Winning Abstracts from the 2008 Medical Student Abstract Competition: “Spam Disease”: A Chronic Cutaneous Disease Linked To A Remote Island In Chuuk, Fsm And Associated With Swimming In World War II Era Bomb Craters And Working In Taro Fields.
Author: Gloria Tumbaga, University of Hawaii, JABSOM
Introduction
Since World War II, residents of Satowan (population 650), a remote outer island in Chuuk, FSM have noted a high prevalence of a chronic, progressive, skin disease known locally as “spam disease” due to a resemblance to the popular food product. A Satowanese patient with this condition had previously been diagnosed in Portland, Oregon with culture positive Mycobacterium marinum. He had responded dramatically to treatment with doxycycline.
Methods
We traveled to Satowan to investigate this disease and invited all island residents to be evaluated. Suspect cases of “spam disease” were defined as patients with chronic, progressive verrucous or keloidal plaques on the extremities. Punch biopsies were obtained on several suspect cases for mycobacterial culture and histopathology. A case control study was performed using suspect cases and randomly selected controls. All suspect cases were treated with antibiotics (doxycycline or doxycycline + rifampicin or azithromycin).
Results
We examined 45 persons, identified 39 case-patients, and enrolled 98 controls. Case-patients and controls were similar with regard to age (median age 26.0 vs. 23.0 respectively, p=0.14), but control patients were more likely female (53.1%) vs. cases (25.6%) [p Mean disease duration was 12.5 years (range 3 months to 53 years). All tissue cultures (n=19) were negative for mycobacteria but PCR analysis revealed non-tuberculosis mycobacteria in 2 out of 3 submitted specimens. Histopathologic sections (n=9) showed epidermal and follicular hyperplasia with dense neutrophilic and epitheloid histiocytic infiltrate and dermal fibrosis, a pattern typical of mycobacterial and fungal infections. AFB and PAS staining was negative in all. All cases were taro farmers (OR undefined p Cases were no more likely to have affected family members than controls (OR 1.04, p=0.93).
Conclusion
“Spam” disease" is a chronic skin infection with high prevalence on Satowan, Chuuk, FSM. It is associated with taro farming and swimming in World War II era bomb craters. Histopathology and PCR analysis suggest that it is likely due to M. marinum infection.
Match Day 2012: An Exciting Experience
Go behind the scenes at Match Day 2012 at The Perelman School of Medicine at the University of Pennsylvania and hear Dr. Katrina Armstrong, Chief of the Internal Medicine Division at Penn Medicine describe being part of the Match Day experience.
Students: Join ACP for Free
Benefits of Membership for Students: ACP's free Medical Student Membership includes benefits designed especially to meet students' needs.
Join Now: Sign-up today and begin enjoying the benefits of ACP Medical Student Membership.
Find a Residency
Search ACP's Internal Medicine Residency Database for information on all internal medicine residency programs in the U.S. and Canada. (ACP Members only)
Share this article
Earn MOC Points for Medical Knowledge
ACP offers its members many ways to earn ABIM MOC points for Medical Knowledge and to make the process easier. See our MOC Timeline Page for details.
Ceramic Bistro-Style ACP Mug
Enjoy your morning brew and show your ACP spirit with our 15-ounce dishwasher- and microwave-safe mug. Enjoy free shipping within the continental U.S. |