Recurrent Herpes Gladiatorum: Should we be Screening Our Service Members Prior to Close Combat Training?

A 19-year-old active duty Marine presented to clinic with a history of a reoccurring vesicular rash on left side of his forehead. The lesion was cultured and identified as herpes simplex virus 1 (HSV-1). Herpes gladiatorum is a recurrent cutaneous infection caused by HSV-1 and spread by skin-to-skin contact. Serious complications have been reported, including blindness from acute retinal necrosis. Outbreaks of herpes gladiatorum have been observed in the high school and collegiate wrestling community for years and to prevent the spread, screening, and treatment guidelines have been implemented by governing bodies of these organizations. Active duty members who participate in the Marine Corps Martial Arts Program and the Army and US Air Force Combatives programs are exposed to similar conditions; however, no uniform screening or treatment protocol exists. To minimize the spread of skin infections, we propose adopting a uniform screening procedure and implementing a standardized form to assist primary care providers in the evaluation and treatment of herpes gladiatorum and other communicable skin diseases commonly seen in close combat training.

Fluticasone as Treatment for Cluster Headaches in a Navy Aircrew Member.

Cluster headaches (CHs) are one of the most debilitating of all the identified headache syndromes. Their pathogenesis is poorly understood, which has made their treatment challenging. Various medicines and modalities have been put forth in an effort to minimize the symptoms, but none have proven to be consistently reliable. For the active duty military aviator with CHs, this is further compounded by the administrative restrictions to use many of those medications secondary to their unwanted and potentially dangerous side effects. We present a case of refractory CH in an active duty air crewman, treated with fluticasone, which resulted in a remarkable reduction in symptoms allowing him to resume his primary flight duties. We propose that fluticasone's effectiveness in improving his CH symptoms stems from its anti-inflammatory properties.

Manual Therapy for Chronic Low Back Pain in an F-5 Pilot.

INTRODUCTION: Low back pain (LBP) in the aviator can be a significant safety risk because of distraction during flight. Flight Surgeons are tasked with seeking out appropriate medical care that reduces pilot risk while providing squadron-specific mission support. CASE: An F-5 pilot presented with chronic LBP seeking nonpharmacological and noninvasive therapy. After 3 days of manual treatment that corrected sacral, pelvic, and lumbar dysfunction, this pilot reported greater than 80% reduction in overall pain and was able to return to flight. DISCUSSION: Although underreported, a radiographic study and multiple case reports, identify LBP as a significant problem among tactical air (tac air) pilots. As such, LBP can become an in-flight distraction increasing the risk of a mishap. Benefits of osteopathic manipulative therapy (OMT) as an adjunct to treatment of LBP in civilian population were recently demonstrated. This case identified a tac air pilot with chronic LBP that responded to three OMT sessions focused at the sacrum, lumbar, and pelvis. CONCLUSION: The use of manual therapy in the form of OMT significantly reduced this pilot's pain in three visits and maintained flight status per aeromedical waiver guidelines.

Toxic Epidermal Necrolysis from suspected Mycoplasma pneumoniae infection.

INTRODUCTION: Toxic Epidermal Necrolysis (TEN) is primarily associated with medication use. Presented is a patient with likely Mycoplasma pneumoniae infection and progression to TEN. CASE: A 19-year-old male presented with 1-week history of pneumonia like symptoms and prescribed antibiotics for suspected community-acquired pneumonia. Onset of a new rash was noted and antibiotics were discontinued less than 24 hours after initiation. The diffuse, maculopapular, bullous rash with mucosal lesions ultimately reached skin involvement greater than 30%. Histological studies were consistent with TEN. Mycoplasma antibodies and cold agglutinins were positive. DISCUSSION: Stevens-Johnson syndrome (SJS) and TEN are a spectrum of mucocutaneous disorders. The most common etiology of both is medications. Mycoplasma is the most common infectious cause of SJS, but has been poorly cited as a cause of TEN. Typical onset of rash from medications is greater than 14 days, whereas onset from infection is typically less than 14 days. The timing of rash onset in this presentation was congruent with infection rather than medication induced. CONCLUSION: Mycoplasma is a well-documented etiology of SJS, but rarely documented as an etiology of TEN. This case suggests the potential of Mycoplasma infection causing more severe mucocutaneous disease in the spectrum of SJS and TEN.

Correlations between watershed and reservoir characteristics, and algal blooms in subtropical reservoirs.

This study examined the correlations between watershed and reservoir characteristics, and water quality parameters related to algal blooms in seven subtropical reservoirs. Analysis of the dissimilarity of physico-chemical parameters resulted in separation of the reservoirs into three main groups: four reservoirs with the highest proportion of agriculture and/or urban land use in their watersheds; two reservoirs with a high proportion of forest cover; and one small reservoir with a relatively pristine watershed intermediate between the other two groups. All reservoirs were dominated by cyanobacteria, and at times, had species capable of producing toxins. However, the three reservoirs with the lowest percentage forest cover ( approximately 50%) had the highest frequency and magnitude of toxic species, principally Cylindrospermopsis raciborskii. Analysis of dissimilarity of algal species composition resulted in three reservoir groups similar to that for the physico-chemical parameters, with the exception of the reservoir with the highest percentage urban land use being an outlier. Across all reservoirs, percentage forest cover in the watershed, watershed area and reservoir volume were all significantly correlated with algal cell concentrations and total nitrogen (TN), but not with chlorophyll a concentrations. Total phosphorus (TP) was only correlated with the proportion forest cover in the watershed, suggesting that reservoir volume and depth were of less importance for TP than for algal cell concentrations or TN. These results suggest that watershed pattern and reservoir characteristics, such as water volume and depth, have a measurable effect on the type of algal blooms in reservoirs.