High incidence of bilateral lower extremity inflammatory lymphedema in air force trainees
1. The incidence of bilateral lower extremity inflammatory lymphedema amongst Air Force basic trainees was 0.4%, most of which were diagnosed within the first 120 hours of training.
2. Antibiotic therapy did not hasten symptom resolution as compared to conservative treatment.
Evidence Rating Level: 2 (Good)
Study Rundown: Clinicians at Lackland Air Force base (AFB) observed that clusters of military trainees were suffering from lymphedema of both legs, a condition that presented with redness and swelling of the limbs. After treating multiple patients who presented with similar histories of acute onset inflammation soon after arriving at AFB in perfect health, it prompted these authors to investigate how common this disease entity was amongst AFB trainees and to identify possible risk factors. Fifty-five new trainees (0.4%) developed the condition of which 98% developed the symptoms within the first 120 hours of training. Vaccines and newly issued military footwear were deemed unlikely risk factors for disease, as alterations in the timing of these factors had no effect on incidence of new cases. The large cohort strengthened the reported findings; however, the observational design had inherent limitations, which may have been more sensitive to identify possible risk factors.
Click to read the study in JAMA Dermatology
Relevant Reading: Medical problems in the trenches
In-Depth [prospective cohort]: Participants included the 14,243 AFB trainees who had initiated training at Lackland AFB in San Antonio, Texas between September 2011 and January 2012. Triage nurses were instructed to identify those who developed suspicious symptoms. For a subset of this time, scheduled vaccinations were delayed by 1 week for new trainees. Also, trainees were instructed to wear athletic shoes other than military footwear. The majority of cases were diagnosed in men (52 of 55 or 95%). Ninety-eight percent of trainees experienced symptom onset within the first processing week. Military footwear was not found to affect incidence, as 27% of the 55 cases were diagnosed in the subset of patients who were instructed not to wear military footwear. Similarly, delayed administration of immunizations did not change incidence, as at least 4% of cases were diagnosed before receiving vaccination shots. Patients who received anti-microbial therapy had no major difference in mean time to symptom resolution as compared to those who did not (5.7 days vs. 5.5 days, p= .34). Future studies may be needed to further elucidate the cause of this disease entity in new AFB trainees.
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