Illnesses of Gulf war vets stump experts.

An increasing, though still unknown, number of veterans of the Persian Gulf war experience debilitating fatigue, diarrhea, muscle and joint pain, memory loss, difficulty breathing, and extreme sensitivity to chemicals. Moreover, some report that their wives and children also have experienced these symptoms.

Physicians' attempts to diagnose or define this cluster of symptoms as a disease have failed. Now, a 12-member National Institutes of Health panel set up to try to develop a working definition of the disease has determined that it perhaps can't do so.

"There is no single disease or syndrome apparent, but rather multiple illnesses with overlapping symptoms and causes," the panel concluded in a 17-page draft report released at a press conference last week in Washington, D.C.

The members, most of them physicians or epidemiologists, wrote the report after reviewing material and listening to 1-1/2 days of testimony from military officers, Gulf veterans, and researchers familiar with the veterans' stressful living conditions in the Gulf, as well as their symptoms.

Determining the nature of the diseases and the number of people ill from them will require more research, the panel warned. In fact, panel member John D. Spengler of the Harvard School of Public Health in Boston says he was struck by the fact that basic information on what troops were exposed to during the Gulf war remains unavailable 3 years after the war ended.

The panel did narrow the list of possible causes of the illnesses, however. Some of the veterans appear to have a distinct form of post-traumatic stress disorder (PTSD) -- one that includes more physical symptoms but less numbing and fewer flashbacks than non-Gulf PTSD cases, they write. The stress that Gulf personnel experienced may also influence "the way ordinary illnesses appear and perhaps induce other illnesses which we aren't used to seeing," says panel chair Gareth M. Green, also of the Harvard School of Public Health.

Examinations of up to 100 sick veterans revealed 31 cases of a "novel and unexpected manifestation of leishmaniasis," a parasitic infection that affects the intestines, says the report. Sand flies carry this difficult-to-diagnose disease, and its symptoms resemble those afflicting the Gulf troops.

Some veterans and researchers suggested that the illnesses may stem from living among a host of irritants, including parasites, pesticides, sky-darkening smoke, sand as fine as dust, and petroleum fumes. Some believe chemical or biological warfare poisons made the veterans sick, although the Department of Defense claims it found no evidence of such agents.

The panel acknowledged that contaminants in the troops' Gulf environment could have contributed to their illnesses. However, it ruled as "unlikely" the possibility that illnesses resulted from exposure to the depleted uranium in munitions and armor, chemical or biological warfare agents, or vaccines the troops received to guard against possible nerve agents or diseases.