Leishmaniasis : a review of recent literature / by C.M. Wenyon.

  • Charles Morley Wenyon
Date:
1922]
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Licence: Public Domain Mark

Credit: Leishmaniasis : a review of recent literature / by C.M. Wenyon. Source: Wellcome Collection.

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    Diagnosis. The diagnosis of kala azar depends upon the discovery of the parasite, and spleen puncture still remains the most reliable and rapid means of attaining this object. The importance of establishing the diagnosis, especially where new drugs are being tested, is well illus- trated by the observation of NICOLLE (1921) in his account of the cases observed in Tunis. Spleen puncture was performed in 172 cases which were suspicious and in only 59 was a diagnosis of kala azar estab- lished. Various other methods of discovering the parasite have been advocated, and if these give positive results puncture of the spleen can be dispensed with. 1. Direct examination of the peripheral blood.—Many observers, including CHRISTOPHERS, DONOVAN, and especially Patron, have demonstrated the frequency with which leishmania can be discovered in the peripheral blood of cases of kala azar. PATTON (1912) recorded the results obtained from the examination of 84 cases in Madras; in 42 of these the parasites were discovered in the first film examined, in 13 in the second, in 12 in the third, in 5 in the fourth, in 2 in the fifth, and in 4 in the sixth; in the remaining cases the parasites were not discovered till a larger number of films were examined. Similar results were also obtained by KorKE (1914) in Madras. MACKIE (1914 and 1915), from the examination of 245 cases, found the parasites in the peripheral blood of 21 per cent. of the indigenous Assamese and in 64 per cent. of the tea-garden coolies. More recently KNOWLES (1920) succeeded in 32 out of 72 cases; this result necessitated the examination of 671 blood films. In the Sudan MARSHALL (1912) observed the parasites in the blood of 80 per cent. of cases examined. In the Mediterranean disease NICOLLE and CassuTo (1908) had observed the parasites in the blood of one case. CANNATA, in Italy (1913 and 1914), discovered leishmania in the blood of 15 out of 16 cases, an observation which required the methodical examination of 20 to 30 films from each case. Similar results were obtained by VAGLIo (1914) in 11 cases, and by RUTELLI (1914) in 7 cases. It is evident from these results that parasites are frequently present in the peripheral blood. They are generally within mononuclear leucocytes, but may occur in other cells. Their discovery, however, appears to be not always an easy matter, and it evidently necessitates the careful examination of a series of well-prepared films from each case. 2. Culture of peripheral blood.—A reliable and easy method of cultivating the organism having been discovered by NIcoLLE (NNN medium), it was hoped that blood culture would yield more uniform results than direct examination of the blood. MAYER and WERNER (1914) and WENyon (1914) were the first to demonstrate that cultures could be obtained by inoculating tubes of NNN medium with a few drops of the peripheral blood. Row (1914), in India, was also suc- cessful with a more elaborate method; the blood from the finger was mixed with a citrate saline solution and allowed to deposit for 12 to 24 hours ; the deposit was then inoculated into culture media. It is stated that this method obviates the addition to the medium of excess of human serum, which is detrimental to the growth of the parasite. GIuGNI (1914) and CannatTa and Caronia (1914) also obtained successful results in Italy. CoRNWALL and LA FRENAIS (1916) obtained cultures from the blood in seven cases in India. KNOWLES (1920), working in Assam, found that this culture method, (6249) A
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