A case–control study of incident rheumatological conditions following acute gastroenteritis during military deployment

Abstract

ObjectivesThe aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis.DesignThis case–control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population.SettingWe analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment.ParticipantsAnonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008–2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population.Main outcome measuresThe primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population.ResultsWe identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter's diseasei (3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates.ConclusionsIncident rheumatological conditions, even those classified as ‘non-specific,’ are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions.

Antibiotic Therapy for Acute Watery Diarrhea and Dysentery

“…61 Furthermore, rheumatoid disorders (e.g., reactive arthritis) have been observed to develop following episodes of diarrheal disease (odds ratio: 2.7; 95% confidence interval: 1.1–6.5). 62 …”

Systematic review of the economic value of diarrheal vaccines

“…11 Lastly, several studies have found an association with rheumatologic conditions. 12,13 In addition to these long-term consequences Ashraf and colleagues found that diarrheal disease episodes increased the likelihood of subsequent respiratory illness in children in Pakistan. 41 Associated with each of these conditions, there are likely to be direct medical costs, reduced economic productivity and morbidity that could be measured as DALYs.…”

“…However there is growing evidence that diarrheal illness can have important long-term consequences including under-nutrition, 8 cognitive function, 9 chronic gastrointestinal conditions, 10 metabolic syndrome, 11 and rheumatologic conditions. 12,13 It is unclear the extent to which these outcomes may affect the overall economic value of the vaccines.…”

Operation United Assistance: Infectious Disease Threats to Deployed Military Personnel

“…30 On occasion, patients developed reac tive arthritis from their gastroenteritis, and some devel oped chronic persistent diarrhea. [31][32][33][34] Along with diarrheal disease, Q-lever and respiratory infections were also observed during the Iraq and Afghanistan deployments. A study of vector-borne disease 2000-2011 at Army and Navy medical facilities revealed 136 cases of Q-fever among military personnel.…”