://www.news-leader.com/today/0801-2moreUSsol-123700.html

Two more U.S. soldiers serving in the Middle East were placed on ventilators this week after developing severe pneumonia, Army officials said Thursday.

Since March 1, approximately 100 troops have been afflicted with the illness, according to a news release from the Army Surgeon General. Of those cases, 14 have been placed on respirators and two have died — including Missouri National Guard Spc. Joshua Neusche of Montreal, in Camden County.

"The 14 cases were geographically dispersed and came from different units," the release stated, adding there's no evidence soldiers were exposed to chemical or biological weapons, environmental toxins or severe acute respiratory syndrome (SARS).

Neusche's parents, Mark and Cynthia Neusche, say doctors told them their son's liver, kidneys and muscles broke down — occurrences the surgeon general's office say are rare in cases of pneumonia.

"There's definitely something out there," Mark Neusche said Friday. "We need to find out what it is and get it fixed. The numbers are climbing."

The Army has deployed two epidemiology units to study the outbreak. One team has been sent to the Landstuhl Regional Medical Center in Germany, where the majority of the severe cases have been treated. The other team will be sent to undisclosed areas of Iraq. The teams are looking for similarities among the cases.

The surgeon general's office says young, healthy soldiers dying from pneumonia is rare, but does occur. From 1998 to 2002, 17 soldiers have died from pneumonia or complications from the illness
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Duluth News Tribune (MN) 1 Aug 2003 [edited]
http://www.duluthsuperior.com/mld/duluthsuperior/news/6437091.htm


Army Sends Teams to Probe Iraq Illness
--------------------------
The Army is trying to figure out what is causing a rash of serious pneumonia
cases, including 2 fatalities, among soldiers serving in Iraq.

A 6-person team of specialists was en route to Iraq today to investigate 14
cases of pneumonia serious enough that the soldiers had to be put on
ventilators to breathe and evacuated from the region, the Army Surgeon
General's office said Fri, 1 Aug 2003. “2 soldiers died, 9 recovered, and 3
were still hospitalized as of Thu, 31 Jul 2003,” spokeswoman Lyn Kukral said.

The team on its way to Iraq includes infectious disease experts, laboratory
officers, and people who will take samples of soil, water, and air.

So far, officials have identified no infectious agent common to all the
cases. There is no evidence any of the cases were caused by exposure to
chemical or biological weapons, environmental toxins or Severe Acute
Respiratory Syndrome (SARS), officials said.

A 2-person team already has gone to Landstuhl Regional Medical Center in
Germany, where most of the cases were treated after evacuation. The 2 teams
also will review patient records and laboratory results and interview health
care workers and patients, if possible, said a statement from the Army
Surgeon General and U.S. Army Medical Command.

The teams will be looking for similarities among the cases, which so far have
hit troops in geographically dispersed areas and from different units, said
the Thursday statement. They also were spread over time, with 2 in March, 3
in April, 2 in May, 3 in June, and 4 in July [2003].

Though only 14 cases were considered serious, there have been 100 cases
altogether since 1 Mar 2003 among troops that began deploying in late 2002 to
the Persian Gulf.

Army-wide, pneumonia cases serious enough to warrant hospitalization happen
in about 9 of 10 000 soldiers per year. Given the number of troops deployed,
the 100 cases "do not exceed expectations," the surgeon general's office said.

[Byline: Pauline Jelinek]
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ProMED-mail


[The information above suggests that the cases were spread out geographically
and over time, but no information is given with regard to common factors.

While a recognized bioterror agent such as botulinum toxin can cause
respiratory failure, it is due to a neuromuscular problem, not pneumonia per
se. If no bacteria were isolated from respiratory and, perhaps, surgical or
postmortem specimens, then unless the organism is fastidious -- as
_Legionella pneumophila_ is -- the illness seems not to be bacterial. Acute
fungal pneumonitis due to histoplasmosis or coccidioidomycosis could present
in this way if those organisms or something similar were found in the soil.
Histopathology and cultures would be helpful in this regard. Certainly, a
viral etiology requires strong consideration. [ProMED understands that
histopathology is being carried at AFIP - the U.S. Armed Forces Institute of
Pathology - Mod.JW]

No information is given regarding prodromal symptoms and possible incubation
periods, so speculation regarding toxin exposures such as phosgene, chlorine,
or paraquat, or metals such as manganese or cadmium is just that --
speculation.

Hopefully, more information about the cases will become available, and the
outbreak curve will diminish.

Regarding _Burkholderia mallei_, brought up in the previous posting in this
thread, an additional point is relevant. Although not fastidious, identifying
the bacillary agent responsible for glanders can be difficult, since
automated identification systems may misidentify it.- Mod.LL]