Rare Blood Infection Surfaces in Injured U.S. Soldiers

[Barrett808]

Rare Blood Infection Surfaces in Injured U.S. Soldiers
Thu Nov 18, 2004 01:44 PM ET
By Paul Simao

ATLANTA (Reuters) - An expectedly high number of U.S. soldiers injured in the Middle East and Afghanistan are testing positive for a rare, hard-to-treat blood infection in military hospitals, Army doctors reported on Thursday.

A total of 102 soldiers were found to be infected with the bacteria Acinetobacter baumannii. The infections occurred among soldiers at Walter Reed Army Medical Center in Washington, Landstuhl Regional Medical Center in Germany and three other sites between Jan. 1, 2002, and Aug. 31, 2004.

Although it was not known where the soldiers contracted the infections, the Army said the recent surge highlighted a need to improve infection-control in military hospitals.

Eighty-five of the bloodstream infections occurred among soldiers serving in Iraq, the area around Kuwait and Afghanistan, the U.S. Army said in a report published on Thursday by the Centers for Disease Control and Prevention.

Military hospitals typically see about one case per year.

(more)

http://www.reuters.com/newsArticle.jhtml?type=topNews&storyID=6857592

[LynzM]

1. an "expectedly high number"?

Does anyone proofread anything these days?

In terms of what it actually might mean, yikes. :scared:

[maddezmom]

3. was thinking the same, huh? did they plan on seeing a high number??

if they did, it would be one of the only things they planned for in Iraq.

[Krupskaya]

9. I USED to proofread!

Until I got laid off after 9/11. /drift

[Rush1184]

21. I think the same thing everytime I read a paper...

Don't worry though, the "No Child Left Behind" act will edumacate people to read good, so it will dun get gooder!

[Roland99]

2. Wouldn't be surprised to hear of an increase in Behcet's

http://www.behcets.com/resources.ivnu

[whistle]

7. Behcet's disease also comes from the middle east?

[Roland99]

17. When my ex's sister was diagnosed with it...

they told us it mainly occurred in men from the Middle East.

[DemBones DemBones]

16. Is Behcet's an autoimmune disease,

like rheumatoid artritis and lupus?

[Roland99]

18. Somewhat...there still seems to be much unknown about Behcet's

and it can encompass other illnesses.

[DemBones DemBones]

20. Thanks for the reply -- I asked because

I clicked your link to learn about Bechet's and the some of the symptomatology (fatigue, arthritis in joints, rashes, sores) is like lupus, which I have. The arthritis in joints especially made me wonder if it was auto-immune.

It seems to me that there is a real increase in autoimmune diseases, in the U.S. at least. Lupus, M.S., asthma, diabetes, endometriosis, even mitral valve prolapse, all seem to be more common now. All have an autoimmune component, too, leading me to a hypothesis that something is bad -- and fairly recently bad -- going on with the environment is causing this. There are lots of cases of fibromyalgia and also of chronic fatigue syndrome, too, but I'm not sure they are autoimmune.

Hope your former sister-in-law is doing well.

[Roland99]

22. Well, thanks for the well wishes for her

She went to Johns Hopkins a few years ago and the Dr. there said she had the worst case of fybromyalgia they'd ever seen. There are times her skin is so sensitive that clothes are painful for her to wear. She's a shell of her former self. Very sad to see.

I'm wondering if these are all connected somehow.

And what is bringing it about? Environmental damage? Diet soft drinks? Big Macs? Advil? Who knows?

[DemBones DemBones]

27. I'm sorry to hear that. Besides the

lupus, I have fibromyalgia, so I really do feel her pain! And that makes Behcet's sound even more suspiciously autoimmune, since people with one autoimmune disease often develop another. I have several of them and the FM causes more of my pain than the lupus does. My rheumatologist just told me last week that new tests have proven FM is a neurological problem -- brain scans show pain is actually felt in different parts of the brain if you have FM than if you don't.

