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IOM - Infectious Disease - May 26th 2005 - commentary

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  • Kirt Love
    IOM - Infectious Disease - May 26th 2005 - commentary The meeting started at 1:00pm, and Chairman Black was a very polite / modest / congenial moderator. He
    Message 1 of 1 , May 27, 2005
      IOM - Infectious Disease - May 26th 2005 - commentary
       
      The meeting started at 1:00pm, and Chairman Black was a
      very polite / modest / congenial moderator. He asked the people
      in the room to give their names, and cut to the chase.
       
      Richard Reithinger spoke first, a young european gentleman with
      a soft demeanor. He presented a variety of global endemic issues
      that tied into South West Asia, but didnt really point out anything
      sweeping. Just basic disease facts, and so on. It was delivered so
      softly that heads bobbed heavily. Noticable portion, photos of old
      run down buildings in SW Asia that were supposed to be federal
      medical buildings. Horrendous.
       
      Craig Hyams spoke, and in truth I cant bring myself to care enough
      to even mention it in any detail. He presents as VA, but his DOD
      career and contempt for veterans just makes him easy to tune out
      as he parades himself. His point is clear, but doesnt deserve the
      courtesy of being expressed. He doesnt care about soldiers, and
      just is trying to say nothing happened in Iraq. Simply not true.
       
      Mike Kilpatrick spoke next, and his presentation was of the policy
      changes at DOD torwards current deployments. According to DHSD
      Combat Stress is running at 1% in Iraq, Joint trama registry to see
      about sports trama injuries. 63% of illness/injury in Iraq have been
      evacuated for diseases in Iraq. 20% combat injuries. 800,000 post
      deployment assessments for returning troops, 90% say they are fine.
       
      In OIF/OEF
      Leishmaniasis ( Jan 03 to may 05 )
      Cutaneous 848   - Visceral 4
       
      Malaria
      Iraq 0                - Afghanistan 52
       
      Pneumonia
      severe 19          - Camp Buehring 235
       
      Gastroenteritis
      TB ( 2.5% skin test conversion )
      Q-Fever ( 10 )
      Brucesllosis - 1
      Acinetobacter Baumannii
       
      You notice they dont give numbers for the Acinetobacter,
      so I volunteered it at 102. Then I asked Mike how many cases
      have shown up since November 2004, he didnt know. He just
      went into the Blood cultures versus wound cultures.
       
      He did go as far as to say this strain wasnt the soil variety, and
      cases were not exclusive to the Tigris river valley. Then he
      volunteered that troops diagnosed with Leishmaniasis are under
      a liftetime ban from giving blood.
       
      I asked about the AFIP serology program, and he explained that
      the vault was running out of room. The new location will be on a
      military installation. He went back into the difficulty of using the
      blood samples drawn for one thing being used for another.
       
      In reference to troops returning from Iraq - Craig Hyams blurted over
      Mike Kilpatrick "We have not seen cases of Leishmaniasis cases
      in the VA system" and Mike quickly countered with "Shisto,
      Shistosomaisis". Which furthers my position that Craig is there to
      just say no to anything.
       
      Alan Magill was the big surprise in the preceedings. He basically
      gave the most complete presentation on Leish to date, that also
      admitted they cant hardly find this when they are looking for it.
       
      That after a 100 years to this day Leishmaniasis is still dependent
      on stain, that PCR and other methods are not dependable.
       
      He begins with the hairy wings of the sand flies, and how a person
      doesnt even know they have been bitten by a sandfly because you
      cant hear them flying about.
       
      He discussed Zoonotic vs Anthroponotic, L. Tropica vs L. Major.
      Basically animal transmission ( zoonotic ) to people.
       
      There is the Promastigote found in sand flies, and the Amastigotes
      found in infected host. There was difficulty isolating the Amastigotes in
      people, very difficult to isolate even with bone marrow samples.
       
      That the cutaneous cases from Gulf War 1990-1991 were L. Major.
      at 20 cases. Kuwait was described as a clean area on leish compared
      to Saudi Arabia.
       
      Visceotropic ( L. Tropica ) Leishmaniasis was not really studied until 1992
      after the war. That it was diagnosed L. Tropica, not L. Donovani or
      L. Infantum. That characterization of the strain was important. 
       
