Gulf War Syndrome and Brucellosis



Gulf War syndrome (GWS), also known as Gulf War illness (GWI) : a chronic multisymptom disorder affecting returning military veterans and civilian workers of the 1990–91 Gulf War. A wide range of acute and chronic symptoms have been linked to it, including fatigue, muscle pain, cognitive problems, rashes and diarrhea.

Brucella melitensis: a bacteria which can cause chronic Brucellosis, with symtoms of chronic fatique, loss of appetite, profuse sweating when at rest, pain in joints and muscles, insomnia, nausea, and damage to major organs.

1942

"Canada, the United States and Great Britain entered into a secret agreement to take the brucellosis bacteria and make it more contagious and more virulent and to weaponize it, make it such that it would do serious damage to an enemy and they came up with a variant which they had tested in a number of places in Canada, the United States and Britain as well as other countries and they had indeed weaponized brucellosis." Donald W. Scott

1987

Riegle Report: The United States Government ships Brucella melitensis Biotype 1 and 3 to the Iraq Atomic Energy Commission.

1988-1989

Brucellosis was already an issue in Kuwait prior to the Gulf War.
The nature of human brucellosis in Kuwait: study of 379 cases.
Brucellosis in Kuwait: a clinico-epidemiological study.

1990–91

The Gulf War

1993

Riegle Report: UNSCOM inspections uncovered evidence that the government of Iraq was conducting research on pathogen enhancement on the following biological warfare related materials:

  • Bacillus anthracis
  • Clostridium botulinum
  • Clostridium perfringens
  • Brucella abortis
  • Brucella melitensis
  • Francisella tularensis
  • Clostridium tetani

1995

A microbiologist notices unusual microorganisms in the stool of Gulf War patients, and eventually partially identifies Brucella melitensis as a potential organism responsible for Gulf War Syndrome symptoms. The VA does not pursue his findings or support completing the identification:
A discovery of unusual microorganisms in stools of Persian Gulf war veterans with Gulf War Illness, and attempts at indentification in a Veteran's Hospital setting, as reported to the Veteran's Oversight Committee.

2001

"Other chronic infections have also been found in GWI patients. For example, in contrast to official reports (31), there is some preliminary evidence for Brucella infections (Unpublished observations). Inhalation of Brucella spp. (Brucella melitensis strains predominantly) can cause the slow onset of brucellosis, a chronic illness that shares many but not all of the signs and symptoms of GWI."
Gulf War Illnesses: Causes and Treatments - Prof. Garth L. Nicolson

2013

Maj. Michael J. Chagaris reports successful treatment of GWS (with an antibiotic combination that would also treat Brucella melitensis). Chagaris believes the cause to be "Q Fever", however the diagnosis is presumptive.
Has this man conquered Gulf War Syndrome?
PDF of Chagaris' paper.
CDC on Q fever

A study finds Brucellosis can cause nuerological changes in the brain.
Aerosol-induced brucellosis increases TLR-2 expression and increased complexity in the microanatomy of astroglia in rhesus macaques.

Future???

A DNA study by PCR for chronic Brucella melitensis on Persian Gulf Veterans should follow the procedures of this publication: Chronic Brucellosis and Persistence of Brucella melitensis DNA

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

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

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.

Click here for CDC resources on Brucellosis

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.

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.

“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"