10th Aeromedical Squadron, US Air Force Academy, Colorado Springs, Colorado.
US Air Force Medical Support Agency, San Antonio, Texas.
JAMA Dermatol. 2015 Apr;151(4):395-400. doi: 10.1001/jamadermatol.2014.3794.
This observational study characterizes a new clinical condition identified in 55 military trainees.
To determine the incidence and underlying cause of bilateral lower extremity inflammatory lymphedema in Air Force basic trainees.
DESIGN, SETTING, AND PARTICIPANTS: An observational study was conducted at Lackland Air Force Base in San Antonio, Texas. Participants included 14 243 Air Force basic trainees who entered training between September 2011 and January 2012 and the 55 trainees (0.4%) who developed bilateral lower extremity inflammatory lymphedema that occurred during the 8½-week basic training course. Two modifiable risk factors were evaluated: vaccine reaction and newly issued military footwear (combat boots and boot socks).
During November 2011, all new trainees wore only white socks and running shoes rather than the issued military footwear. During December 2011 and January 2012, the scheduled administration of tetanus/diphtheria/acellular pertussis and meningococcal vaccines, respectively, was delayed by 1 week for all new trainees. A full medical record review was conducted for every confirmed case of bilateral lower extremity inflammatory lymphedema.
Identification of incident cases, symptom onset, antimicrobial treatment, immunization reaction, laboratory studies, specialty referral, and biopsy.
Fifty-four of the 55 incident cases (98%) of bilateral lower extremity inflammatory lymphedema occurred during the first 120 hours of training. Alterations in the timing of the military footwear used and selected vaccine administration had no effect on the incidence of new cases. Two participants (4%) experienced symptom onset before receipt of the vaccines. Oral antimicrobial medications were not found to speed symptom resolution compared with conservative treatment measures (P = .34). One incident case was diagnosed as leukocytoclastic vasculitis by tissue examination.
Multiple training-related risk factors were ruled out as sources of bilateral lower extremity inflammatory lymphedema. Cases are likely secondary to prolonged standing with resultant gravity-dependent venous congestion and inflammatory vasculitis. The potential roles of undiagnosed venous reflux disease and the military physical training environment in these cases remain to be elucidated.
本观察性研究描述了在 55 名军事受训人员中发现的一种新的临床病症。
确定空军基础受训人员中双侧下肢炎症性淋巴水肿的发生率和根本原因。
设计、地点和参与者：在德克萨斯州圣安东尼奥的拉克兰空军基地进行了一项观察性研究。参与者包括 2011 年 9 月至 2012 年 1 月期间入训的 14243 名空军基础受训人员，以及在 8 周半的基础训练课程中发生双侧下肢炎症性淋巴水肿的 55 名受训人员（0.4%）。评估了两个可改变的危险因素：疫苗反应和新发放的军用鞋（作战靴和靴袜）。
2011 年 11 月，所有新兵只穿白色袜子和跑鞋，而不是发放的军用鞋。2011 年 12 月和 2012 年 1 月，分别为所有新兵推迟了 1 周接种破伤风/白喉/无细胞百日咳和脑膜炎球菌疫苗。对每例双侧下肢炎症性淋巴水肿的确诊病例进行了全面的病历回顾。
确定发病病例、症状发作、抗菌治疗、免疫反应、实验室研究、专科转诊和活检。
55 例双侧下肢炎症性淋巴水肿的发病病例（98%）中有 54 例发生在训练的前 120 小时内。改变使用军用鞋的时间和选择疫苗接种时间对新发病例的发生率没有影响。有 2 名（4%）参与者在接种疫苗前出现症状。与保守治疗措施相比，口服抗菌药物并没有加快症状缓解（P =.34）。1 例发病病例经组织检查诊断为白细胞碎裂性血管炎。
排除了多个与训练相关的危险因素是双侧下肢炎症性淋巴水肿的原因。这些病例可能继发于长时间站立引起的重力依赖性静脉充血和炎症性血管炎。静脉反流性疾病和军事体能训练环境在这些病例中的潜在作用仍有待阐明。
