Sago haemolytic disease: towards understanding a novel food-borne toxicosis

Sago haemolytic disease is a rare but sometimes fatal disease found primarily in the coastal regions of Papua New Guinea and among groups in which sago is a primary source of carbohydrate. It has been known since 1961 and fungi consistently have been suspected of being involved. Investigations carried out on stored sago and samples recovered from poisoning episodes have failed to indicate the consistent presence of mycotoxins. However, fungi (especially Aspergillus, Fusarium, Penicillium, Trichoderma) with strong haemolytic activity have been associated with sago, particularly when stored in open-weave baskets and sago-leaf-wrapped bundles. The haemolytic activity has been attributed to fatty acids (principally oleic, palmitic, linoleic) contained primarily in the fungal hyphae. It is hypothesized that when these acids are released through hyphal breakdown during digestion and are present in individuals with a low serum albumin level, free fatty acid excess occurs resulting in red cell membrane destruction and intravascular haemolysis. In extreme cases, blood transfusion is required. Methods of storage providing high levels of access to oxygen favour the development of fungi: eg, leaf-encased bundles and open-weave storage favour growth over that seen in starch stored under water, such as in earthen vessels. Ensuring storage does not exceed 3-4 weeks, encouraging anaerobic conditions of the starch and maintaining protein nutrition in communities where sago is relied upon should alleviate outbreak episodes.

Melioidosis--an uncommon but also under-recognized cause of pneumonia in Papua New Guinea

Melioidosis is being increasingly recognized as an important cause of severe, acute community-acquired pneumonia in various tropical regions. The chronic form of melioidosis can also mimic tuberculosis. Studies have established that, while uncommon in the Port Moresby region, melioidosis is an important cause of pneumonia and sepsis in the Balimo region of Western Province. Phylogenetic analyses of strains of Burkholderia pseudomallei from Papua New Guinea have shown them to be more closely related to strains of B. pseudomallei from Australia than to strains from Southeast Asia. This is consistent with the proposed origins of B. pseudomallei in Australia, with subsequent spread out of Australia to Southeast Asia during the last ice age. Further surveillance across Papua New Guinea is likely to unmask other locations where B. pseudomallei occurs in the environment and where melioidosis is currently not being diagnosed.