Sequelae of World War II: An Outbreak of Chronic Cutaneous Nontuberculous Mycobacterial Infection among Satowanese Islanders

Joseph V. Lillis, Vernon E. Ansdell, Kino Ruben, Eric Simpson, Gloria Tumbaga, David Ansdell, Samuel Bremmer, Stephen E. Kurtz, Clifton White, Andrew Blauvelt, Kevin Winthrop

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background. After World War II, residents of Satowan (population, 650 persons), an outer island in the state of Chuuk, Federated States of Micronesia, noted a high prevalence of a chronic, progressive skin disease known locally as "spam." Methods. Island residents who had chronic, progressive verrucous or keloidal plaques for >3 months were considered case patients. Tissue specimens were obtained for culture, histopathological analysis, mycobacterial polymerase chain reaction (PCR), and comparison with the hsp65 gene of Mycobacterium marinum. We performed a case-control study involving all cases and randomly selected control individuals from the community. Results. A total of 39 case patients were identified, with a median age of 26.0 years (range, 8-82 years); 74.4% were male, and the mean duration of disease was 12.5 years. A total of 98 control individuals were enrolled. Results of all 19 mycobacterial tissue cultures were negative, and histopathological analysis of all 9 lesions showed suppurative granulomatous inflammation with negative results of mycobacterial and fungal stains. In 7 of 9 paraffin- embedded samples, nontuberculous mycobacterial DNA was detected by PCR, and 2 sequenced products had 95% and 87% identity to M. marinum. All case patients were taro farmers (odds ratio, undefined; P<.01), and among taro farmers, when the analysis was controlled for sex, contact with water-filled World War II-era bomb craters was associated with infection (odds ratio, 8.2; P<.01). Conclusions. "Spam disease" is a chronic, progressive skin disease of high prevalence on Satowan and is associated with taro farming and contact with World War II-era bomb craters. Histopathological and PCR data demonstrate a nontuberculous mycobacterial infection as the cause.

Original languageEnglish (US)
Pages (from-to)1541-1546
Number of pages6
JournalClinical Infectious Diseases
Volume48
Issue number11
DOIs
StatePublished - Jun 1 2009

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Colocasia
World War II
Mycobacterium marinum
Bombs
Disease Outbreaks
Skin Diseases
Islands
Polymerase Chain Reaction
Skin
Infection
Micronesia
Odds Ratio
Agriculture
Paraffin
Case-Control Studies
Coloring Agents
Inflammation
Water
DNA
Population

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)
  • Medicine(all)

Cite this

Sequelae of World War II : An Outbreak of Chronic Cutaneous Nontuberculous Mycobacterial Infection among Satowanese Islanders. / Lillis, Joseph V.; Ansdell, Vernon E.; Ruben, Kino; Simpson, Eric; Tumbaga, Gloria; Ansdell, David; Bremmer, Samuel; Kurtz, Stephen E.; White, Clifton; Blauvelt, Andrew; Winthrop, Kevin.

In: Clinical Infectious Diseases, Vol. 48, No. 11, 01.06.2009, p. 1541-1546.

Research output: Contribution to journalArticle

Lillis, Joseph V. ; Ansdell, Vernon E. ; Ruben, Kino ; Simpson, Eric ; Tumbaga, Gloria ; Ansdell, David ; Bremmer, Samuel ; Kurtz, Stephen E. ; White, Clifton ; Blauvelt, Andrew ; Winthrop, Kevin. / Sequelae of World War II : An Outbreak of Chronic Cutaneous Nontuberculous Mycobacterial Infection among Satowanese Islanders. In: Clinical Infectious Diseases. 2009 ; Vol. 48, No. 11. pp. 1541-1546.
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abstract = "Background. After World War II, residents of Satowan (population, 650 persons), an outer island in the state of Chuuk, Federated States of Micronesia, noted a high prevalence of a chronic, progressive skin disease known locally as {"}spam.{"} Methods. Island residents who had chronic, progressive verrucous or keloidal plaques for >3 months were considered case patients. Tissue specimens were obtained for culture, histopathological analysis, mycobacterial polymerase chain reaction (PCR), and comparison with the hsp65 gene of Mycobacterium marinum. We performed a case-control study involving all cases and randomly selected control individuals from the community. Results. A total of 39 case patients were identified, with a median age of 26.0 years (range, 8-82 years); 74.4{\%} were male, and the mean duration of disease was 12.5 years. A total of 98 control individuals were enrolled. Results of all 19 mycobacterial tissue cultures were negative, and histopathological analysis of all 9 lesions showed suppurative granulomatous inflammation with negative results of mycobacterial and fungal stains. In 7 of 9 paraffin- embedded samples, nontuberculous mycobacterial DNA was detected by PCR, and 2 sequenced products had 95{\%} and 87{\%} identity to M. marinum. All case patients were taro farmers (odds ratio, undefined; P<.01), and among taro farmers, when the analysis was controlled for sex, contact with water-filled World War II-era bomb craters was associated with infection (odds ratio, 8.2; P<.01). Conclusions. {"}Spam disease{"} is a chronic, progressive skin disease of high prevalence on Satowan and is associated with taro farming and contact with World War II-era bomb craters. Histopathological and PCR data demonstrate a nontuberculous mycobacterial infection as the cause.",
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T2 - An Outbreak of Chronic Cutaneous Nontuberculous Mycobacterial Infection among Satowanese Islanders

