Infectious Complications as a Result of Military Operations - Research Paper Example

Infectious Complications as a Result of Military Operations Throughout recorded history, infectious diseases have accompanied war. The clinical aspects of Operation Iraqi Freedom (OIF) have been no different. Despite technological advancement in warfare and preventive medicine and the fact that the United States’ military medical and epidemiologic personnel can anticipate the exposure of troops to various pathogens and mitigate their effects, naturally occurring pathogens infected some troops during these military missions, which led to transient decreases in operational efficiency. This paper discusses leishmaniasis, one of the most common infectious insect-borne diseases caused by a bite by infected female sand flies identified among US troops who served during OIF in 2003, its effects on the soldiers as well as the war, and the methods that were implemented to limit the disease. Also included in the paper are the steps that could have been implemented to lower the rate of the disease and the current actions that the US army performs today to limit its effects. Introduction On October 10, 2002, the United States’ Congress had adopted a joint decree that authorized the use of force against Iraq and later in March of 2003, President George W. Bush launched Operation Iraqi, a freedom campaign aimed at deposing Saddam Hussein, Iraq's dictator in order to set up a democratic government in Iraq. This was after President George W. Bush labeled Iraq as one of the ‘Axis of Evil’ – a rogue state intention on acquiring mass destruction weapons thereby posing a threat to the US and its allies. On 17 March 2003, in an address to the United States, President George W. Bush gave Saddam Hussein and his regime forty-eight hours to leave Iraq. United States and an allied Coalition’s military operations against Iraq started on 19 March 2003, an action called Operation Iraqi Freedom in the United States (Pike para1). One of the most noteworthy modern-day efforts in the prevention and control of an arthropod-borne ailment during a military operation took place when a team of military entomologists from the United States led attempts towards characterizing, preventing, and controlling of leishmaniasis at Iraq’s Tallil Air Base (TAB), during OIF. After their arrival at Tallil Air Base on March 2003, military entomologists established that there were numerous sand flies at Tallil Air Base and that in a single night; individual soldiers were receiving several bites from sand flies. They also established that in 1.5% of the female sand flies, Leishmania parasites were present as a fluorogenic real-time Leishmania-generic polymerase chain reaction assay found out (Coleman, et al. p1). Coleman and his co-authors further explain that the quick discovery that leishmaniasis was a specific threat in this area called for the founding of an all-inclusive Leishmaniasis Control Program (LCP) over five months before the confirmation of the first case of leishmaniasis in a United States’ soldier deployed to Iraq. The Leishmaniasis Control Program had four components including enhancement of personal protective measures use by all personnel at Tallil Air Base, risk assessment, education of military personnel about sand flies and leishmaniasis, and vector and reservoir control (1). Some of the methods implemented to limit the disease during that time included reducing the soldiers’ exposure to sand fly vectors through control and prevention measures adopted following the observation of the first outbreak, use of permethrin and Diethyl-meta-toluamide (DEET) -treated uniforms, improving the soldiers’ living conditions, and efforts to eradicate sand flies near US installations. Additionally, during the initial 2003 outbreak, army policy necessitated the evacuation of all leishmaniasis patients/soldiers with confirmed cases to the Walter Reed Army Medical Center, the DOD referral center for Leishmaniasis treatment (Furlow para6-9). Repaci explains that definitive treatment among infected soldiers involved evacuation from theater to Walter Reed Army Medical Center. Voluntary intravenous administration of pentostam for twenty days treated and still treats cutaneous leishmaniasis and Walter Reed Army Medical Center closely monitors pentostam treatment in soldiers, adjusting use accordingly. He adds that among soldiers, this treatment has been ninety-five percent effective. Another important point that he notes is that even if cutaneous leishmaniasis is not treated, spontaneous healing occurs within weeks or months since it is a self-limited infection. Sometimes, it may last for a year or further (1). Dau, Oda & Holodniy further explain that the infected soldiers received treatment in theater through systemic therapy with oral azoles, cryotherapy, topical antibiotics, pentavalent antimony or thermotherapy (para16). Since there are no vaccines or effective medication for leishmaniasis prevention, other ways in which the US troops could have accomplished prevention efforts and that are still in use today include suppressing the insect vector (sand fly), which is vital in the prevention of exposure in stationary troop populations, and suppressing the reservoirs including rodents and dogs. Additionally, there was need for command emphasis on personal protective measures including use of screened enclosures and permethrin-treated bed nets, application of repellent lotion containing Diethyl-meta-toluamide specially prepared for extended use to exposed skin, and properly wearing Permethrin-treated battle dress uniform, with pants tucked into boots and sleeves rolled down (Repaci p1&2). Between August 2002 and February 2004, 