- Smoke and Mirrors!
- Pentegon Puffs Out Blame For Mystery Pneumonia Hitting
US Troops In On 'CIGARETTE SMOKING'
- I wonder what the Pentegon Epdemiologists have been smoking
when they came up with this 'cause' for military respiratory illness cases?
As I mentioned previously when the Military claimed they knew what was
responsible for the illness and death of troops in Iraq, they haven't a
- Of course, cigarette smoking is detrimental to one's
health but it's not the major culprit here. Depleted Uranium and other
pollutants in the Iraqi environment are far more harmful than cigarette
smoking. However, it has been suggested that the gummy nicotine in the
troop's lungs would certainly be like glue for inhaled pollutants...like
- The military should look a lot farther then "cigarettes"
as the cause of the current mystery respiratory outbreak. After all, troops
have been smoking cigarettes for eons - especially during combat operations
- but this is the first time I have heard of cigarette smoking named as
the cause of pneumonia that progressed to ventilator intervention and deaths.
Either the miltary is clueless... or they KNOW what is causing the illness
but don't want to make the information public.
- Patricia Doyle
- UNDIAGNOSED RESPIRATORY ILLNESS, DEATH - IRAQ (08)
- A ProMED-mail post ProMED-mail is a program of the International
Society for Infectious Diseases www.isid.org
-  Date: Wed, 10 Sep 2003 17:13:24 +0100 From: George
Robertson <George.Robertson@itt.com Source: New York Times 10 Sep 2003
- Smoking Tied to Pneumonia Cases in War Zones
- The puzzling cluster of pneumonia cases among American
troops in Iraq and other countries in the war region seems to be partly
related to the fact that many had taken up smoking shortly before they
became ill, Pentagon officials said 9 Sep 2003.
- 2 teams of military and civilian epidemiologists and
environmental health specialists have been investigating a cluster of 19
cases of severe pneumonia, including 2 deaths, that occurred from 1 Mar
through August 2003. No new cases have occurred since 20 Aug 2003, and
the earlier patients have all been discharged from the hospital.
- "We do not have an epidemic," and there is
not an unusual number of pneumonia cases among troops in the war area,
Dr. William Winkenwerder Jr., Assistant Secretary of Defense for Health
Affairs, told reporters in a telephone conference call.
- He said the military has investigated the cluster because
of the particular severity of the pneumonia -- all patients needed assistance
from mechanical ventilators to breathe. Most responded "fairly dramatically"
within days after such therapy and antibiotics, said Col. Bob DeFraites,
the Army's chief of preventive medicine.
- The SARS coronavirus, adenovirus, parasites, and vaccinations
against smallpox or anthrax have been ruled out. Though the specific cause
of the outbreak has not been identified, "we have a somewhat improved
understanding" of what the phenomenon is, Dr. Winkenwerder said.
- The investigators found that 4 of the 19 patients had
suffered bacterial pneumonia. Of the other 15 cases, 10, including the
2 men who died, had markedly increased numbers of a certain type of white
blood cell known as an eosinophil. The eosinophil count was from 4 to 11
times higher than normal.
- The investigators are leaning towards a noninfectious
cause and are focusing on one finding "that has jumped out at us,"
that 9 of the 10 patients with high eosinophil counts reported that they
had started smoking recently, Dr. DeFraites said.
- Tobacco smoke is a prime suspect because it is known
to damage lungs and increase their susceptibility to pneumonia. Also, at
least one published paper has reported a similar link between smoking and
severe pneumonia. A combination of stress, heat, dust, and other factors
may have acted in concert with smoking to cause illness, Dr. DeFraites
- Pentagon officials provided no information on what cigarette
brand the sick individuals smoked but said such information could come
from additional studies that are being planned.
- 13 of the patients became ill in Iraq. 3 became ill in
Kuwait, and one each in Qatar, Uzbekistan, and Djibouti. There has been
no evidence of person-to-person spread of the illness. Only 2 of the cases
involved members of the same battalion, and the onset of their illness
was 4 months apart.
- [Byline: Lawrence K. Altman]
- -- George A. Robertson, PhD ITT - Advanced Engineering
and Sciences Alexandria, VA <George.Robertson@itt.com
- [A summary of the information as provided by American
Forces Press Service can be found at <http://www.defenselink.mil/news/Sep2003/n09102003_200309102.html
- ******  Date: Thu, 11 Sep 2003 From: ProMED-mail <email@example.com
Source: Morbid Mortal Weekly Rep 2003;52:857-59. [edited] <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5236a1.htm
- Severe Acute Pneumonitis Among Deployed US Military Personnel
- Southwest Asia, Mar-Aug 2003 -------------------------------------------------
During March-August 2003, a total of 19 US military personnel deployed
in the Central Command (CENTCOM) area of responsibility had bilateral pneumonitis
requiring intubation and mechanical ventilation [see figure at above website
- Mod.LL]); 2 patients died. This report summarizes the results of the
US Army's investigation of these cases and describes the ongoing investigation
to determine the cause(s). Cases of rapidly progressive respiratory failure
among former or current CENTCOM personnel should be reported to state health
departments and to the Department of Defense (DoD).