I have the same questions and same list of suspects you do, although I also wonder about genetically modified foods and high fructose corn syrup, since both were added to our diets in the last twenty years, along with the new dietetic sweeteners (earlier there was saccharin and it wasn't used as much.) Hadn't really thought about Advil or other over the counter drugs, but they are "new" and widely used.

Another possibility I have wondered about is vaccines. I've read that the early polio vaccines were made using blood products from monkeys, and I was one of the early recipients of Salk vaccine back in 1956. I can't remember all the details but the gist was that the vaccines could have been contaminated or otherwise caused problems. Hmm, monkeys? Didn't HIV spread from monkeys to humans? :think:

There is a controversial biologist who posits that lots of diseases we don't think are bacterial or viral actually are. He's written at least one book on the topic and I think he may be right. He's not selling any cures, either, which gives him more credibility in my book.

[Roland99]

37. You know, there's one other thing I fear (or think, at least)

that as we cure one disease, we're only clearing a path for a weaker disease to surface and gain strength.

We are peeling an endless onion and the greater dangers lie within.

[JerseygirlCT]

34. Crohn's, RA...

yes, the list seems to go on forever, doesn't it? I have also wondered -- is this just better and broader diagnosing? Or is something seriously wrong with us?

[knitter4democracy]

23. My MIL has that

She was diagnosed with Behcets after finishing her radiation treatment for breast cancer (yeah, she's had a sucky couple of years). Her doctor, the head of rheumatology at University Hospitals in Cleveland, told her that it's a potential side effect of radiation treatment. All I know is that she was really ill with ulcers in her mucosal tissues and that it took forever for her to get the right treatment. I wouldn't wish that disease on anyone.

Btw, don't they have ID guys working in the Army?

[pnutchuck]

4. I also saw a news program where soldiers were given an anti-malaria pill

by the US govt and it was causing them to have phsychotic episodes. Most of the soldiers who have taken this experimental drug, issued by the govt, have had violent episodes. One female soldier attacked her lieutenant and was discharged. Another came home, killed his family, then shot himself. There are over 100 cases of soldiers who have taken this drug becoming homicidal, or suicidal.

[soaky]

28. It was probably Lariam (also known as mefloquine)

It was recently revealed that the australian army was dosing soldiers in East Timor.
Defence confirms drug made soldiers sick

A friend of mine was badly affected after taking it during a trip to south america years ago - not psychotic but big personality changes and constant migranes.

[DemBones DemBones]

32. Is Lariam supposed to be superior to Plaquenil?

Or do we just go to using new drugs because they're there?

[pig.]

35. Ever see the movie "Jacob's Ladder?"

They give soldiers out in the jungle a "antibiotic" i think it was...

they all go nuts and kill eachother, only like 6 survive. years later one starts having flashbacks and piecing it all together.

[maddezmom]

5. yikes a quick yahoo search

Background: Acinetobacter baumannii is a pleomorphic aerobic gram-negative bacillus (similar in appearance to Haemophilus influenzae on Gram stain) commonly isolated from the hospital environment and hospitalized patients. A baumannii is a water organism and preferentially colonizes aquatic environments. This organism is often cultured from hospitalized patients’ sputum or respiratory secretions, wounds, and urine. Acinetobacter also colonizes irrigating solutions and intravenous solutions.

Acinetobacter is an organism of low virulence, but it is capable of causing infection. Most Acinetobacter isolates recovered from hospitalized patients, particularly those recovered from respiratory secretions and urine, represent colonization rather than infection.

Acinetobacter infections are uncommon, but, when they occur, they usually involve organ systems with a high fluid content (eg, respiratory tract, peritoneal fluid, urinary tract), manifesting as nosocomial pneumonia, infections associated with continuous ambulatory peritoneal dialysis (CAPD), or catheter-associated bacteruria. The presence of the organism in respiratory secretions in intubated patients nearly always represents colonization. Acinetobacter pneumonias occur as outbreaks and are usually associated with colonized respiratory support equipment or fluids.

more: http://www.emedicine.com/med/topic3456.htm

[xpunkisneatx]

10. haha...

great minds think alike :)

[Javaman]

11. Well duh, wounded soldiers crawling through bad water...

Also remember, Baghdad has two rivers running through it.
Hmmm, wonder if any of these docs pulled any of the VA records of soldiers from Vietnam, Korea or WWII, they would probably see the same, if not more cases there.

