An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection.

Campylobacter is a leading cause of traveler's diarrhea in Thailand. Since resistance to quinolones is high among Campylobacter isolates, empiric therapy with quinolones for traveler's diarrhea may be ineffective in this region. We conducted an observational study among 169 U.S. military personnel with acute diarrhea and compared their microbiologic findings to those of 77 asymptomatic personnel deployed to Thailand in May 1998. Of 146 pathogenic bacterial isolates, the most common were nontyphoidal Salmonella (n = 31), enterotoxigenic Escherichia coli (n = 24), and C. jejuni/coli (n = 23). Campylobacter was strongly associated with disease (odds ratio = 5.9; 95% confidence interval = 1.3-37.3), with a more severe clinical presentation, and with a reduced functional ability at presentation (P = 0.02). In vitro resistance to ciprofloxacin was observed in 96% of the Campylobacter isolates. Sub-optimal treatment response to ciprofloxacin was observed in 17% of the cases of Campylobacter infection versus 6% due to other causes. These results highlight the importance of Campylobacter as a cause of severe traveler's diarrhea in Thailand and illustrates the ongoing problem with antibiotic-resistant strains and associated treatment problems.

The fitness training unit in U.S. Army basic combat training: physical fitness, training outcomes, and injuries.

This study involved a retrospective examination of physical fitness, training outcomes, and injury rates among personnel in the Fitness Training Unit (FTU). Personnel were assigned to the FTU based on low performance on push-ups, sit-ups, and/or a 1-mile run (N = 44 men, 95 women) and received an augmented physical fitness program before basic combat training (BCT). They were compared with 712 men and 379 women who took the same test but were not assigned to the FTU and went directly to BCT. FTU and non-FTU personnel trained in the same battalions. Army Physical Fitness Test scores and BCT outcomes (discharged or completed BCT in 8 weeks) were obtained from unit training records. Injuries during BCT were documented from a review of the medical records. On entry to BCT, FTU women had similar 2-mile run times compared with non-FTU women (21.6 vs. 21.5 minutes, respectively; p = 0.86); FTU men were considerably slower on the 2-mile run than non-FTU men (20.3 vs. 17.3 minutes; p < 0.01). FTU women and non-FTU women had similar graduation success (60% vs. 68%, respectively; p = 0.14) and time-loss injury rates (1.3 vs. 1.4 people injured/100 person-days, respectively; p = 0.90). FTU men were less likely to graduate than non-FTU men (55% vs. 82%; p < 0.01) and more likely to suffer a time-loss injury (1.2 vs. 0.7 people injured/100 person-days; p < 0.01). Efforts should be directed toward providing a sufficient training stimulus to improve the aerobic fitness level of men (as well as women) in the FTU.