title: Diarrheal disease during Operation Desert Shield.
abstract: BACKGROUND
  Under combat conditions infectious disease can become a major threat to military forces. During Operation Desert Shield, there were numerous outbreaks of diarrhea among the U.S. forces. To evaluate the causes of and risk factors for diarrheal disease, we collected clinical and epidemiologic data from U.S. troops stationed in northeastern Saudi Arabia.
  
  
  METHODS
  Between September and December 1990, stool cultures for enteric pathogens were obtained from 432 military personnel who presented with diarrhea, cramps, vomiting, or hematochezia. In addition, a questionnaire was administered to 2022 soldiers in U.S. military units located in various regions of Saudi Arabia.
  
  
  RESULTS
  A bacterial enteric pathogen was identified in 49.5 percent of the troops with gastroenteritis. Enterotoxigenic Escherichia coli and Shigella sonnei were the most common bacterial pathogens. Of 125 E. coli infections, 39 percent were resistant to trimethoprim-sulfamethoxazole, 63 percent to tetracycline, and 48 percent to ampicillin. Of 113 shigella infections, 85 percent were resistant to trimethoprim-sulfamethoxazole, 68 percent to tetracycline, and 21 percent to ampicillin. All bacterial isolates were sensitive to norfloxacin and ciprofloxacin. After an average of two months in Saudi Arabia, 57 percent of the surveyed troops had at least one episode of diarrhea, and 20 percent reported that they were temporarily unable to carry out their duties because of diarrheal symptoms. Vomiting was infrequently reported as a primary symptom, but of 11 military personnel in whom vomiting was a major symptom, 9 (82 percent) had serologic evidence of infection with the Norwalk virus.
  
  
  CONCLUSIONS
  Gastroenteritis caused by enterotoxigenic E. coli and shigella resistant to a number of drugs was a major problem that frequently interfered with the duties of U.S. troops during Operation Desert Shield.
authors.affiliation: Epidemiology Division, U.S. Naval Medical Research Institute, Bethesda, Md.
authors.forename: K C
authors.initials: KC
authors.lastname: Hyams
authors.forename: A L
authors.initials: AL
authors.lastname: Bourgeois
authors.forename: B R
authors.initials: BR
authors.lastname: Merrell
authors.forename: P
authors.initials: P
authors.lastname: Rozmajzl
authors.forename: J
authors.initials: J
authors.lastname: Escamilla
authors.forename: S A
authors.initials: SA
authors.lastname: Thornton
authors.forename: G M
authors.initials: GM
authors.lastname: Wasserman
authors.forename: A
authors.initials: A
authors.lastname: Burke
authors.forename: P
authors.initials: P
authors.lastname: Echeverria
authors.forename: K Y
authors.initials: KY
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004405:Dysentery, Bacillary / Q000188:drug therapy; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy; D005243:Feces / Q000382:microbiology; D005759:Gastroenteritis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009663:Norwalk virus / Q000302:isolation & purification; D012529:Saudi Arabia / Q000453:epidemiology; D012764:Shigella sonnei / Q000302:isolation & purification; D011795:Surveys and Questionnaires; D013752:Tetracycline / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014481:United States / Q000208:ethnology; D014839:Vomiting / Q000209:etiology; D014857:Warfare
chemical_list: D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013752:Tetracycline