This is the story about finding and preventing a new disease This is the story about finding and preventing a new disease. Almost all diseases of man have been found, this was a new disease that potentially had serious consequences, but its cause was found, and a major catastrophe was averted. I read about toxic oil syndrome about 10 years. It was first described by a pediatrician in the 1980. It was a brand new, and scary entity as it affected thousands of people. Brilliant epidemiologic work tied together with basic immunologic and toxicologic research lead to the identification of its cause, which lead to its prevention.This, however, is not the complete story as even more interesting findings have come forth. The late consequences of the disease appear to be an autoimmune rheumatologic condition. The story is coming forth that we have identified a toxic agent which interacts with host susceptibility (Human Leukocyte Antigens: HLA Markers) to produce disease. Thus from basic shoe leather epidemiologic studies, a new disease was identified. Linking the basic epidemiology with host susceptibility produces a fascinating picture into the etiology of this condition, and in fact many other HLA associated autoimmune diseases. TOXIC OIL SYNDROME RESEARCH CENTER (CISAT) PowerPoint file of this lecture - http://www.pitt.edu/~super7/0011-1001/0062.ppt

If you were seeing a patient with these symptoms what would you suspect? It was identified in the New England Journal of Medicine as a new disease, but what could have caused it? Initially it was thought that it was infectious. The disease suddenly appeared during Easter, 1981, affecting thousands of people, then was gone within weeks.

The striking immunologic features clearly indicated abnormalities, but were non-specific. Nothing pointed to what the agent might be.

Evaluation of evidence for an infectious agent is done by examining the disease population to see if the patterns of disease match that of known infections. It is also done within individuals to find antibodies to known agents.

This is from the MMWR in 1981 showing the outbreak This is from the MMWR in 1981 showing the outbreak. It did not look like an infectious disease pattern. The disease clustered in houses, there was the suspicion that it was a food outbreak, but microbiologic, serologic and pathologic studies did not indicate that it was food.

Case series, however with no control groups provide poor estimates of effect. It is important therefore to establish some type of case control study. There were still bottles of oil left. When analyzed, analyses appeared a high concentration. A pediatrician noticed that only one very young child developed the disease. This child was not breast-fed and ate the oil at very young age. This suggest the oil was related to disease.

There has been 4 case referent studies There has been 4 case referent studies. All of them have been consistent where the cases were much more likely to eat the oil than the controls.

The patterns of the disease changed dramatically over time The patterns of the disease changed dramatically over time. There appeared to be an acute phase and a chronic phase. This is characteristic of very auto immune disease.

The problem was not only with the early symptoms The problem was not only with the early symptoms. Some individuals appeared to go on to a much more severe course.

Only a small proportion went on to the late states of disease Only a small proportion went on to the late states of disease. It is of interest that the late stages have many of the characteristics of an autoimmune disease. At this stage the skin manifestations are often scleroderma-like.

There was a surprisingly very strong association to the end stages of disease, but not the initial manifestions. This indicates that there are only a few who are susceptible to go on to the apparent autoimmune characteristics of the disease.