Three cases of trypanosoma in man in Entebbe, Uganda / by C.J. Baker.

  • Baker, C. J.
Date:
1903
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Licence: Public Domain Mark

Credit: Three cases of trypanosoma in man in Entebbe, Uganda / by C.J. Baker. Source: Wellcome Collection.

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    Mepicat Jounmar 1254 UGANDA, [Mfax 30, 1003 the disease shall run the course of a true septicaemia, with numerous parasites occurring and multiplying in the general circulation, or whether their presence shall be restricted to certain of the internal organs, appeara to be mainly the resistance of the particular species. The experiments of Bruce,’ Lav rin and Mesnil,‘ Plimmer and Bradford,’ and of Mantini,® thov the widely separated limits of the time required by tne trypanosoma of nagana to cause death in the Aiverent species investigated. Thus, the very susceptible rat diex in a few days, while the guinea-pig may live for several months. Speaking generally, the more resistant the species or individual, the lees likely are we to find the organisms in numbers in the peripheral blood during life. Taking the white rat, again, as an example we find the parasites appearing in the blood three or four days after inoculation; they then increase enormously in numbers antil, just before death, they may be almost as numerous as the red blood corpuscles. On the other hand, in the rabbit, avhich shows a considerably greater power of resistance, death being postponed frequently for a month or six weeks, para- sites can only rarely be found, and frequently the most care- ful search of several films fails to demonstrate a single ¢ryparnosoma, the organisms in this case being found in large aumbers either in some of the internal organs and the bone marrow, or forming accumulations in the lymphatics of cer- tain regions, such as the eye or the genital organs. It is thus evident that a fatal attack of trypanosomiasis in an animal does not necessarily postulate the occurrence of the parasites in the peripheral blood, in numbers large enough to permit of microscopical detection. Again, the chronic nature of the disease in the few recorded <ases of trypanosomiasis in man and the immunity which man appears to poszess to infection by other varieties of trypano- #oma,’ such as nagana, surra, dourine, mal de caderas, etc., would appear to show that man is very resistant to trypano- soma infection. It is not, then, I think, unreasonable to assume, first, that when trypanosomiasis does occur in man the parasites are more likely to multiply aud accumulate in the capillaries or lymphatics of the internal organs than to invade the general <irculation in large numbers; an3j, secondly, that the cases which have been recently reported are in reality exceptional cases, in which the resistance of the individual was compara- tively low, and in which the parasites were able te develop and multiply in the blood stream, as they do in the case of a horse, rat, or mouse infected by trypanosoma brucei. It appears to me, therefore, as at least possible that trypano- somiasis may be a much commoner disease of tropical ‘countries, including India, than is generally supposed. and that its non-recognition may be due, as I have suggested above, partly to the tendency of the parasite to confine itself to the internal organs during the life of its host, and partly to the rapid degeneration and loss of characteristic shape which follow on the death of the organiem and render its identification, in sections or smear preparations, a matter of difficulty. This difficulty is further increased by reason of the fact that only by Romanowsky staining can the macro- auclei and micro-nuclei be rendered visible, and then only in smear preparations, since it is very hard to produce gatis- factory chromatin staining in sections owing to the chemical alterations induced in the tissues by the various processes of hardening and embedding. I have tried to modify these pro- cesses in various ways, bnt go far without success. With a view, then, to finding out whether some of these severe tropical cachexias, such as the Dum-dum fever, may not be due to trypanosomiasis, I would suggest that, as a routine practice, necropsies of such cases should include the staining of smear preparations from the spleen, lungs, and fiver by Komanoweky’s method, and a careful search for the degeneration forms of the parasites which J have described. nereased facilities for the detection of trypanosomiasis during life are much to be desired. Positive results might be obtained by inocalation of a susceptible animal with blood from a suspected case, although this procedure does not appear to have been euccessful in Dr. Mangon’s ease, and Drs. Annett and Dutton record that