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AU - Ansdell, Vernon E.

AU - Ruben, Kino

AU - Simpson, Eric

AU - Tumbaga, Gloria

AU - Ansdell, David

AU - Bremmer, Samuel

AU - Kurtz, Stephen E.

AU - White, Clifton

AU - Blauvelt, Andrew

AU - Winthrop, Kevin

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N2 - Background. After World War II, residents of Satowan (population, 650 persons), an outer island in the state of Chuuk, Federated States of Micronesia, noted a high prevalence of a chronic, progressive skin disease known locally as "spam." Methods. Island residents who had chronic, progressive verrucous or keloidal plaques for >3 months were considered case patients. Tissue specimens were obtained for culture, histopathological analysis, mycobacterial polymerase chain reaction (PCR), and comparison with the hsp65 gene of Mycobacterium marinum. We performed a case-control study involving all cases and randomly selected control individuals from the community. Results. A total of 39 case patients were identified, with a median age of 26.0 years (range, 8-82 years); 74.4% were male, and the mean duration of disease was 12.5 years. A total of 98 control individuals were enrolled. Results of all 19 mycobacterial tissue cultures were negative, and histopathological analysis of all 9 lesions showed suppurative granulomatous inflammation with negative results of mycobacterial and fungal stains. In 7 of 9 paraffin- embedded samples, nontuberculous mycobacterial DNA was detected by PCR, and 2 sequenced products had 95% and 87% identity to M. marinum. All case patients were taro farmers (odds ratio, undefined; P<.01), and among taro farmers, when the analysis was controlled for sex, contact with water-filled World War II-era bomb craters was associated with infection (odds ratio, 8.2; P<.01). Conclusions. "Spam disease" is a chronic, progressive skin disease of high prevalence on Satowan and is associated with taro farming and contact with World War II-era bomb craters. Histopathological and PCR data demonstrate a nontuberculous mycobacterial infection as the cause.

AB - Background. After World War II, residents of Satowan (population, 650 persons), an outer island in the state of Chuuk, Federated States of Micronesia, noted a high prevalence of a chronic, progressive skin disease known locally as "spam." Methods. Island residents who had chronic, progressive verrucous or keloidal plaques for >3 months were considered case patients. Tissue specimens were obtained for culture, histopathological analysis, mycobacterial polymerase chain reaction (PCR), and comparison with the hsp65 gene of Mycobacterium marinum. We performed a case-control study involving all cases and randomly selected control individuals from the community. Results. A total of 39 case patients were identified, with a median age of 26.0 years (range, 8-82 years); 74.4% were male, and the mean duration of disease was 12.5 years. A total of 98 control individuals were enrolled. Results of all 19 mycobacterial tissue cultures were negative, and histopathological analysis of all 9 lesions showed suppurative granulomatous inflammation with negative results of mycobacterial and fungal stains. In 7 of 9 paraffin- embedded samples, nontuberculous mycobacterial DNA was detected by PCR, and 2 sequenced products had 95% and 87% identity to M. marinum. All case patients were taro farmers (odds ratio, undefined; P<.01), and among taro farmers, when the analysis was controlled for sex, contact with water-filled World War II-era bomb craters was associated with infection (odds ratio, 8.2; P<.01). Conclusions. "Spam disease" is a chronic, progressive skin disease of high prevalence on Satowan and is associated with taro farming and contact with World War II-era bomb craters. Histopathological and PCR data demonstrate a nontuberculous mycobacterial infection as the cause.

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