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Gastroenteritis in US Marines during Operation Iraqi Freedom
Scott A Thornton1, Sterling S Sherman, Tibor Farkas
1Navy Environmental and Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii 96860, USA. thornton@nepmu6.med.navy.mil
Summary
Gastrointestinal illnesses, primarily norovirus (NV) and Shigella, were common among US Marines in Iraq. Most bacterial pathogens were susceptible to ciprofloxacin, but not doxycycline or trimethoprim-sulfamethoxazole.
Area of Science:
- Military Medicine
- Infectious Diseases
- Preventive Medicine
Background:
- Operation Iraqi Freedom involved approximately 83,000 US Marines in Spring 2003.
- A Navy Preventive Medicine laboratory provided diagnostic support in Ad Diwaniyah, Iraq.
- The laboratory supported Marine medical units during a period of repositioning.
Purpose of the Study:
- To identify infectious agents causing illness in US Marines during Operation Iraqi Freedom.
- To provide clinical diagnostic support for military personnel.
- To assess the impact of gastrointestinal illnesses on troop health.
Main Methods:
- Collected stool samples from >30 primary care medical stations.
- Utilized various diagnostic methods including culture, serology, and RT-PCR for norovirus (NV).
- Performed antimicrobial susceptibility testing and NV genetic sequencing.
Main Results:
- Gastrointestinal illness was the most frequent reason for sick call visits.
- Enteropathogens were detected in 44% of stool samples; NV in 23% and Shigella species in 20%.
- NV strains belonged to 7 genetic clusters; ciprofloxacin showed in vitro efficacy against most bacterial agents.
Conclusions:
- Norovirus (NV) and Shigella species predominated as causes of infectious illness.
- The high prevalence of NV and Shigella may be due to their low infectious dose.
- Troop health was generally maintained due to the rarity of other infectious agents.