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Abstract
Pigbel has been recognized as a major cause of morbidity and mortality in the Papua New Guinea highlands for over 20 years.2 The pathological changes in the intestine characteristic of the disease3 are produced by the B toxin of Clostridium perfringens type C.4 5 6 This organism is ubiquitous in the highlands village environment and is found in the feces of over 70 per cent of normal villagers.7 The disease occurs predominantly in children because of poor immunity to B toxin and a low level of intestinal proteases.4, 5, 8 The latter is the result of a diet low in protein, consisting predominantly of sweet potato (Ipomoea batatas), which also contains trypsin inhibitors.Some reports suggest a role for antitoxin in the management of pigbel.1, 10, 11 However, a controlled trial showed no benefit from this treatment.12 This is not surprising since the intestinal damage from B toxin occurs early, at the time of rapid growth of C. perfringens .6 The symptoms are often delayed for up to several days, until intestinal obstruction occurs.M. W. Davis F.R.A.C.P. Robert M. Kliegman M.D. Avory A. Fanaroff M.D. Institute of Medical Research, Papua New Guinea Case Western Reserve University School of Medicine, Cleveland, OH 44106