the pathogenicity of the trypanosoma in their cate was not marked in white rats. Possibly the monkey might prove more susceptible to the trypanosoma of man. Some of the methods of staining thick blood films by dissolving out the haemoglobin, such as those of Laveran atd of Ross, may also give an increased chance of euccess, and in this connexion I may note that the modifica- tion of Romanowsky’s stain, described by meinthe Brirtisu MepicaL JounNAL,’ may be utilized for this purpose by mixing a little‘of the stain with twice ite volame of wa’ pouring the mixture on to the unfixed tilm, and at the: of three or four minutes gently washing it off, when the: may be dried and mounted. It has also been suggested t: larger quantities of blood may be examined by citrating : employing the centrifuge. “ 1 would further suggest, in conclusion, that the procec I have indicated might possibly be of service in the inve- gation of kala-azar and of sleeping sickness. both of w! have recently been considered as perhaps cue to tryps sOmiasis. REFERENCES. 1 BRitisH MEDICAI. JOURNAL, September acth, 1302. ? Ibid, Mareh : 1903. 3 Preliminary Reporton the Tectse Dimwease or Negana, 1853; a icr | Report, 1897. 4 Ertraitdu Bulletin de VAcad/mie de Médecine, Jur: | 3602. ® Quarterly Journal of Microscopical Science, February. 123.1! | 6Zeitechrift J. Hygiene, vol. xiii, p. 341, 1963. 7 BRITISH MeEDICcat Jot: September 21tt, 1902. : THREE CASES OF TRYPANOSOMA IN MAN ENTEBBE, UGANDA. By ©: J.. BAKER, L.R.C.P., M.RC.E&., Medical Officer, Entebbe, Uganda. Case 1.—A native policeman came to the dispensary Entebbe on March 12th, 1902, suffering from pain in the } and on finding his temperature was over 102° F. I exam: a fresh film of his blood for possible malarial paras Though unsuccessful in this direction, I diecove ant gated, actively motile body which. on closer inspectic made out to be a trypanosoma. I called in Pr. Mo: P.M.O. Uganda, and Dr. Castellani, of the Sleeping Sick Commission, who both happened to be close at hand, andt were able to give their valuable confirmation to my diagn: I afterwards found about a dozen of these parasites In same slide. On admission, the patient, a native of the Us| district, stated that he had never been outside the Ce Protectorate, and had lived for the past 12 months in | tebbe, except when he had made three journeys to Mas” (Unyoro district). He had never to his knowledge | bitten by any cattle-biting fly, but had been badly bitte: leeches about a year previously. He had never hsda sin attack before, and had been quite well up to two days be admission, when he began to complain of zeneral heads His temperature was 102.6°, his pulse-rate 1009 per minute. respirations were normal, his organs on examination app perfectly healthy, the spleen not being enlarged, and t was no oedema of the skin. After admission his tempera on the second day reached 104°, after which it begun to reaching normal on the fifth day, though he underwer treatment. At the same time the parasites gradc diminighed in number and apparently disappeared from blood on the same day as the temperature reached nor and subsequent daily examination of his blood produced negative reeults. Casx 11 —Komour Sabha, a native policeman, came to dispeneary on March 28th, 1903. sufering from headach¢ having a temperature of 101.8°, I examined his blood found a gingle trypanosoma, which was also seen by Nabarro. On admission his temperature was 101.8”, his} was 92, and there was the same slight general headache 4 the firat case. Ile stated he was one of the Lendu trib migrated from the west side of the Albert Nyanza «4 1895, Since when he had been in the Buddu district of Us up till 1o months ego, after which he has always reside! Entebbe. He could give no history of having been bitte: any biting fly, and had had no previous similar attack. was quite well up to the day before admission. On exan- tion his epleen and other organs appeared to be norma: there was no oedema of the skin. Though I have : examined several films of his blood, I have not founda s trypanosoma other than the one mentioned above. temperature dropped tog9° on the second day, and be: subnormal on the fifth ae after admission. there bx slight rise on the third and fourth days. All headach: him on the second day. : Case 111.—Jardien Murjan, a prisoner, was admitte hospital on March 31¢t. On admission his temperature HG pat 110 per minute, respirations normal, and he plained of severe headache. On examination of his bh): ‘ found reveral trypanozomesr. His spleen was ¢£.1 enlarged but not tender, and he had slight oedema of the ! over the abdomen extending upwards over the lower He could give no history of a previous similar attack, an’! | ad
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