[DemBones DemBones]

14. Sounds more like nosocomial infections to me. nt

[VegasWolf]

25. nosocomial, have not heard that word for awhile!! n/t

[xpunkisneatx]

6. some info on A. baumannii (for us micro dorks :))

Background: Acinetobacter baumannii is a pleomorphic aerobic gram-negative bacillus (similar in appearance to Haemophilus influenzae on Gram stain) commonly isolated from the hospital environment and hospitalized patients. A baumannii is a water organism and preferentially colonizes aquatic environments. This organism is often cultured from hospitalized patients’ sputum or respiratory secretions, wounds, and urine. Acinetobacter also colonizes irrigating solutions and intravenous solutions.

Acinetobacter is an organism of low virulence, but it is capable of causing infection. Most Acinetobacter isolates recovered from hospitalized patients, particularly those recovered from respiratory secretions and urine, represent colonization rather than infection.

Acinetobacter infections are uncommon, but, when they occur, they usually involve organ systems with a high fluid content (eg, respiratory tract, peritoneal fluid, urinary tract), manifesting as nosocomial pneumonia, infections associated with continuous ambulatory peritoneal dialysis (CAPD), or catheter-associated bacteruria. The presence of the organism in respiratory secretions in intubated patients nearly always represents colonization. Acinetobacter pneumonias occur as outbreaks and are usually associated with colonized respiratory support equipment or fluids.

A baumannii is a multiresistant aerobic gram-negative bacillus sensitive to relatively few antibiotics. Multidrug-resistant Acinetobacter is not a new or emerging phenomenon, but A baumannii has always been an organism inherently resistant to multiple antibiotics.

http://www.emedicine.com/med/topic3456.htm

[DemBones DemBones]

13. You refer, I suppose, to an affinity for

studying microscopic organisms rather than to being a short nerd?

:evilgrin:

Personally, I prefer protozoan parasites to bacteria -- as organisms of interest, not as, um, co-habitants. Seriously thought about going into parasitology/ public health work but opted instead for studying phytoplankton in grad school. (I'm a sucker for the cool-looking stuff!) Do you work in microbio or med tech?

[xpunkisneatx]

15. Hah! short nerds...

I am in fact short...but i was referring to studying microscopic organisms...I am a Biotechnology/Microbiology major...I prefer viruses to bacteria and protozoa, and briefly considered pursuing an epidemiology degree, but changed my mind when i read more into it and realized I would be in Africa studying diseases for 2 years of my life. Would much rather work in the states thankyouverymuch.

[DemBones DemBones]

19. I took the CDC course in epidemiology and loved it.

but going into public health work with a B.S. involved becoming a VD control officer, meaning you follow up all the sexual contacts of new VD patients. I talked with a woman who had done that and then been promoted to direct epidemiology in the county. She said she went places where the police wouldn't go and I wasn't sure I wanted to do that, also being a woman (and fairly short, as well as having nerdy interests.)

My undergrad mentor was a professor who had retired after 20 years with USPHS, 10 of them at CDC. He was a malariologist and worked in Iraq, the Philippines, Egypt, etc. If I could have done grad work in parasit dealing with arbor-vectors like mosquitoes and biting flies, it would have been cool, but I chose a grad program within commuting distance and the parasitologist on the faculty was a flea man. Not being excited about fleas, I did my research in phytoplankton ecology, which I do find exciting.

[knitter4democracy]

24. I wonder if

I wonder if they're getting infected from the IVs and whatever company is supplying the IVs and saline bags has the problem. I hope they start there.

