Gulf War Illness

Gulf War Syndrome or Gulf War Illness (GWI) has been used to describe a collection of chronic signs and symptoms reported by U.S., British, Canadian, Czech, Danish, Saudi, Egyptian, Australian and other Coalition Armed Forces that were deployed to Operation Desert Storm in 1991. Over 100,000 American veterans of Desert Storm /Desert Shield (approximately 15% of deployed U.S.  Armed Forces) returned from the Persian Gulf and slowly (over 6-24 months or more) and presented with a variety of complex signs and symptoms characterized by disabling fatigue, intermittent fevers, night sweats, arthralgia, myalgia, impairments in short-term memory, headaches, skin rashes, intermittent diarrhea, abdominal bloating, chronic bronchitis, photophobia, confusion, transient visual scotomata, irritability and depression and other signs and symptoms that until recently have defied appropriate diagnoses.  These symptoms are not localized to any one organ, and the signs and symptoms and routine laboratory test results are not consistent with a single, specific disease.

Unfortunately, when a veteran has symptoms suggestive of GWI, the type of care they get may depend on the type of doctor they see.  A 2001 study shows that mental healthcare workers are more likely to believe that GWI is caused by a physical factor such as a contagious or toxic agent, while general internal medicine doctors are more likely to believe the syndrome is caused by mental illness.  "It's particularly frustrating for patients when they are bounced back and forth between clinicians and psychologists", says lead author Dr. Ralph D.  Richardson, co-director of the Gulf War Clinic in Portland, Oregon.  [Archives of Internal Medicine, May 28th, 2001;161: pp.1289-94]

Although there is not yet a case definition for Gulf War Illness, the chronic signs and symptoms loosely fit the clinical criteria for Chronic Fatigue Syndrome and/or Fibromyalgia Syndrome.  Some patients also have what appears to be neurotoxicity and brainstem dysfunction that can result in autonomic, cranial and peripheral nerve demyelination, possibly due to complex chemical exposures.  Often these patients have been diagnosed with Multiple Chemical Sensitivity Syndrome (MCS) or Organophosphate-Induced Delayed Neurotoxicity (OPIDN).  Chemically-exposed patients can be treated by removal of offending chemicals from the patient's environment, depletion of chemicals from the patient's system and treatment of the neurotoxic signs and symptoms caused by chemical exposure(s).

Causes and Development

Some 40% of GWI patients have transmittible infections, including mycoplasmal and possibly other chronic bacterial infections, that have resulted in the appearance of GWI in immediate family members and civilians in the Gulf region.  It is likely that veterans of the Gulf War who are ill with GWI owe their illnesses to a variety of exposures:

• chemical mixtures, primarily organophosphates, antinerve agents and possibly nerve agents
• radiological sources, primarily depleted uranium and possibly fallout from destroyed nuclear reactors
• biological sources, primarily bacteria, viruses and toxins, before, during and after the conflict.

Such exposures can result in poorly-defined chronic illnesses, but these illnesses can be treated if appropriate diagnoses are forthcoming.

Signs and Symptoms

Symptoms include, but are not limited to, the following: Severe Headaches; Rashes; Joint Pain; Muscle Pain; Nerve/Neurological Damage; Kidney Damage; Lung Damage; Cardiovascular signs or symptoms; Thyroid Disease; Multiple Cancers; Auto-Immune Deficiencies; Unusual Fevers; Night Sweats; Fluid Buildup; Sleep Disturbances; Gastrointestinal signs or symptoms; Genetic Alterations; Abnormal Births; Birth Defects; Menstrual Problems; Reduced IQ; Confusion; Memory Loss; Blood In Stools and Urine; Fybromyligia; Epstein Barr Syndrome; Sinus Diseases; Micoplasma Fermentans; Incognitis Infections; Unusual Hair Loss; Loss Of Smell; Chemical Sensitivities; Asthma; Vision Problems.