GIs in Iraq Got Rare Pneumonia

Acute eosinophilic pneumonia is considered a rare disease, but it occurred at an increased rate among a population of soldiers serving in or near Iraq between March 2003 and March 2004, and may be associated with new-onset smoking and/or dust inhalation, an epidemiologic study shows.

Of 183,000 military personnel deployed in or near Iraq during the study period, 18 developed acute eosinophilic pneumonia (AEP), for an incidence of 9.1/100,000 patient- years.

Two patients died and the remaining soldiers responded to treatment.

No known causes of pulmonary eosinophilia, common sources of exposure, clustering, or person-to-person transmissions were identified, reported Andrew F. Shorr, M.D., of Walter Reed Army Medical Center, Washington, and his colleagues (JAMA 2004;292:2997–3005).

All the patients were smokers, and 78% had recently started smoking. Compared with 48 controls, new-onset smokers had a significantly increased risk of AEP (odds ratio 122).

Prior studies have also suggested a link between new-onset smoking and AEP. All but one patient reported significant exposure to fine airborne sand or dust.

AEP should be considered, and bronchoscopy performed, in military personnel with unexplained respiratory failure, the investigators concluded.

Most patients survive when treated promptly with corticosteroids, they said.