illness in 0.2% of the soldiers. Al Eskan disease or a similar illness has not been reported in troops deployed to OIF or OEF.
Al Eskan disease was first reported in 1992 (Korenyi-Both et al. 1992). The disease is characterized by sudden or insidious onset of chills, fever, sore throat, hoarseness, nausea and vomiting, and generalized malaise and then respiratory tract complaints, including increasingly severe dry cough or expectoration of tan sputum. Some patients experience symptoms of gastroenteritis. Physical findings are minimal, and x-ray pictures on occasion reveal “atypical pneumonitis”. The disease appears to be self-limited, and less than 1% of patients with the complaints had a relapse. Systematic description and precise case definition of Al Eskan disease are unavailable.
No data link Al Eskan disease to any specific chronic illness. In their initial report, Korenyi-Both et al. (1992) indicated that most patients had recovered within 6 weeks and that the relapse rate was less than 1%. They argued later that exposure to sand particles can serve as a source of pneumoconiosis and can stimulate a severe and perhaps chronic allergic immune response (Korenyi-Both et al. 1997; Korenyi-Both et al. 2000). They refer to such a chronic immune response as the “second phase of Al Eskan disease”, which they imply might explain some of the health problems noted in Gulf War veterans (Korenyi-Both et al. 1997).
Military personnel deployed to the Persian Gulf are inevitably exposed to sand. Working at the Armed Forces Institute of Pathology, Irey (1994) reported birefringent sand particles in the lungs of some of 86 casualties from the Kuwait theater of operations. However, the author found no long-term lung inflammation.
Korenyi-Both et al. demonstrated that although many sand grains were agglomerated, 18% of the sample included dispersed particles in the range of 0.1-0.25 µm; such particles would be expected to bypass lung defenses (Korenyi-Both et al. 1992). The sand material was extremely rich in calcium and silicon. Sand from Iraq had a calcium-to-silicon ratio of 4.2:1, and sand from Kuwait had a ratio of 3.75:1 (Korenyi-Both et al. 1997). Both the size of the sand grains and their composition differ considerably from those of sand samples harvested from other sites (for example, sand taken from Hawaii). Cultures of the sand showed some filamentous fungi, yeast, and staphylococcal species. No mycobacteria or chlamydia specimens were recovered. Contamination of sand with weapons of chemical warfare has been proposed but not studied (Korenyi-Both et al. 2000).
Korenyi-Both et al. have argued that Al Eskan disease is most likely a form of acute silicosis aggravated by the pulmonary immune response and perhaps other genetic and environmental factors (Korenyi-Both et al. 1997; Korenyi-Both et al. 1992; Korenyi-Both et al. 2000). However, there are no clinical data to support that hypothesis and no reports of chronic lung disease consistent with silicosis in veterans.