Defect in plasma clearance of bromsulphthalein in Papua New Guineans with systemic infections.

One hundred and one Papua New Guineans, most of whom had systemic infections, received 5 mg kg body-weight-1 bromsulphthalein (BSP) intravenously after an overnight fast; serial venous blood BSP concentrations were measured for up to 2 hours. Many of those with infections had a reduction in plasma BSP disappearance rate and 30-minute retention. However, 15 per cent of 86 with infection had a secondary rise in plasma BSP concentration after 30 minutes, and in those followed serially a secondary peak was observed; that returned to normal after treatment and was not seen in 12 who were free of infection. Liver-biopsy specimens taken from four who had that defect in clearance did ot show Dubin-Johnson pigment. BSP curves with an exactly similar secondary rise after 30 minutes have previously been considered specific for the Dubin-Johnson syndrome, which is probably inherited as a Mendelian recessive; it seems possible that in the present study systemic infections have exposed the forme fruste of the condition. The present finding might explain some cases of jaundice associated with systemic infection commonly seen in Papua New Guinea. It might explain some toxic therapeutic reactions, because plasma concentrations of agents excreted in bile are likely to be abnormally elevated. If this abnormality in excretion proves to have a genetic basis it might prove valuable in mapping gene dispersal in South-east Asia and the Pacific.