Arthritis in the highlands of Papua New Guinea.

Acute polyarthritis is an important cause of morbidity in many tropical countries. Classification has often been difficult, with the term tropical polyarthritis used for those in whom a diagnosis could not be made. The implication that this is a distinct entity is probably incorrect, with likely causes being septic arthritis or post-infective reactive arthritis. This study aimed to determine the types of arthritis found in 43 patients (30 men) presenting consecutively to the Goroka Base Hospital in the Eastern Highlands of Papua New Guinea. Gonococcal arthritis was diagnosed in eight patients (six men) on the basis of isolation of Neisseria gonorrhoeae from the joint aspirate. In all cases the N gonorrhoeae was identified by the closed culture system on chocolate agar, but not always by routine plating. There were no specific clinical features that identified patients with a gonococcal septic arthritis. The remaining 34 patients had an undifferentiated oligoarthritis. The pattern of arthritis in men and women was of a lower limb pauciarticular arthritis with a predilection for the knee and ankle joints. A total of 30% of male patients had a history of urethral discharge and 44% of all patients had preceding diarrhoea. Arthritis was the only feature in 59% of patients and in 32% there was an associated enthesitis. In this study most patients had an oligoarthritis consistent with a reactive arthritis or a septic arthritis due to N gonorrhoeae. Broth inoculation of synovial fluid was the best method to isolate N gonorrhoeae, with standard methods for gonococcal isolation failing in some patients. It is recommended that the term 'tropical polyarthritis' is no longer used as it does not refer to a specific entity but consists of several known arthritides.

HLA-B27, arthritis and spondylitis in an isolated community in Papua New Guinea.

Rheumatic complaints in a sample of 109 individuals from an isolated community in Papua New Guinea were documented and 92/109 were tissue typed for HLA-B27. Eleven (10.1%) subjects had active peripheral arthritis, but 38 (34.9%) had previously suffered an episode of arthritis. In those with current peripheral arthritis, 6/10 (60%) were HLA-B27 positive compared to 15/58 (25.9%) with no history of arthritis (P less than 0.05). In total, 16/34 (47.1%) with either current or a previous history of peripheral arthritis were HLA-B27 positive compared to the 15/58 (25.9%) with no history of arthritis (P less than 0.05). Back pain was common. In 84/109 individuals the cause was mechanical injury; 24/72 (33.3%) of these were HLA-B27 positive. Ankylosing spondylitis was identified in one HLA-B27-negative woman.

Evaluation in Papua New Guinea of a urine coagglutination test and a Widal slide agglutination test for rapid diagnosis of typhoid fever.

Two simple rapid tests for the laboratory diagnosis of typhoid fever were evaluated, a coagglutination test for detecting Salmonella typhi antigens in urine and a Widal slide agglutination for detecting serum antibodies. Ninety-two culture-confirmed typhoid cases were compared with 64 non-typhoid fever patients, 50 close contacts of typhoid patients, 30 vaccinated staff and 72 healthy community members. A strong urine Vi coagglutination was found to be 86.5% sensitive and 91.8% specific for typhoid, but was not always easy to read. The slide Widal H was found to be 99% sensitive and 95% specific whereas the slide Widal O was 98% sensitive and 98% specific. These data suggest that a single slide Widal O, at a reciprocal titre of 40, is the most suitable rapid test for the diagnosis of typhoid in a population with low typhoid antibody levels in the community, few other cross-reacting Salmonella infections, and a tendency for patients to present late in the infection.

Fibrocalculous pancreatic diabetes in Papua New Guinea.

While fibrocalculous pancreatic diabetes (FCPD) has long been recognized in neighboring Indonesia, there has been only one single case reported from Papua New Guinea. Over an eighteen month period, four new cases of FCPD were seen at this hospital, making FCPD the predominant form of diabetes seen in Papua New Guinea highlanders. Abdominal pain was prominent in only one patient. Cassava formed a small part of the diet of all patients. Control with tolbutamide alone was possible in two patients and the addition of a small dose of isophane insulin gave satisfactory control in the other two. Two patients were particularly sensitive to low doses of insulin.

Childhood phaeochromocytoma--two cases.

The clinical features and management of two cases of phaeochromocytoma in childhood are described, with emphasis on the diagnostic value of ultrasonography.