- Of the 19 patients (median age: 25 years; range: 19-47
years), 18 were men; 12 were full-time active duty personnel, and 7 were
in the Reserve Component or National Guard (based in Arkansas, Illinois,
Indiana, Kansas, Missouri, New Mexico, and North Dakota). 17 were in the
Army, one was in the Navy, and one was in the Marine Corps; 11 were junior
enlisted personnel, 7 were noncommissioned officers, and one was an officer.
Military specialties included combat arms (8), engineering (3), transportation
(2), signal corps (2), medical services (2), supply (one), and military
police (one). Illness onset occurred a median of 81 days (range: 1-189
days) after arrival in the area of responsibility.
- 10 patients had evidence of elevated eosinophils in at
least one of the following: peripheral blood (8), bronchoalveolar lavage
fluid (3), pulmonary tissue (1), or pleural fluid (1). Among the 8 patients
with peripheral eosinophilia, the maximum absolute number of eosinophils
was 2000-6600 in microL of blood (normal: <600). The peripheral eosinophilia
was detected a median of 6 days (range: 4-11 days) after illness onset.
- An interim case definition has been established. A confirmed
case of severe acute pneumonitis with elevated eosinophils is defined as
an illness occurring in a current or former member of the US armed forces
or a US government employee deployed to the CENTCOM area of responsibility
who had 1) bilateral pneumonitis (i.e., radiographically confirmed pulmonary
infiltrates) that required mechanical ventilation and that did not result
from a complication of another medical condition and 2) elevated pulmonary
eosinophils (identified histologically, in bronchoalveolar lavage fluid
[5 percent] or in pleural fluid [5 percent]). A probable case is defined
as an illness in a person deployed to the CENTCOM area of responsibility
who had bilateral pneumonitis requiring mechanical ventilation and the
presence of peripheral eosinophilia (600 microL blood absolute count).
A suspect case is defined as an illness in a person deployed to the CENTCOM
area of responsibility who had bilateral pneumonitis requiring mechanical
- As of 8 Sep 2003, 4 cases were confirmed, 6 were probable,
and 9 were suspect. 4 patients had laboratory evidence of infection with
a microbial agent. _Streptococcus pneumoniae_ was isolated from sputum
culture in one probable case. 3 patients with suspect cases showed evidence
of infection (_S. pneumoniae_ based on urine antigen, _Coxiella burnettii_
based on serology, and _Acinetobacter baumannii_ from bronchoscopic culture).
[ProMED previously posted a cluster of community-acquired _Acinetobacter_
infections in Iraq - Acinetobacter, drug resistant - Iraq: RFI 20030417.0934
- All patients were treated with broad-spectrum antibiotics,
and 6 received corticosteroids, including 2 patients whose cases were confirmed
and 3 whose cases were probable. The course of illness varied (median duration
of intubation: 6 days; range: 2-35 days). For some patients, infiltrates
and respiratory failure resolved rapidly (i.e., 2-3 days) with or without
steroids, and other patients required longer periods of mechanical ventilation.
All 17 surviving patients either have been placed on convalescent leave
or have returned to duty.
- When they became ill, 13 patients were in Iraq, and 6
were in other countries (Kuwait , Djibouti , Qatar , and Uzbekistan
). Other than 2 patients from the same unit with suspect cases and with
onset of illness 4 months apart, no apparent geographic or unit-level clustering
has been identified. Of the 19 patients, 15 (79 percent) smoked cigarettes
or cigars, including the 10 patients whose cases were either confirmed
or probable. 9 of these 10 patients had begun smoking tobacco after deployment,
compared with none of the 9 patients whose cases were suspect. 2 recent-onset
smokers reported smoking non-US-brand cigarettes. All troops in the CENTCOM
area of responsibility have been exposed to heat, dust, and various amounts
of environmental pollution (e.g., smoke).
- The US Army is conducting a clinical and epidemiologic
investigation to identify the cause(s) of this disease, including intensive
testing of clinical material (i.e., blood, urine, bronchoalveolar lavage
fluid, and acute and convalescent sera) to identify potential microbial
pathogens and toxins. In addition, military personnel are interviewing
patients systematically to identify any common exposures or practices.
Environmental testing to identify potential toxins will be guided by clinical,
diagnostic, and patient surveys. Initial data analysis suggests that medications,
vaccines, and biologic weapons are not associated with the disease.
- Reported by: Operation Iraqi Freedom Severe Acute Pneumonitis
Epidemiology Group, U.S. Army Medical Command. National Center for Infectious
Diseases; National Center for Environmental Health, CDC.
- MMWR Editorial Note: The majority of cases of acute lower
respiratory illness (LRI) among US military personnel in Southwest Asia
have been comparable clinically and have occurred at a rate similar to
those in other military populations and settings (1). In contrast, the
rapidly progressive LRI cases described in this report were life-threatening
and required intensive medical care, including mechanical ventilation with
high-end expiratory pressures.
