Viral hepatitis and liver cancer on the Island of Guam.

Patient records from the Guam Cancer Registry were compared with patients listed in a health department viral hepatitis case registry and the numbers of liver cancer and viral hepatitis cases were compared by ethnicity. Hepatitis C was the form of viral hepatitis most common among liver cancer cases on Guam (63.3% of viral hepatitis-associated liver cancer cases). Since viral hepatitis is an important cause of liver cancer, studies such as the present one may provide the information necessary to establish programs (screening of populations at risk and infant vaccination in the case of hepatitis B, for example) that may lessen the impact of liver cancer in the future.

Familial nature and continuing morbidity of the amyotrophic lateral sclerosis-parkinsonism dementia complex of Guam.

Chamorros suffer from two neurologic syndromes known as ALS and the parkinsonism-dementia complex (PDC) of Guam. We report mortality figures for these syndromes during 1991 to 1995 and compare them with those at 5-year intervals dating back to 1951. In contrast to predictions of disease disappearance, both syndromes remain prevalent. However, age of onset and age at death have increased for both syndromes, suggesting that shifting environmental factors are causing disease postponement. We also report the clinical, familial, neuropathologic, and immunohistochemical findings on a consecutive autopsy series of Guamanian Chamorro cases. Twelve cases were diagnosed as PDC, known locally as "bodig," and three as ALS, known locally as "lytico." All but three of these fifteen patients had a pronounced family history of similar illness. Eight of twelve boding patients had siblings who were also affected with bodig; two of three lytico cases had siblings afflicted with lytico. The family histories are compatible with genetic transmission of each syndrome. The neuropathology of bodig is characterized by severe and widespread neurofibrillary tangle (NFT) development. NFTs are surrounded by reactive microglia and reactive astrocytes, and complement proteins and other molecules connected with inflammation are associated with them. Similar inflammatory responses also occur in Alzheimer's disease (AD) but have been largely attributed to the presence of senile plaques. These data indicate that tangles, as well as plaques, generate inflammatory reactions that such reactions may exacerbate the fundamental pathology in bodig as well as in AD.

Infant salmonellosis and vacuum cleaners.

Microbiological examination of the contents of vacuum cleaner bags collected from case and control homes demonstrated a statistically significant association (OR = 3.13, CL = 1.32-7.50) between infant salmonellosis cases and Salmonella contamination of the vacuums used in their homes. This suggests that some cases of infant salmonellosis may result from contact with contamination in the home environment and that steps taken to protect infants from potentially contaminated dust or dust aerosols may reduce the risk of contracting this infection.

The origin of non-outbreak Vibrio parahaemolyticus infections on Guam.

A study of Vibrio parahaemolyticus infected patients not associated with known outbreaks and controls matched for sex, ethnicity and age (+/- 5 years) was conducted on Guam. Cases were asked if they had eaten seafood within the 24-hour period preceding onset of illness and controls were asked if they had eaten seafood within the 24-hour period preceding their interview. Cases were more likely than controls to have eaten seafood (OR = 37.59, CL [8.30-220.24]).

Are the endemic motor neuron diseases of Guam really disappearing?

Death certificates were reviewed to observe trends in the number of persons on Guam reported to have chronic degenerative motor neuron diseases (amyotrophic lateral sclerosis, parkinsonism-dementia or Parkinson's disease) at the time of death. Additional data, including age and race of the deceased and the name of the certifying physician were also collected. The number of persons having been diagnosed with amyotrophic lateral sclerosis is apparently decreasing while their mean age is increasing suggesting that the etiologic agents or factors causing this disease are less prevalent on Guam today than they have been in the past. Trends with regard to parkinsonism-dementia and Parkinson's disease are less clear.

Infant diet and salmonellosis.

BACKGROUND: The Island of Guam has experienced a high incidence of infant salmonellosis for a number of years (age-specific incidence rate of approximately 3700 cases per 100,000 infants in 1984). Interviews of case parents suggested that the use of high-iron infant formula was associated with this problem. METHODS: A case-control study was conducted to test this hypothesis. Information on feeding practices and a variety of medical and socioeconomic factors was collected for 78 laboratory-confirmed Salmonella-case infants and 167 control infants. RESULTS: Case infants were less likely to have been breast-fed (odds ratio [OR] = 9.15; 95% confidence interval [CI] = 2.71-30.9) and more likely to have been fed infant formula with an iron content of 10 mg/L or greater (OR = 2.96; 95% CI = 1.24-7.08) than were control infants. CONCLUSIONS: Although the precise means by which infants are most commonly exposed to Salmonella bacteria remain obscure, breast-feeding apparently protects against the development of physician-diagnosed clinical salmonellosis, while the feeding of high-iron infant formula has the opposite effect.

Trabulsiella guamensis, a new genus and species of the family Enterobacteriaceae that resembles Salmonella subgroups 4 and 5.

