Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan.
Occupational Lung Diseases among Soldiers Deployed to Iraq and Afghanistan.
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DOI：
10.4172/2329-6879.1000117
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发表时间：
2013-01-01
期刊：
影响因子：
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通讯作者：
Szema, Anthony M
中科院分区：
文献类型：
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作者：
Szema, Anthony M
从2004年至今，部署到伊拉克和阿富汗的军事人员是在独特的环境条件下服役的。其中包括暴露在露天“燃烧坑”中燃烧的垃圾中，燃烧坑用喷气燃料JP-8点燃。根据燃烧的垃圾-水瓶，泡沫塑料托盘，医疗废物，未爆炸的弹药和计算机-毒素可能会释放，如二恶英和正己烷和苯。颗粒物空气污染从这些火灾和烟雾中达到顶峰。额外的环境暴露导致沙尘暴（哈布、沙马尔和沙奇），它们的方向和与雨的关系不同。这些战争中首次使用了简易爆炸装置（路边磷酸盐炸弹）以及车辆简易爆炸装置（汽车炸弹），这些装置不仅可能使金属雾化，而且还通过爆炸超压产生冲击波，引起肺损伤。基地组织在伊拉克和阿富汗也使用常规迫击炮弹。在伊拉克南部底格里斯河和幼发拉底河沿岸，来自椰枣树的室外空气过敏原很普遍，而室内空气过敏原曲霉菌在雨季占主导地位。高海拔肺病也可能使问题复杂化，特别是在阿富汗的坎大哈。临床上，士兵可能会出现新发哮喘或固定性气道阻塞。有些人有缩窄性细支气管炎和开放性肺活检血管重塑-尽管有正常的肺功能测定和胸部X光片和胸部CT扫描。其他人被发现在肺中有钛和其他金属（自然界中罕见）。还有一些人有暴发性活组织检查证实的结节病。我们在一名患有肺炎的士兵的肺中发现了DNA探针阳性的鸟分枝杆菌复合体，当时他在阿布加里卜城外的死水、骆驼和山羊附近服役。本次审查强调了潜在的暴露，临床综合征和丹佛工作组对部署后健康的建议。
Military personnel deployed to Iraq and Afghanistan, from 2004 to the present, has served in a setting of unique environmental conditions. Among these are exposures to burning trash in open air "burn pits" lit on fire with jet fuel JP-8. Depending on trash burned--water bottles, styrofoam trays, medical waste, unexploded munitions, and computers--toxins may be released such as dioxins and n-hexane and benzene. Particulate matter air pollution culminates from these fires and fumes. Additional environmental exposures entail sandstorms (Haboob, Shamal, and Sharqi) which differ in direction and relationship to rain. These wars saw the first use of improvised explosive devices (roadside phosphate bombs),as well as vehicle improvised explosive devices (car bombs), which not only potentially aerosolize metals, but also create shock waves to induce lung injury via blast overpressure. Conventional mortar rounds are also used by Al Qaeda in both Iraq and Afghanistan. Outdoor aeroallergens from date palm trees are prevalent in southern Iraq by the Tigris and Euphrates rivers, while indoor aeroallergen aspergillus predominates during the rainy season. High altitude lung disease may also compound the problem, particularly in Kandahar, Afghanistan. Clinically, soldiers may present with new-onset asthma or fixed airway obstruction. Some have constrictive bronchiolitis and vascular remodeling on open lung biopsy - despite having normal spirometry and chest xrays and CT scans of the chest. Others have been found to have titanium and other metals in the lung (rare in nature). Still others have fulminant biopsy-proven sarcoidiosis. We found DNA probe-positive Mycobacterium Avium Complex in lung from a soldier who had pneumonia, while serving near stagnant water and camels and goats outside Abu Gharib. This review highlights potential exposures, clinical syndromes, and the Denver Working Group recommendations on post-deployment health.