      Current Visceral cases from Iraq and Afghanistran are L Infantum
      ( i.e. name refers to infant infections ).
       
      They havent found L. Major Viserotropic cases yet.
       
      First tale tell clue on visceral is enlarged spleen, and deaths from
      Leishmaniasis die of complications of illness. The illness itself weakens
      the person until pneumonia or other disease overwelm them.
       
      That many cases are asymptomatic upto three years.
       
      That most medical labratories in America will not successfully culture
      Leishmaniasis.
       
      The L. Tropica reference strain numbers for Iraq are:
      MHOM/4Q/00/avraham
      MHOM/4Q/66.1,75
      Which doesnt show up in any external references I can find of the
      International reference code.
       
      A example reference:
       
      That after a cultured parasite sample is drawn, its placed
      on a gel zymodeme. That enzymes present in the gel make
      the parasites easier to view in a microscope.
       
      Treatment with patients often involve Neuropsychiatric medications.
       
      That persistant Leishmaniasis infection is for the lifetime of the
      person infected, that never leads to the eradication of the
      parasites. Which supports the 2003 CDC presentation that at
      this time none of these people can guarantee a sterile cure for
      Leishmaniasis. Which would be why DOD has imposed a lifetime
      blood donation ban on soldiers diagnosed with Leishmaniasis.
       
      What he also admitted in Q&A is the need to develope a diagnostic
      tool that can detect small numbers of leishmaniasis parasites in
      a host. Methods now still require large numbers of parasite to be
      typed and diagnosed. This is late in the disease stage.
       
      Blood PCR of Leishmaniasis is useless. No PPD for Leish, that
      skin test were useless, and splenic asparate was only helpful if
      the swarming parasites burden were in the 10 to the 15th power.
       
      When he wouldnt discuss the disease burden in the sandfly
      population, I offered a number of 1 in 5 infected sand flies in
      a outbreak area. He agreed.
       
      Magill alluded that he did not know Arvid Brown or his families
      Leishmaniasis case in Michigan. That or the Iraq contractee
      Merlin Clark of Florida who stayed at Walter Reed. Which I
      dont buy.
       
      Access to contractors in military service is a issue since Walter
      Reed doesnt grant access even though they are almost exclusive
      asto Leishmaniasis diagnosis in this country.
       
      The IOM committee did volunteer as the last other two have,
      that other sessions can be public if we ask them to do so.
      In that I asked could the committtee to try to get with veterans
      on agenda points before the meetings. So that we dont have
      to wait till 10 days out before a meeting to try, and prepare
      a reponse or presentation to them.
       
      In closing, Mike Kilpatrick surprised me early on by walking
      up and shaking my hand at the front of the room. Without
      missing a beat, I commented on the obfuscation of his
      underling staff with me these last few months. The hiding
      of the NSO data, the lack of response from his staff, and
      the final Whitehouse / UNSEC Chu involvement to get answers
      from his, and VA departments. That his team has made it nearly
      impossible to interact with DOD on veteran health issues, of
      which I detailed to the committee in the public comments
      session. Then I went after the USCENTCOM medical survey
      and that they were holding it back.
       
      I explained to Mike this was part of the 1995 Gulf war declassifcation
      program, and the document has the words "medical" in it. That
      DHSD has it, and should have released it since it was of medical
      relevance. That I have written for more than a year to them on this,
      with no reply at all. He understood what I had implied, and explained
      he would go back to ask about it.
       
      So you will notice in my next email following this, that DHSD gave
      me a email response this morning explaining part of this. As I take
      it Mike said something to his staff this morning about getting back
      to me. This as well as VenusVal Hammacks Executive Director
      position of the 501 c3 DSJF entitles her to attend the NSO meetings
      at DHSD.
       
      Venus and I double teamed the room by videotaping front and
      back the whole afternoon. So Im trying to both scan the slides
      to put out as well as build video masters of the 4 presentations.
      Which will take a few days. If there was ever a IOM event to tape,
      it was this one.
       
      More to follow.....
       
                                                                  Sincerely
                                                                  Kirt P. Love
                                                                  Director, DSBR
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