[NewYorkerfromMass]

8. "Acinetobacter baumannii is an opportunistic pathogen"

Acinetobacter baumannii is an opportunistic pathogen operating in hospitals creating serious infections such as pneumonia. It principally affects patients who have weakened health and this is why we call it opportunistic. Moreover, the mortality rate from these infections are usually high given, on the one hand, the weakness of the patient and, on the other, A. baumannii is resistant to many antibiotics.....

http://www.innovations-report.de/html/berichte/biowissenschaften_chemie/bericht-24693.html

[depakid]

30. that's a pretty good explaination

It would still be a good idea to put together a case control study to try to narrow down what's going on here.

The article didn't mention whether they were planning to do anything like that.

[sldavis]

12. report was published today in MMWR

This is some of the CDC's official report of the infections. There will likely be additional epidemiologic analyses of the cases in the literature later.

-----------------------------------
Acinetobacter baumannii Infections Among Patients at Military Medical Facilities Treating Injured U.S. Service Members, 2002--2004

Acinetobacter baumannii is a well known but relatively uncommon cause of health-care--associated infections. Because the organism has developed substantial antimicrobial resistance, treatment of infections attributed to A. baumannii has become increasingly difficult (1). This report describes an increasing number of A. baumannii bloodstream infections in patients at military medical facilities in which service members injured in the Iraq/Kuwait region during Operation Iraqi Freedom (OIF) and in Afghanistan during Operation Enduring Freedom (OEF) were treated. The number of these infections and their resistance to multiple antimicrobial agents underscore 1) the importance of infection control during treatment in combat and health-care settings and 2) the need to develop new antimicrobial drugs to treat these infections.

(more)

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5345a1.htm

[Gin]

26. if treatment of radiation can be a cause...is it possible the DU all over

Iraq is a cause?

[DemBones DemBones]

29. Interesting idea. Radiation treatment for cancer weakens

the patient a lot, plus patients are visiting a hospital to get it. The excerpts posted here suggest it is a nosocomial infection, i.e., the kind you get in a hospital while being treated there for something else.

Is the depleted uranium (gee, I hate to call it DU!) all over Iraq weakening our soldiers so they're more susceptible to infection with this bacterium? Maybe it simply weakens some more than others, since if they were all weakened we might have heard about it. Then the weaker ones who are wounded pick up the bacterial infection in hospital.

I hope we find out someday, so I can see how my armchair epidemiological hypotheses pan out, as well as, obviously, so we can prevent these infections. I do know that nosocomial infections are very hard to control and that hospitals usually have staff working just on that.

[Gin]

31. expanding on your thought.....the very act of being in that hostile

environment daily...has to weaken your immune system from the tremendous stress on the immune system.....so...those who are more vulnerable...may in fact get it....also..who is to say that the number is only 100+? I trust nothing I read anymore about this war and the affects it is having on our troops.

[DemBones DemBones]

33. Very good point that I hadn't thought of

and I have lupus, which we know is exacerbated by stress and may even be initially triggered by stress. War would probably be pretty high on the stress meter.

[peacetalksforall]

36. I know nothing about medicine, but a thought crossed by....does the

U.S. bring blood in from the U.S. or do they solicit from local citizens? I don't even know if the question is relevant to the problem, but isn't it a possibility? Especially, the saving money part of the story - with this being a corporate war.

[errorbells]

38. lice..maybe

Emerg Infect Dis. 2004 Sep;10(9):1671-3. Related Articles, Links


Acinetobacter baumannii in human body louse.

La Scola B, Raoult D.

Faculte de Medecine de Marseille, Marseille, France. [e-mail]

While we were isolating Bartonella quintana from body lice, 40 Acinetobacter baumannii strains were also isolated and genotyped. One clone was unique and the other was ampicillin susceptible. A. baumannii DNA was later detected in 21% of 622 lice collected worldwide. These findings show an A. baumannii epidemic in human body lice.

PMID: 15498175