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Smoking Cited in Iraq Pneumonia Cases
WASHINGTON - Most of the soldiers in and around Iraq with unexplained, severe pneumonia had taken up smoking shortly before falling ill, military medical authorities said Tuesday. The military is investigating 19 cases of severe pneumonia since March, including two fatalities. Four of those cases were linked to bacterial infections. Of the remaining 15, 10 patients, including the two who died, had elevated levels of a certain type of white blood cells. Nine of the 10 reported they had started smoking recently, said Col. Bob DeFraites, a top Army medical officer. Itâs unclear whether smoking caused or contributed to the pneumonia, but since tobacco smoke damages lungs, itâs a chief suspect, DeFraites said. "It may be a combination of the desert deployment with heat and dust and everything else in conjunction with the smoking," DeFraites told reporters in a telephone conference call. "Itâs not a coincidence, the association with smoking. ... Itâs a known irritant for lungs and a known risk factor for pneumonia in general. It may be sensitizing the lungs for the pneumonia." Hmmm, this might be possible, but lots of people smoke without getting pneumonia or hypersensitivity pneumonitis. Iâm guessing for now but I donât think this is it. DeFraites and other military officials said the military has not seen an unusual number of pneumonia cases but was investigating the 19 illnesses because they were so severe, requiring the patients to be put on ventilators to help them breathe. All 17 survivors have fully recovered and are out of the hospital, DeFraites said. Army Sgt. Michael L. Tosto, 24, a tank driver from Apex, N.C., died June 17 from pneumonia that developed rapidly and killed him before he was airlifted from Baghdad to Germany. Spc. Joshua M. Neusche, 20, of Montreal, Mo., died July 12 in Germany after falling ill in Iraq. Of the 19 affected troops, 13 got sick in Iraq, three in Kuwait and one each in Qatar, Uzbekistan and Djibouti, DeFraites said. The 18 men and one woman included 17 Army soldiers, one Navy sailor and one Marine. The four soldiers with suspected infections included two with pneumococcal infections, one with a disease known as "Q fever" and one with a bacterium called acinetobacter baumannii, DeFraites said. All three bacteria are common causes of pneumonia. The 3 other than the one with Q fever are what we call "community acquired pneumonia" due to bacteria. Nothing too unusual about this when you factor in the stress, changes in nutrition, sleep, etc. Q fever is common in that part of the world so itâs not surprising that one of our guys got it. Itâs not surprising that no clear clues to the cause have been found in five of the pneumonia cases, since the same can be said for many cases in the civilian health care system, DeFraites said. Fully 75% of community acquired pneumonia have no specific bacteriological diagnosis at the time of discharge from an American or British hospital. "I wouldnât be a bit surprised if we werenât able to come down with a definite cause and effect relationship for each of these cases," DeFraites said. "I hope we can, but I wouldnât be surprised if we ran a bit short." Military authorities have ruled out some causes. Thereâs no evidence of the SARS virus or parasitic infections, for example. Thereâs also no evidence indicating that vaccinations against smallpox or anthrax were the cause, said Col. John Grabenstein, deputy director of the military vaccine office. Iâd buy that. One of the most significant findings is that 10 of the sickened troops had high levels of white blood cells called eosinophils. Those immune system cells are associated with a wide range of conditions, including allergies and parasitic infections. "allergies" here means hypersensitivity pneumonitis which can look a lot like an acute pneumonia. Also caused by drug exposure -- e.g., a new medication in a susceptible soldier. Parasitic infections are rampant in that part of the world. Levels of eosinophils in the 10 soldiers ranged from three times to 11 times higher than normal, DeFraites said. How interesting. In the patients with pneumonia, doctors believe that something â possibly the cigarette smoke â irritated the lung cells, causing the eosinophils to come and cause inflammation. That caused pneumonia, the medical name for fluid filling up the lungs. Wrong, fluid filling the lungs is called "pulmonary edema." And I donât buy the theory. I donât think smoking had a lot to do with this. I hate to say that since Iâm a lung doc! Posted by: Steve White 2003-09-10 |
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