- Although investigations are ongoing, preliminary findings
suggest a subset of these cases are compatible with the diagnosis of acute
eosinophilic pneumonia (AEP). AEP is an acute febrile illness without an
identifiable infectious cause that is characterized by the rapid onset
and progression of respiratory failure, diffuse bilateral infiltrates on
chest radiographs, and elevated eosinophils in lung biopsy specimens or
bronchoalveolar lavage fluid (2).
- Cigarette smoking (particularly of recent onset) is a
risk factor for AEP (3-7), and some affected persons have experienced acute
respiratory distress when exposed to cigarette smoke in a laboratory setting
(5,6). The finding that 9 of the 10 persons whose cases were severe and
who had documented elevated eosinophils started smoking cigarettes after
their deployment suggests the possibility of a toxin or allergen exposure;
however, no single brand of cigarette or location of production has been
implicated in this association. DoD has advised CENTCOM personnel that
cigarette smoking, particularly the initiation of smoking, might be associated
with the development of severe acute pneumonitis with elevated eosinophils.
- In 1997, 2 US soldiers had rapidly progressive acute
respiratory distress syndrome and elevated eosinophils shortly after returning
from field training in the Mojave Desert in California (8). The occurrence
of these cases in troops who were not deployed overseas suggests that exposures
unique to Iraq (e.g., abandoned buildings, unexploded ordnance, and war-damaged
vehicles or equipment) or to any of the countries in which the cases occurred
(e.g., indigenous food, water, and materials) might not be necessary or
sufficient for the development of this disease.
- No US-based military personnel are known to have had
severe acute pneumonitis with increased eosinophils during this period.
However, the return of troops from Southwest Asia raises the possibility
that US health-care providers might be the first to observe members of
this population who experience otherwise unexplained acute respiratory
- Clinicians should elicit the travel histories of patients
with rapidly progressive respiratory failure of unknown etiology and report
cases among persons -- particularly military personnel -- who have returned
recently from the CENTCOM area of responsibility to their state health
department and to the U.S. Army Center for Health Promotion and Preventive
Medicine, telephone 410-436-4655.
- 1. Gray GC, Callahan JD, Hawksworth AW, et al. Respiratory
diseases among U.S. military personnel: countering emerging threats. Emerg
Infect Dis 1999;3:379-85.
- 2. Allen JN, Pacht ER, Gadek JE, et al. Acute eosinophilic
pneumonia as a reversible cause of noninfectious respiratory failure. N
Engl J Med 1989;321:569-74.
- 3. Shiota Y, Kawai T, Matsumoto H, et al. Acute eosinophilic
pneumonia following cigarette smoking. Intern Med 2000;39:830-3.
- 4. Shintani H, Fujimura M, Yasui M, et al. Acute eosinophilic
pneumonia caused by cigarette smoking. Intern Med 2000;39:66-8.
- 5. Tanino Y, Yamaguchi E, Takaoka K, et al. Cytokines
and Th2 cells in AEP of smoking. Allergy 2002;57:463-4.
- 6. Watanabe K, Fujimura M, Kasahara K, et al. Acute eosinophilic
pneumonia following cigarette smoking: a case report including cigarette-smoking
challenge test. Intern Med 2002;41:1016-20.
- 7. Nakajima M, Manabe T, Sasaki T, Niki Y, Matsushima
T. Acute eosinophilic pneumonia caused by cigarette smoking. Intern Med
- 8. Giacoppe GN, Degler DA. Rapidly evolving adult respiratory
distress syndrome with eosinophilia of unknown cause in previously healthy
active duty soldiers at an Army training center: report of two cases. Mil
- -- ProMED-mail <firstname.lastname@example.org
- [This newly available CDC paper is the most detailed
report regarding the clinical and microbiological aspects of the cases.
It may well the case that recent onset of tobacco smoking may play a role
in the cases. Data on smoking habits of totally unaffected personnel would
be instructive. It is not clear whether rechallenge with cigarettes (if
they contain the potential immunogen) would cause a relapse. One 1997 report
from Japan suggested it might (1), but one later report from the same group
reported that it did not (2).
- 1. Sasaki T, Nakajima M, Kawabata S, et al. Acute eosinophilic
pneumonia induced by cigarette smoke [Japanese]. Nihon Kyobu Shikkan Gakkai
- 2. Nakajima M, Yoshida K, Miyashita N, et al. Eosinophilia
and cough induced by resumption of cigarette smoking in a beginning smoker
recovering from acute respiratory failure [Japanese]. Nihon Kokyuki Gakkai
Zasshi 1999;37:543-48. - Mod.LL]
- Patricia A. Doyle, PhD Please visit my "Emerging
Diseases" message board at: http://www.clickitnews.com/ubbthreads/postlist.php?Cat=&Board=emerging
- Zhan le Devlesa tai sastimasa Go with God and in Good