TY - JOUR
T1 - Sequelae of World War II
T2 - An Outbreak of Chronic Cutaneous Nontuberculous Mycobacterial Infection among Satowanese Islanders
AU - Lillis, Joseph V.
AU - Ansdell, Vernon E.
AU - Ruben, Kino
AU - Simpson, Eric L.
AU - Tumbaga, Gloria
AU - Ansdell, David
AU - Bremmer, Samuel
AU - Kurtz, Stephen E.
AU - White, Clifton R.
AU - Blauvelt, Andrew
AU - Winthrop, Kevin L.
N1 - Funding Information:
Financial support. K.L.W.’s work was funded by the Agency for Healthcare Research and Quality (grant 1K08HS017552-01). Potential conflicts of interest. All authors: no conflicts.
PY - 2009/6/1
Y1 - 2009/6/1
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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U2 - 10.1086/598928
DO - 10.1086/598928
M3 - Article
C2 - 19405866
AN - SCOPUS:66949140094
SN - 1058-4838
VL - 48
SP - 1541
EP - 1546
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -