title: Sequelae of World War II: an outbreak of chronic cutaneous nontuberculous mycobacterial infection among Satowanese islanders.
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.
authors.affiliation: Department of Dermatology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA. jlillis01@gmail.com
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Lillis
authors.forename: Vernon E
authors.initials: VE
authors.lastname: Ansdell
authors.forename: Kino
authors.initials: K
authors.lastname: Ruben
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
authors.forename: Gloria
authors.initials: G
authors.lastname: Tumbaga
authors.forename: David
authors.initials: D
authors.lastname: Ansdell
authors.forename: Samuel
authors.initials: S
authors.lastname: Bremmer
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kurtz
authors.forename: Clifton R
authors.initials: CR
authors.lastname: White
authors.forename: Andrew
authors.initials: A
authors.lastname: Blauvelt
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Winthrop
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000383:Agriculture; D002648:Child; D004196:Disease Outbreaks; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D019910:Mycobacterium marinum / Q000235:genetics / Q000302:isolation & purification*; D017422:Sequence Analysis, DNA; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D055815:Young Adult