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.
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