Hip disease of Mseleni.

Mseleni in Northern Zululand is a remote geographically isolated improverished district in which about 2,000 persons suffer from a crippling joint disease similar to dysplasia epiphysealis multiplex and spondyloepiphyseal dysplasia. Eleven per cent of the men and 39% of the women in young adult life are seriously disabled and, with concurrent osteoarthritis, 90% of the population are grossly incapacitated in old age. Affected and unaffected control areas have been compared. Analysis of the climate, dietary factors, social taboos and soil and water does not implicate these as causes. Genetic studies, despite considerable field work, sociological surveys and laboratory investigations have not provided the answer. Despite a high incidence in the Mseleni area no disturbance of blood group percentages could be determined. The disease had dissimilarities from Kashin Beck disease in which fusarium fungus allegedly causes small joint polyarthritis. Fusarium sporotrichiella has not been grown in subtropical Zululand and thus could not be a causative agent. Mseleni disease also differs from Handigodu disease in Karnataka India, in which the hips are also destroyed in 80% of cases in the acute form of this disease which is brought on by environmental factors related to subtropical climate, low animal protein intake and intake of a variety of possibly toxic products of vegetable origin. Investigation of stored groundnuts in the affected districts has not revealed a fungus toxin in food which can as yet be implicated. A multifactorial genetic and environmental cause appears probable.