Saturday, 19 May 2012

Gulf War syndrome

Gulf War Syndrome or Gulf War Illness has been used to describe a collection of chronic signs and symptoms reported by U.S., British, Canadian, Czech, Danish, Saudi, Egyptian, Australian and other Coalition Armed Forces that were deployed to Operation Desert Storm in 1991. Over 100,000 American veterans of Desert Storm /Desert Shield (approximately 15% of deployed U. S. Armed Forces) returned from the Persian Gulf and slowly (6-24 months or more) and presented with a variety of complex signs and symptoms characterized by disabling fatigue, intermittent fevers, night sweats, arthralgia, myalgia, impairments in short-term memory, headaches, skin rashes, intermittent diarrhea, abdominal bloating, chronic bronchitis, photophobia, confusion, transient visual scotomata, irritability and depression and other signs and symptoms that until recently have defied appropriate diagnoses (see publications). These symptoms are not localized to any one organ, and the signs and symptoms and routine laboratory test results are not consistent with a single, specific disease.

Although there is not yet a case definition for Gulf War Illness, the chronic signs and symptoms loosely fit the clinical criteria for Chronic Fatigue Syndrome and/or Fibromyalgia Syndrome. Some patients have additionally what appears to be neurotoxicity and brainstem dysfunction that can result in autonomic, cranial and peripheral nerve demyelination, possibly due to complex chemical exposures. Often these patients have been diagnosed with Multiple Chemical Sensitivity Syndrome (MCS) or Organophosphate-Induced Delayed Neurotoxicity (OPIDN). Chemically exposed patients can be treated by removal of offending chemicals from the patient's environment, depletion of chemicals from the patient's system and treatment of the neurotoxic signs and symptoms caused by chemical exposure(s). A rather large subset (~40%) of GWI patients have transmittible infections, including mycoplasmal and possibly other chronic bacterial infections, that have resulted in the appearance of GWI in immediate family members and civilians in the Gulf region. It is likely that veterans of the Gulf War who are ill with GWI owe their illnesses to a variety of exposures: (a) chemical mixtures, primarily organophosphates, antinerve agents and possibly nerve agents, (b) radiological sources, primarily depleted uranium and possibly fallout from destroyed nuclear reactors, and (c) biological sources, primarily bacteria, viruses and toxins, before, during and after the conflict. Such exposures can result in poorly defined chronic illnesses, but these illnesses can be treated if appropriate diagnoses are forthcoming.

Studies on Gulf War Illnesses: Chronic Infections

Identification of Mycoplasmal Infections in Gulf War Illness Patients and their Family Members:

Scientists at The Institute for Molecular Medicine have found that slightly under one-half of the very sick Gulf War Illness patients in a pilot study with the signs and symptoms of Chronic Fatigue Syndrome or Fibromyalgia Syndrome have chronic invasive infections involving certain uncommon mycoplasmas, such as Mycoplasma fermentans. This has now been confirmed in a large Department of Defense - Department of Veterans' Affairs clinical trial. Staff at The Institute for Molecular Medicine have recommended that these infections can be successfully treated with certain antibiotics, allowing the recovery of patients who have been long-term disabled. Similarly, in ongoing preliminary studies on Chronic Fatigue Syndrome and Fibomyalgia patients, we have found that a subset of patients have mycoplasmal infections that can be successfully treated with antibiotics, allowing patients to recover from their illnesses.

These chronic bacterial infections can spread to immediate family members. In a recent study we found that spouses of veterans with Gulf War Illness and chronic infections, such as M. fermentans, were at high risk for the infection. We also found that the children (aged 2-11 years) of Gulf War veterans with Gulf War Illness and a positive test for mycoplasmal infection (mostly M. fermentans) often were diagnosed with Autistic Spectrum Disorders (ASD). Upon examination of the ASD patients we found that over 80% had the same infection as their veteran parent. The onset of ASD (after the veteran returned from service) and the presence of the same infection suggested transmission of the infection and its involvement in ASD.

Identification of Other Infections in Gulf War Illness Patients:

The Institute for Molecular Medicine has been engaged in examining the blood of Gulf War Illness, Chronic Fatigue Syndrome, and Fibromyalgia patients for chronic infections that could explain their clinical conditions. In preliminary research we have found that some patients have microorganism infections, such as those caused by Brucella species, Y. pestis or other bacteria. This line of investigation is now being actively pursued at the Institute