Infantile leishmaniasis (marda tal biccia) in Malta / by A. Critien.

  • Critien, A.
Date:
1911
Catalogue details

Licence: Public Domain Mark

Credit: Infantile leishmaniasis (marda tal biccia) in Malta / by A. Critien. Source: Wellcome Collection.

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    g- Girl, 5 years, seen in January, 1910. Ill since November, 1909. Had whooping cough a year ago. The disease began with spells of fever and anaemia, then swelling of the spleen; this organ now reaches to inguinal fold; liver is little enlarged. She is very pale and very sad, has diarrhoea, no blood with stools, no epistaxis, no bleeding from gums, no purpura, feet are oedematous. A cousin on mother’s sidé died from the same complaint when eighteen months old. Seen again in April, no change; administration of 77. senegae suggested. Seen again in October : very marked improvement, the spleen has receded to one finger’s breadth below the costal margin, the child has recovered her gaiety, has a healthy colour and good appetite. One dog in house. 10. Boy, 34 years, seen in January, 1g1o. II] since seven months, after a fright, as stated. Spells of fever, loss of appetite, great pallor and emaciation, oedema of feet, hands and eyelids, great sadness, dysenteric diarrhoea and bronchial catarrh. The splenic tumour fills the left inferior and part of the right inferior quadrant; the liver reaches down to a finger’s breadth below costal margin. Seen again in February, the spleen maintains the same curved configuration but does not reach quite down to the ilium, the liver is also smaller, the diarrhoea persists, general condition worse. Peripheral blood examined, no parasites. Died in November, 1910. A brother died of the same disease in June, 1907, when two years old, after an illness of fourteen months. No dogs. 11. Boy, 3 years. He is one of six, of which the eldest is 14 years old and the youngest 15 months. No other children have had the disease. Ill since fifteen months. It was only after three months of irregular fever that the enlarged spleen began to attract attention. Iron preparations were prescribed. After three months’ treatment the splenic tumour was so reduced in size that the mother believed him cured. He then contracted whooping-cough and the spleen started growing again. About the time this patient sickened two other children living near were suffering from splenic anaemia, both developed cancrum oris and died. A dog was owned by these people. I saw the child in March, 1o10, three days before death: great pallor and emaciation, oedema of feet and eyelids, spleen reaches down to one finger’s breadth from iliac crest, liver moderately enlarged, diarrhoea, a black stool occasionally (melaena?). Cancrum oris_ started opposite right upper premolars, now mortification of right cheek, exposure of buccal cavity; no epistaxis, no purpura. Post mortem: Cancrum oris, extensive destruction of right cheek and gums, loss of teeth. Lungs: right, caseous lobular pneumonia; left, emphysema. Heart: all cavities dilated. Liver: enlarged, consistency increased. Spleen : weight 84 ounces, about three times normal size, rounded margins, many notches, very firm, capsule thickened and adherent; the cut surface greyish towards the middle, brownish-red at periphery, malpighian corpuscles prominent. Mesenteric glands enlarged, not caseous, the other glands normal in size and appearance, bone marrow body of femur reddish and swollen. Smears and sections of spleen and liver show a fair number of Leishman Donovan bodies. Smears from mesenteric glands, a few parasites present. Smears from bone marrow, owing to defective fixation, could not be stained successfully. 12. Girl, 4 years, seen in March, 1g10. Has had fever and diarrhoea since three months, moderate emaciation, skin and mucous membranes anaemic, loss of appetite, the child is listless and sad. Diarrhoea every now and then, with tenesmi and passage of mucus, but no blood. Splenic tumour rather narrow, it does not reach below navel, easily movable, not painful; liver cannot be felt on palpation, lymphatic glands normal in size. Seen again in December. Abdomen greatly distended as the splenic tumour has grown down to the iliac crest and, to the right, under the linea alba, the liver is two and a half fingers’ breadth below the costal margin, cervical glands are larger than normal, eyelids are oedematous, respiration is much hindered, hollow cough, fever, no haemorrhages. December 3rd, 1910.—Peripheral blood examined: no parasites. Relative leucocytic values: Large mononuclear, 36°2; small mononuclear, 29°4; transitional, 7°03; polynuclear, 26-2; eosinophile, 1-2.
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