Infectious Diseases Current Topics in Infectious Diseases

Rare Pneumonia in Iraqi Soldiers

Two soldiers in Iraq have died from a rare form of pneumonia with symptoms that mimic the community-acquired pneumonia commonly seen in the winter, according to a study in the December 22/29 Journal of the American Medical Association.

The researchers, led by Andrew F. Shorr, MD, MPH, chief of the pulmonary clinic of Walter Reed Army Medical Center in Washington, DC, reported 18 cases of acute eosinophilic pneumonia (AEP) among 183,000 military personnel in Iraq from March 2003 though March 2004. All of the patients were currently using tobacco, and 14 of the 18 were recent smokers. Additionally, all but one of the soldiers reported having been exposed to fine airborne sand or dust.

In AEP, the lungs are infiltrated with eosinophils, or white blood cells. The eosinophils cause inflammation and can lead to a fever, cough and shortness of breath, resembling the more common community-acquired pneumonia, which is spread from person to person by viruses or bacteria. Unlike community-acquired pneumonia, however, no bacterial or viral infection is present in AEP and it is not contagious. Consequently, the treatment of these types of pneumonia also varies—and getting the correct treatment can be lifesaving.

"The treatment of this condition is profoundly different," Dr. Shorr said. "Clearly, the most important thing with community-acquired pneumonia is antibiotics. In AEP, the treatment is a short course of a corticosteroid."

According to Dr. Shorr, people with AEP recover quickly when they are diagnosed and treated appropriately. A diagnosis of AEP is made with a bronchoscopy, a test in which a tube with a camera is inserted into the lungs.

The cause of the cases of AEP was unknown, and the researchers were not able to find evidence that the affected soldiers had been exposed to a particular toxin other than tobacco.

"In this population, the strongest link was the relationship between recent onset smoking at AEP," Dr. Shorr explained. "The relative risk for patients who started smoking when they got to Iraq was 72 times higher than it was for people who were chronic smokers or who never smoked."

"My advice to soldiers is to keep yourself healthy," Dr. Shorr continued. "Wear your protective equipment if you are going to be exposed to anything that might be toxic to your airways. If you're smoking, you should stop. If you're a non-smoker, don't start."

Dr. Shorr also advised health care professionals who might be taking care of people who have been in service in Iraq to consider an AEP diagnosis in people with symptoms associated with community-acquired pneumonia.