Gulf War Syndrome and Brucellosis

Saudi Food Service (Astra Foods)

"...a Saudi by the name of Zahir Masri had been instructed by the king to feed the American troops (Khaled 1995, 295)...Masri contracted for Saudi and Filipino cooks, and set up mess halls throughout the theater. He served produce from Astra Foods, the largest covered farm operation in the world, which was already on contract by King Fahd to feed the Saudi military. Astra Foods served over 300,000 troops per day with these contract meals, using food stuffs provided by Astra Foods and paid for by King Fahd (Khaled 1995, 295)."
SELECTIVE PRIVATIZATION OF SECURITY: WHY AMERICAN STRATEGIC LEADERS CHOOSE TO SUBSTITUTE PRIVATE SECURITY CONTRACTORS FOR NATIONAL MILITARY FORCE - BRUCE EDWIN STANLEY, 2012

"Pagonis established contact with Zahir Masri, a wealthy Saudi businessman, who with Chief Warrant Officer 4 Wesley Wolfe, Pagonis’ food czar, arranged to supply troops with hot meals (lasagna, hot dogs, pizza, etc.) and fresh pita bread, fruit and vegetables, even to soldiers at the front lines, a remarkable morale-booster. By December up to 300,000 U.S. troops were eating these so-called “A-rations” each day, plus “Wolfburgers” – hot hamburgers supplied by several mobile vans Wolfe sent to desert posts."
Gulf War: Logistics Marvels Made the “Left Hook” Work

Wolf Burgers!?

Wolf Burgers were served throughout the region, and could have played an important role in disseminating Brucella melitensis to US troops.
The burgers were made with local goat cheese, before the vaccination campaign. They were served from both stands and mobile vans that Wesley Wolfe sent to desert posts.
https://www.apnews.com/0d7627da0672881dd1706c7935ff7da4

Sand?

"In one subset of GWI patients Murray-Leisure et al. (4) have described an association with cutaneous sand exposure. This is most likely caused by a chronic transmittable infection found in sand that is endemic to the region, such as Bacillus anthracis or Brucella species. The risk for sand-associated illness appeared to be highest in the fall. Although no infections were ever identified, the slow appearance of the same signs and symptoms in spouses and children of veterans with GWI suggested that a slow-growing microorganism was being transferred (4)."
Gulf War Illnesses: Causes and Treatments - Prof. Garth L. Nicolson

Unless a labratory is committed to a full and thorough screening for Brucella, it will most likely not be detected, or misdiagnosed. There is a PCR DNA test, but it is not something readily available to most patients. Patients who cannot get a proper diagnosis may wish to seek presumptive antibiotic treatment anyway.

To do clinical testing on Brucella you cannot do routine standardized testing. Specimen cultures that are routinely terminated at 48 hours need to be held for 21 days or longer. The same for blood cultures, instead of 5 days they should be held 30 days. Preferred specimens are bone marrow and blood cultures. This is why it is imperative that the doctor communicates to the microbiologist if a case of Brucellosis is suspected, otherwise the smears and culture work up will most likely be negative and useless.

A standard clinical microbiology lab such as used in the VA, cannot fully identify Brucella species unless set up to do so. Special dye testing plates and special serological reagents are needed. Automated identification systems in use in VA microbiology labs will almost always give you a misidentification on a Brucella isolate. A reference lab is always needed. A presumptive diagnosis can be made based on staining characteristics, growth patterns on media, available biological tests, and a patient’s history. For example, whether the patient was in an endemic area, his symptoms, risk factors such as consuming dairy products such as goat cheese, being around sheep, goats, camels and their droppings, and other environmental factors such as bacteria laden dust, dead animals, and contaminated water.

Brucella exhibits very quirky staining properties. In clinical specimens it may barely be visible and may be missed using the standard Gram stain. Unless you modify the procedure and are specifically looking for Brucella, you will most likely miss it. Extending the counter stain of the routine Gram stain with safranin or carbofuchin will show the organism, whereas in the routine stain it could be missed or be very lightly stained organisms, resembling grains of sand.

Through the use of a Methylene Blue Wet Prep and phase contrast microscopy, clear, unstained, refractive like spore structures, .5 to 1.0 micron become visible.

Methylene Blue is a poistive charged basic dye. Brucella will stain red with the negatively charged Rose Bengal dye. The Rose Bengal Test is a siroligy test commonly used in the middle east to detect Brucella antibodies. From Mukasa-Mugerwa, E. Review Of Reproductive Performance of Female Bos Indicus (Zebu) Cattle. Addis Ababa, Ethiopia :International Livestock Centre for Africa, 1989, page 95:

RBT is performed on serum using stained antigen at pH 3.6. It is economical, simple to perform and gives results in 4 minutes. Like the MRT, it is used as a quick screening test. A positive result is indicated by clear agglutination.

“Specific Detection of Brucella DNA by PCR” - Journal of Clinical Microbiology, March 1995

Doxycycline alone is not permanently effective against Brucella. Doxycycline will kill extracellular organisms and may show some short-term effect. However, it does not effectively penetrate the macrophage cells where the organism replicates. A doxycycline/rifampin combination is more effective as Rifampin effectively enters the cells to permanently kill the organism (when properly taken, and not abandoned early). Doxycycline alone may act as a prophylactic against brucellosis and kill the organism before it becomes established.

From the CDC: "Generally, the antibiotics doxycycline and rifampin are recommended in combination for a minimum of 6-8 weeks"