522 soldiers were confirmed infected. From the year 2003 to 2004, an anonymous survey of fifteen thousand troops revealed that 2.1% of the soldiers received a diagnosis of leishmaniasis. The most common manifestation was cutaneous leishmaniasis, which resulted in an ulcerating skin lesion among the soldiers. Repaci explains that typically, it was characterized by one or more open/crater-like skin sores that developed over time following an infected sand fly bite. In cutaneous leishmaniasis-infected soldiers, the skin sore could be ugly and left a permanent scar. Coupled with the military personnel’s mobility, this prolonged delay in the characteristic lesions’ appearance, often complicated the identification of the exact location of initial infection. Cutaneous leishmaniasis was not fatal (1). However, visceral leishmaniasis, a more serious deadly systemic form of the disease infecting the bone marrow, spleen and liver presented later among very few American troops serving in Iraq (Dau Oda & Holodniy para16). Korzeniewski and Olszanski indicate that only two cases of visceral leishmaniasis were reported among the OIF soldiers by the end of March 2004 and that most of them suffered from cutaneous leishmaniasis – 653 cases were reported by the end of March 2004. They further report that US sources indicate that the number of cutaneous leishmaniasis-infected American soldiers could have been higher, ranging from 750-1250 or even more, what constituted almost one percent of United States’ troops deployed in Iraq in 2003-2004 (1). In addition to putting a strong emphasis on personal protective measures, some of the current actions that the army performs today in an attempt of limiting the effect of Leishmaniasis include troop Education. The United States’ Army Center for Health Promotion and Preventive Medicine has produced laminated, wallet-size information cards and distributed them to deployed soldiers. In these cards is information on preventive measures against sand flies, leishmaniasis contact information, diagnostic support as well as treatment. The DOD Deployment Health Clinical Center has developed a website, which provides information on leishmaniasis to health care providers, soldiers and their family members (Repaci p2). With many veterans of the 2003 OIF having returned to the US after potential leishmaniasis exposure, more cases of leishmaniasis have been reported. Repaci notes that as of February 2004, among troops deployed to OIF, 127 soldiers had a confirmed diagnosis of cutaneous leishmaniasis and that they received treatment at Walter Reed Army Medical Center. Fortunately, most leishmaniasis patients suffer from cutaneous leishmaniasis, which is non-fatal, does lead to long-term problems and heals even when untreated. It is important to note that both visceral and cutaneous leishmaniasis have a pre-patent period – the period between actual infection and the beginning of symptoms. Therefore, infection in most soldiers was diagnosed later, some months or years after OIF. Furlow cites a 2004 AMSA report that indicates that visceral leishmaniasis can be clinically unapparent for lengthy periods and that the initial clinical manifestations can be vague and hard to diagnose, particularly by inexperienced doctors or those who are not familiar with the disease. Therefore, it is possible that a soldier can get leishmaniasis infection, fail to develop any signs, become immuno-suppressed years afterward and then develop the clinical signs of leishmaniasis (para17&19). Fortunately, leishmaniasis infection among US troops who served during OIF in 2003 did not have any diverse effects on the war. This is especially so because most of the soldiers who were infected did not suffer from visceral leishmaniasis and at some point, evacuation of cutaneous leishmaniasis-infected soldiers to the Walter Reed Army Medical Center ceased and they could receive treatment in their camps. Therefore, the United States of America accomplished her mission on Iraq. Conclusion As earlier mentioned, infectious diseases have accompanied war throughout recorded history and combat-related diseases are characteristically the most severe and dramatic health risks that troops encounter during wartime operations. Among others, there is need for protection of soldiers deployed to leishmaniasis-infested areas. The step of the US army of educating troops and their family members is imperative, as they can now understand the importance of taking personal preventive measures. This would make them more effective in wars in addition to saving the money used for the treatment of this epidemiology. Also necessary is further appreciation of leishmaniasis’ diagnostic and treatment options. I concur with Furlow that it is imperative that primary care providers as well as physicians include leishmaniasis among possible diagnoses among veterans of military service in Operation Iraqi Freedom (OIF). Works Cited Coleman, Russell E., et al. “Impact of Phlebotomine Sand Flies on U.S. Military Operations at Tallil Air Base, Iraq.” Journal of Medical Entomology 43.4 (2006): 647-662. Print. Dau, Birgitt, Oda, Gina & Holodniy. “Infectious Complications in OIF/OEF Veterans with Traumatic Brain Injury.” Journal of Rehab R and D 46.6 (2009): 673-684. Print. Furlow, Bryant. US Army reports fewer cases of leishmaniasis, but a complex threat persists. 2009. Web. 15 September 2010. Olszanski, Korzeniewski. “Leishmaniasis among Soldiers of Stabilization Forces in Iraq.” Int Marit Health 55.1-4 (2004): 155-63. Print. Pike, John. Operation Iraqi Freedom Introduction. 2010. Web. 15 September 2010. Repaci, Paul. Leishmaniasis among Soldiers Deployed to Operation Iraqi Freedom (OIF). 2003. Web. 15 September 2010. Read More