In 1985 the vernacular name Enteric Group 90 was coined for a small group of strains that had been referred to our laboratory as probable strains of Salmonella but did not agglutinate in Salmonella typing antisera. By DNA-DNA hybridization (hydroxyapatite method, 32P), seven strains of Enteric Group 90 were found to be closely related (98 to 100% at 60 degrees C and 94 to 100% at 75 degrees C) to the first strain received (0370-85). The relatedness of Enteric Group 90 to 62 strains of other species of the family Enterobacteriaceae was only 6 to 41%, with the highest values obtained with strains of Salmonella, Kluyvera, Shigella, Klebsiella, Enterobacter, and Citrobacter. We propose a new genus, Trabulsiella, with a single new species, Trabulsiella guamensis, for the highly related group of eight strains formerly known as Enteric Group 90. The type strain is designated ATCC 49490 (CDC 0370-85). T. guamensis strains grew well at 36 degrees C and had positive reactions in the following tests: methyl red, citrate utilization (Simmons) (38% positive at day 1, 88% positive at 2 days), H2S production, lysine decarboxylase, arginine dihydrolase (50% positive at 2 days, 100% positive at 7 days), ornithine decarboxylase, motility, growth in KCN medium, mucate fermentation, acetate utilization, nitrate reduction to nitrite, weak tyrosine hydrolysis (88% positive at 2 days, 100% positive at 7 days), and ONPG (o-nitrophenyl-beta-D-galactopyranoside) test. The strains fermented D-glucose with gas production and fermented L-arabinose, cellobiose, D-galactose, D-galacturonate, maltose, D-mannitol, D-mannose, L-rhamnose, D-sorbitol, trehalose, and D-xylose. T. guamensis strains had negative reactions in the following tests: indole production (13% positive), Voges-Proskauer, urea hydrolysis, phenylalanine deaminase, malonate utilization, lipase (corn oil), DNase, oxidase, pigment production, and acid production from adonitol, D-arabitol, dulcitol, erythritol, myo-inositol, melibiose, alpha-methyl-D-glucoside, raffinose, and sucrose. There were delayed positive reactions for gelatin liquefaction (22 degrees C), which was positive at 12 to 23 days, esculin hydrolysis (13% positive at day 1, 50% positive at 7 days), lactose fermentation (13% positive at 3 to 7 days, 100% positive at 8 to 10 days), glycerol fermentation (88% positive at 7 days), and salicin fermentation (13% positive at day 1, 88% positive at 7 days). All strains were susceptible by the disk diffusion method to colistin, nalidixic acid, gentamicin, streptomycin, kanamycin, chloramphenicol, and trimethoprim-sulfamethoxazole, and most strains were susceptible to sulfadiazine (75% susceptible), tetracycline (88%), and carbenicillin (75%). The strains were resistant to penicillin, cephalothin, and ampicillin. The strains were isolated from vacuum cleaner dust (five strains), soil (one strain), and human feces (two strains). Although T. guamensis can occur in human diarrheal stools, there is no evidence that it actually causes diarrhea. Its main interest to clinical microbiologists may be its possible misidentification as a strain Salmonella.

Observations on the ecology of Salmonella waycross and Salmonella typhimurium on Guam.

A period of high incidence of human Salmonella infections on the island of Guam saw the emergence of S. waycross as the most commonly isolated serotype as well as a concurrent decreasing proportion of isolates due to S. typhimurium. Predation of local rodents by an introduced snake is believed to account for the decreased prevalence of S. typhimurium infections, but reasons for the increased prevalence of S. waycross infections are unknown.

Risks to infants on Guam from bites of the brown tree snake (Boiga irregularis).

The brown tree snake, Boiga irregularis, is abundant on Guam and commonly invades human habitations. Data on emergency room visits on Guam document a high frequency of snakebites on Guam. Over 50% of the emergency room visits for snakebite involved children less than 4 years old. Records exist of 4 infants, 1, 2, 5, and 10 months old, who displayed significant symptoms after being bitten, while sleeping, by snakes. Two infants developed respiratory problems within a few hours and required medical treatment for asphyxiation. Lethargy, diminished sensory perceptions, drooping eyelids, swelling, discoloration, and bleb formation were variable in occurrence in the patients.

A search for infant salmonellosis risk factors on Guam.

A study was conducted in the hope of identifying risk factors associated with a 10-year epidemic of salmonellosis among infants on Guam. Salmonella bacteria were found in soil and vacuum cleaner samples suggesting that Salmonella infections may result from contamination introduced into homes from the outdoor environment by mechanical means rather than by the ingestion of contaminated animal-origin foods.

NAG Vibrio cholerae isolated from imported shellfish in Guam.

A survey of imported shellfish available in public markets on the Island of Guam revealed the presence of NAG Vibrio cholerae contamination (10 of 38 sample lots positive) and high coliform counts (21 of 33 sample lots in excess of 2400 per 100 grams). NAG V. cholerae contamination was associated with high coliform counts and origin in fresh or brackish waters rather than saltwater. Further importation of fresh shellfish from other than approved sources was prohibited.

Salmonella isolation experience in the Pacific Basin region: a survey.

To determine if the unusually high incidence of salmonellosis reported on Guam for several years might be the result of more frequent bacteriologic examination of gastroenteritis/diarrhoea patient stool specimens, a survey of medical clinic and laboratory activities was undertaken among countries in the Pacific Basin Area. Survey results suggest that while Guam laboratories may be particularly proficient in isolating Salmonella organisms, the quantity of stool specimens examined could not account for the higher incidence of salmonellosis observed on the island.

Salmonella surveillance in Guam.

A high incidence of human Salmonella infections (66/100,000 population for 1978) is reported for the island of Guam in Micronesia. S. waycross, a relatively rare serotype in other areas of the world and first isolated on Guam in 1974, accounted for 39% of all serotyped isolates from human cases in 1978. The possibility of this organism being introduced in imported products is discussed.